The arthritis is typically polyarticular and asymmetrical and affects the large joints of the lower limbs. Other joints may, however, be affected, as in the patient presented who had a reactive arthritis of his wrist. Small superficial painless ulcers are also commonly seen in the mouth and on the glans penis, where they are know as circinate balanitis. Other rare manifestation of Reiter's syndrome include uveitis, keratitis, optic neuritis, aortic insufficiency, and cardiac conduction defects. There is no specific test to confirm the presence or absence of a reactive arthritis.
Diagnosis is made on clinical grounds.
It is important to consider and exclude the differential diagnosis of acute gonococcal arthritis. Taking urethral swabs for gonococcal cultures can do this, and, unlike a reactive arthritis, gonococcal arthritis will respond quickly to penicillin treatment Reiter's syndrome lasts between days and months. Treatment is based on relieving the symptoms, and the maintenance of function of the joints. Physiotherapy is essential to maintain mobility and function of the joints. The urethritis may respond to the use of an appropriate course of antibiotics, but there is no evidence that they affect the associated reactive arthritis.