1. Clinical syndromes. Since the first description by Winchester and co-workers in 1987, no group of rheumatic syndromes has been the topic of so much discussion as the reactive arthritides in patients infected with HIV. The central issue has been whether HIV contributes to reactive arthritis. The arguments obviously hinge on the question of whether there is indeed an increased incidence of reactive arthritis in the HIV-infected population. The difficulty of comparing equivalent populations, the lack of adequate diagnostic criteria for some disease states, and the incomplete manifestation of some syndromes have hampered the resolution of this question. The best study, which prospectively evaluated all patients in an infectious disease clinic, concluded that incomplete Reiter's syndrome and enthesopathy were increased in frequency in HIV-infected patients. This does not, however, imply a direct causal role for HIV in the arthropathy. The advent of highly effective antiretroviral therapies has not resolved the question. One might explain an increased incidence on the basis of exposure to or persistence of the same pathogens (Chlamydia and enteric pathogens) known to elicit reactive arthritis in non-HIV-infected persons.
The spectrum of reactive arthropathy or spondyloarthropathy is impressive. Findings range from frank synovitis to enthesitis and axial skeleton involvement. Extraarticular manifestations include dermal (psoriasiform, keratoderma blennorrhagicum, circinate balanitis), ocular (conjunctivitis, uveitis), mucosal (palatine and buccal ulcerations), genital (urethritis, cervicitis, prostatitis), and intestinal involvement. Any combination of findings may coexist. In the HIV-infected patient, two categories are frequently found—the post-infectious and psoriasis-related reactive type of arthritides.
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