Abim Rheum

Front 1

Inflammatory monoarthritis that often forms sinus tracts

Back 1

TB arthritis

Front 2

Infectious inflammatory polyarthritis with a false (+)ve RF

Back 2

Hepatitis C

Front 3

Arthritis location classically associated with sarcoidosis

Back 3

Ankle Arthritis

Front 4

DDx of a joint so painful,the patient will not let you move it

Back 4

Think "BBC"

(1) Bugs:
- NG bacterial arthritis
- Gonococcal arthritis

(2) Blood in joint
- ACL tear/Meniscal tear
- Hemophilia
- Anticoag use
- Intra-articular fx

(3) Crystals
- Urate gout
- CPPD

Front 5

Bilateral shoulder and hip stiffness; worse in the morning and better later in the day. "Rolls out of bed".

Back 5

Polymyalgia Rheumatica
-- Periarticular tenosynovium; NOT a myopathy
-- Start Prednisone 15 mg daily

Front 6

B/L Shoulder weakness + Increased ESR + Increased CPK

Back 6

Polymyositis

Front 7

HA + visual changes + Jaw Claudication + shoulder/hip stiffness

Back 7

GCA -- high dose prednisone

Front 8

(+)ve Empty Can Sign

Back 8

Supraspinatus Tendonitis --- most commonly involved

Front 9

Gout drug associated with neuromyopathy and elevated CPK

Back 9

Colchicine

Front 10

Patient with polymyositis flare treated with steroids --- steroids tapered and weakness relapses but CPK is lower than prior to when the pt had the initial flare. What is then next step?

Back 10

Taper the steroids more rapidly --> the patient has steroid induced myopathy

Steroids have a direct catabolic affect on muscle

LE>UE; weakness then atrohy develops

CPK and EMG will be normal

Bx will show atrphy of the type IIb fibers wtihout inflammation

After safe rapid taper, improvement in 3-4 weeks

Front 11

Antibody that predicts interstitial lung disease in patients with inflammatory myopathies

Back 11

Positive Anti-Jo-1 Antibody predicts interstitial lung disease in patients with polymyositis/dermatomyositis.

Front 12

Inflammatory myopathy that is T-cell mediated with endomysial inflammation

Back 12

Polymyositis (P-E-T)

Front 13

Inflammatory myopathy that is B-cell mediated with perivascular, perimysial inflammation

Back 13

Dermatomyositis (D-B)

Front 14

Mechanic's Hands and Dilated nailbed capillaries

Back 14

Dermatomyositis

Front 15

Calcinosis cutis (calcification of muscle)

Back 15

Dermatomyositis

Front 16

Association of malignancy with inflammatory myopathies

Back 16

Malignancy associated with Dermatomyositis NOT Polymyositis

LOOK FOR CANCER IN DERMATOMYOSITIS -- AGGRESSIVE SCREENING!

Front 17

Men>Women; Age >50

Distal>Prox Weakness and atrophy

Asymmetiric atrophy of florearm flexors, intrinsic hand muscle, quads

"Tear Drop Sign" -- can't make an "o" with hands

Esophageal problems

Normal to low CPK

Unresponsive to steroids

Back 17

Inclusion Body Myositis

Front 18

Most common cause of scleritis (Deep boring pain of the eye)

Back 18

Rheumatoid Arthritis

Front 19

Miner with Pulmonary nodules/Pneumoconiosis + RA

Back 19

Caplan syndrome -- associated with silica exposure

Front 20

Leukopenia + Splenomegaly + RA

Increased infections, leg ulcers

Back 20

Felty Syndrome

Front 21

Side effects of Hydroxychloroquine

Back 21

Retinopathy

Myopathy

Rash/diarrhea

Front 22

Side effects of sulfasalazine

Back 22

Serious - Agranulocytosis

Mild - Rash, increased LAEs, Azospermia

Front 23

Side effects of methotrexate

Back 23

Serious - cirrhosis, leukopenia, anemia, pnumonitis, reversible lymphoma

Mild - stomatitis, icnreased LAEs, Alopecia

Front 24

Side effects of TNF-inhibitors

Back 24

Serious - TB reactivation, fungal infxns, MS-like dz, HBV reactivation (NOT HCV), infection

Front 25

Dactylitis (sausage digits)

Back 25

Psoriasis

Reason: psoriasis lvoes inflammation of tendon insterts

Front 26

Sudden onset of Psoriasis as an adult; Next step?

Back 26

Check HIV status

Front 27

Arthritis associated with keroterma blennorrhagicum and circinate balanitis

Back 27

Reactive Arthritis

Front 28

Gull Wing appearance of DIPs

Back 28

OA

Front 29

Which part of the knee does OA affect (Medial Vs. Lateral)

Back 29

Medial

Front 30

Swelling along the distal radius and pain with ulnar deviation of the wrist -- pain with extending thumb.

(+) finkelstein's test

Back 30

DeQuervain's Tenosynovitis

Front 31

Patient with Raynaud's finding --- What is the best way to predict if the patient will develop a connective tissue disease?

Back 31

Check Nailfold Capillaroscopy -- if nailfold capillaries noted, then patient is at increased risk of CTD.

Front 32

Quotidian fever (High spiking fever that comes down), intermittent salmon rash on chest and extremities with Koebner phenomenon, Arthritis, Lymphadenopathy, Neutrophilia (WBC in the 20s), Anemia, increased LAEs, Hyperferritenemia

Back 32

Adult Still's Disease

Front 33

(+)ve anatomical snuff box

Back 33

Check for scaphoid fx -- CT/MR if Hand X-ray negative

Front 34

Important complications of Ankylosing Spondylitis

Back 34

- Vertebral dix space fx following mild trauma (classically c5-7)
- Bilateral upper lobe fibrosis; may cavitate; can be colonized by aspergillosis and form mycetomas
- Restrictive pulmonary disease
- Uveitis that is vision threatening
- Cauda Equina Syndrome
- Amyloidosis
- Aortic valve incompetence
- Mortatily increased after 20 yrs of disease --> increased heart dz d/t chronic inflammation

Front 35

Endplate destruction

Back 35

Think Osteomyelitis -- check MRI

Front 36

Most specific sign for meniscal tear

Back 36

McMurray Test

most sensitive -- joint line tenderness

Front 37

Pain with getting up from a sitting position

Going down stairs is worse

Back 37

Patellofemoral syndrome

Front 38

Back 38

crescent sign, patient has a ruptured baker's cyst

Associated with psedothrombophlebitis

Front 39

Tx of gout if kidney injury

Back 39

Intraarticular steroids

Note -- do not start allopurinol in the setting of an acute gout flare; wait after the flare

Front 40

Medications that should be avoided in gout

Back 40

Thiazides
Niacin
Calcinurin inhibitors (Tacrolimus)
LD ASA
Laxatives in excess

Front 41

Medications that help gout patients

Back 41

Vit C
Losartan
Statins
Dairy
Low purine diet
Avoid EtOH (Wine ok, beer bad)

Front 42

Reasons to use hypouricemic tx

Back 42

3 or more gouty attacks/year
Tophi or joint damage present
Uric acid >11 in Female; >13 in Male


Goal is <6; <5 if tophi present

Front 43

Side effect of allopurinol

Back 43

Rash, Hypersensitivity Syndrome

Front 44

Cannot plantar flex while squeezing calf

Back 44

Sing of achilles tendon rupture -- Thompson's Test

Front 45

Elderly patient with anemia, fatigue. ESR elevated, but CRP normal.

Back 45

Check SPEP/UPEP

Associated with MM

Front 46

Patient with Raynaud's + Arthritis + Dysphagia + small red dots on her face and hands appearing over the last 6 months; Next step?

Back 46

Check anti-centromere antibodies for Limited Scleroderma (CREST)

Front 47

Anti-SSA/SSB

Back 47

Sjogren's

Front 48

Anti-dsDNA

Back 48

Specific for SLE

Front 49

Anti-Scl-70

Back 49

Diffuse Scleroderma

Front 50

A positive ANA of 1:40 or 1:80

Back 50

Clinically insignificant --> Ignore

Front 51

A child born to a mom with SLE has the above rash --- what antibody did the mom have?

Back 51

Anti-SSA (RO) antibodiy

Associated with Neonatal Lupus in child and congenital heart block

Front 52

Can use this antibody to follow the course of SLE

Back 52

DsDNA

Front 53

Complement deficiency in SLE

Back 53

C2*, C4

Front 54

Is discoid lupus associated with SLE?

Back 54

Not really -- usually an isolated dz w/o systemic findings

Only 5-10% with isolated discoid lupus will progress to SLE

Front 55

Arthopathy associated with SLE

Back 55

RA-like --> Jacoud's Arthropathy

Hypermobility of joint

Front 56

Rx of lupus nephritis

Back 56

Cyclophosphamide

Front 57

Important complications to know associated with SLE

Back 57

(1) INFECTIONS
- Functional Asplenia (encapsulated organisms)
- Immunocompromising infections (PCP, aspergillosis, Crypto)

(2) Osteonecrosis

(3) CAD, Libman-Sacks endocarditis, vasculitidies

(4) Osteoporosis

(5) Ovarian failure from cyclophosphamide use

Front 58

Drugs associated with positive ANCA

Back 58

Minocycline

Propylthiouracil -- Most common drug to cause (+ve) ANCA

Front 59

Anti-mitochondrial Antibody

Back 59

Primary Biliary Cirrhosis (PBC)

Front 60

Anti-smooth Muscle Antibody

Back 60

Autoimmune Hepatitis

Front 61

Anti-LKM

Back 61

Autoimmune Hepatitis

Front 62

Anti-thyroglobulin Antibody

Back 62

Hashimotos

Front 63

Anti-microsomal Antibodies

Back 63

Hashimoto's

Anti-TPO

Front 64

Unequal BP

Carotidynia

UE Claudication

Stroke in a young woman

Renovascular HTN

Increased ESR/CRP

Back 64

Takayasu's

Do an angiogram/MRA

Front 65

Polyarteritis Nodosa spares what organ

Back 65

Lungs

Front 66

Cauliflower ear

Back 66

Relapsing Polychondritis

Front 67

DDx of Saddle Nose Deformity

Back 67

GPA
Relapsing polycondritis
Congenital Syphilis
Trauma
Cocaine use

Front 68

Staining for which class of antibody is useful for dx of Henoch-Schonlein purpura

Back 68

IgA

Front 69

Most common cause of leukocytoclastic vasculitis

Back 69

Remove offending drug (antibiotics, anti-sz meds, allopurinol)

Front 70

Watermelon stomach (GAVE)

Back 70

Associated with Diffuse Scleroderma -- causes GIB

Front 71

Scleroderma REnal Crisis Tx

Back 71

ACE-I (Captropril)

Front 72

Indentation along superficial veins (Groove Sign) + Eosinophilia + onset following vigorous exercise

Back 72

Eosinophilic Fasciitis

- Associated with lymphomas

Front 73

Leg pain with walking down hill; relief of pain when leaning forward while walking or standing erect.

Back 73

Neurogenic Claudication

Front 74

Discomfort with abduction of leg + Groin Pain

Back 74

Hip OA

Front 75

Point tenderness over the medial knee and negative valgus stress maneuver

Back 75

Anserine bursitis

- place a pillow b/w kneeds at night, avoid leg crossing, limit repetitive knee bending, and use ice to reduce pain.
- NSAIDs are ok

Front 76

Complications of Dermatomyositis

Back 76

- Interstitial lung disease
- Malignancy (lung, ovarian, etc.)
- Esophageal disease (i.e. weakness of proximal muscles, oropharyngeal muscles and striated muscles in the upper 1/3 of the esophagus) --- Dysphagia, nasal regurgitation, and/or aspiration (ESPECIALLY IN OLDER PATIENTS)
- Myocarditis

Front 77

Patient with controlled SLE desires to be pregnant; next step?

Back 77

- Check anti-phospholipid antibodies (for thrombotic risk/pregnancy loss risk), Anti-RO/SSA Ab (for possibility of neonatal lupus/heart block)

**Pregnant women with APL are usually tx with ASA and/or LMWH, depending on prior hx of fetal loss or pregnancy complications

**Note: Hydroxychloroquine is safe in pregnancy

Front 78

Tx of choice for symptomatic acute vertebral fractures

Back 78

Symptomatic vertebral compression fractures are managed acutely by NSAIDs, Tylenol, and Sometimes opioids. When this tx fails, intranasal calcitonin for 2-4 weeks can provide symptomatic relief. Long term, bisphosphonates should be give but this will not provide short term relief.

Front 79

Drug-Induced Vasculitis criteria

Back 79

Age >16
Temporal relationship b/w offending drug use and symptom onset
Palpable purpura
Maculopapular rash
Skin bx showing leukocytoclastic vasculitis (neutrophils around an arteriole or venule)

Front 80

Dx Criteria for Sjogren's Syndrome

Back 80

-Ocular symptoms (dry eyes/decreased tears)
-Oral symptoms (dry mouth, swollen salivary glands)
-Positive ocular signs (Schirmer Test)
-Salivary gland biopsy (**lower lip bx diagnostic**) with focal lymphocytic sialoadenitis
-Salivary gland involvement (e.g. decreased salivary flow, delayed uptate on salivary scintigraphy)
-Autoantibodies to RO/La (SSA/SSB)

Front 81

Antisynthetase antibodies

Back 81

classically, Anti-Jo-1 -- for myositis

Front 82

Anti-topoisomerase Ab = ?

Back 82

SCL-70

Scleroderma associated with Anti-Scl70 (Antitopoisomerase), Anticentromere, and anti-RNA polymerase II Abs

Front 83

Feared complication of limited vs. diffuse scleroderma

Back 83

Pulmonary HTN --> Limited SS

Pulmonary Fibrosis --> Diffuse SS

Front 84

Indicated in individuals at high risk of fractuer and those failing other therapeutic agents

Back 84

Teriparatide (recomobinant form of parathyroid hormone)

Front 85

Stomatitis in patient receiving MTX

Back 85

GIVE FOLATE ACID

Front 86

2 diseases to watch out for when giving TNF-inhibitors

Back 86

TB reactivation

HBV reactivation (NOT HCV)

Front 87

Recurrent Abdominal/Testicular Pain + HBV history + Mononeuritis Multiplex

Back 87

Polyarteritis Nodosa

Front 88

Tx of respiratory impairment in Ankylosing Spondylitis

Back 88

Noninvasive Positive Pressure Ventilation

Front 89

Cytoplasmic Vacuolization on muscle biopsy + Proximal Muscle wekness + Neuropathy + Elevated CPK

Back 89

Colchicine Toxicity -- D/C Colchicine

Front 90

Intermittent painless swelling of partoid glands in long-standing Sjogren Patient -- what is the likely dx?

Back 90

NHL - B-cell type

RFs - Anti-RO/La, RF, Cryoglobulinemia, Hypocomplimentemia, and lymphocytopenia

Front 91

Confirming dx test for a patient who presents with lower extremity paplpable purpura, nonspecifgic abdominal symptoms, renal disease, arthritis/arthralgias with recent infection

Back 91

Skin Biopsy shows IgA deposition --- Henoch Schonlein Purpura

Front 92

Presents after an injury with throbbing pain, paresthesias, skin temp changes, and local edema. Dx is suggested clinically by symptoms and abrupt relieft with a local anesthetic blcok

Back 92

Complex Regional Pain Syndrome

Front 93

Elderly patient who reports stiffness with >50% reduction in both passive and active ROM

Back 93

Adhesive Capsulitis

NOTE: PMR is associated with active >>> passive decreased ROM

Front 94

Knee swelling after parathyroidectomy

Back 94

Likely CPPD (Pseudogout)

Parathyroidectomy can precipitate a pseudogout attack during the post-operative period. this is due to an abrupt drop in serum calcium levels, which in tern stimulates crystal shedding into the synovial fluid

Front 95

Ankylosing Spondylitis unrelieved by NSAIDs, PT, and local measures; next step?

Back 95

TNF-inhibitor (Adalimumab)

Front 96

OA in an RA distribution

Back 96

Hemochromatosis

Front 97

Prognostic Factors for Erosive RA

Back 97

(1) (+)ve anti-CCP and RF
(2) Early development of multiple joint inflammation
(3) Radiographic erosions
(4) Severe functional limitations
(5) Lower economic status and less education
(6) Elevated ESR/CRP
(7) Persistent joint inflammation >12 weeks

Front 98

Neutropenia + lymphocytosis + RA

Back 98

Large Granular Lymphocyte Syndrome

Front 99

Decreased C4 + Purpura

Back 99

Check HCV RNA (i.e. (+)ve HCV RNA but Negative Anitbodies) --- THINK MIXED (TYPE II) CRYOGLOBULINEMIA

If HCV Ab (+) and RNA (-), think of another dx!

Front 100

Punch purpura + Cardiomyopathy + Proteinuria

Back 100

Think Amyloidosis -- do fat pad bx (apple green birefringence on congo red stain)

Check SIED (not SPEP or UPEP) and free light chains (Ig light chain) in regards to protienuria for AL (most common)

Front 101

Hypocomplimentemia Disorders (Decreased c3 and c4)

Back 101

"SCIMP" -- SLE + Cryoglobulinemia + Inf Endocarditis + MPGN + PSGN

Decreased C3: PSGN, MPGN, Infective Endocarditis

Decreased C3/C4: SLE, Cryoglobulinemia

**NOTE: IgA and HSP have normal complements

Front 102

Older woman with trauma to shoulder -- develops a destructive inflammatory arthritis (Milwaukee Shoulder) with effusion - what crystals are associated?

Back 102

Basic Calcium Phosphate Crystals - BCP crystals cannot be seen under polarized light microscopy but can be visualized as aggregates after alizarin red staining of synovial fluid (although not done routinely), which can confirm the clinical diagnosis.

Basic calcium phosphate crystals are commonly associated with chronic and highly destructive inflammatory arthritis such as Milwaukee shoulder.

Front 103

What is the difference between pseudogout and CPPD?

Back 103

Pseudogout is an acute inflammatory arthritis caused by CPP crystals in the joint. Although this patient has CPP deposition, there is no evidence of a current or prior acute inflammatory arthritis. This patient's 2-year history of joint pain is not consistent with acute pseudogout.

Front 104

Patient with Carpal Tunnel Syndrome and Fatigue and >60 min of morning stiffness

Back 104

Carpal tunnel syndrome is occasionally the presenting symptom of rheumatoid arthritis.

Overuse injury has not been convincingly shown to play a causative role in the pathogenesis of this neuropathy.

Front 105

New-onset fever, arthralgia, myalgia, nonblanching purpuric rash, pleuritis, pancytopenia, and proteinuria with active urine sediment in patient with RA being treated with TNF-Inhibitor

Back 105

Drug-Induced Lupus

Front 106

Subacute Cutaneous Lupus Erythematous (SCLE)

Back 106

The annular form of SCLE is characterized by scaly erythematous circular plaques with central hypopigmentation; the less common papulosquamous variant resembles psoriasis. These rashes most commonly involve the neck, trunk, and extensor surfaces of the arms. They can be chronic and recurrent but do not scar. SCLE may be associated with medications (hydrochlorothiazide, calcium channel blockers, ACE inhibitors, and terbinafine). SCLE occurs in up to 10% of patients with systemic lupus erythematosus (SLE), usually with some of the less serious SLE manifestations (arthritis, serositis), and is associated with anti-Ro/SSA and anti-La/SSB antibodies. This condition also manifests as its own entity; up to 50% of patients with SCLE do not develop systemic manifestations of lupus.

Front 107

Can be effective in the management of both peripheral arthritis and skin manifestations that occur in patients with psoriatic arthritis.

Back 107

Methotrexate

Front 108

Considered first-line therapy for patients with axial spondyloarthritis.

Back 108

NSAIDs

Tumor necrosis factor (TNF)-α inhibitors such as etanercept are used to treat both peripheral and axial involvement that occur in spondyloarthritis. However, because of cost and long-term safety concerns, these agents currently are not recommended as first-line therapy. If NSAIDs are insufficient, poorly tolerated, or contraindicated, TNF-α inhibitors are then advised.

Front 109

Initial treatment of patients with polyarteritis nodosa who also have active hepatitis B virus infection

Back 109

A limited course of corticosteroids in conjunction with antiviral therapy.

Front 110

If temporal artery biopsy results are negative for giant cell arteritis (GCA) in a patient with cranial symptoms, what's the next step?

Back 110

A biopsy of the contralateral temporal artery is then indicated to diagnose GCA

Front 111

Most common disease-related cause of death in patients with mixed connective tissue disease.

Back 111

Pulmonary arterial HTN

Front 112

Gold standard disease-modifying antirheumatic drug therapy for rheumatoid arthritis and is central to most treatments for the disease.

Back 112

Methotrexate

Front 113

A category of cutaneous sclerosis that involves only the skin in the absence of other systemic manifestations of systemic sclerosis.

Back 113

Morphea

Front 114

Periodic monitoring for changes in _________ is indicated for patients receiving tocilizumab.

Back 114

Lipid Status

Tocilizumab is FDA approved to treat patients with rheumatoid arthritis who have experienced an inadequate response to tumor necrosis factor α inhibitors. This biologic disease-modifying antirheumatic drug is associated with leukopenia, thrombocytopenia, and elevated serum aminotransferase levels. Tocilizumab also is associated with increases in serum cholesterol levels, a concern given the increased risk for premature cardiovascular disease associated with rheumatoid arthritis. Periodic monitoring for changes in lipid status is therefore indicated for patients receiving tocilizumab, particularly for patients with additional risk factors for coronary artery disease, as noted in this patient who has a family history of the disease.

Front 115

Standard first-line treatment for patients with uncomplicated dermatomyositis.

Back 115

Prednisone

Immunosuppressive therapy such as azathioprine or methotrexate in conjunction with corticosteroids is an important and frequently utilized treatment option for steroid-resistant disease or as steroid-sparing therapy and is often started concurrently with prednisone for severe disease or for those in poor prognosis groups, including patients with extramuscular manifestations of cardiovascular or pulmonary involvement.

Intravenous immune globulin is reserved for patients who require additional therapy in conjunction with corticosteroids or for those who have a contraindication to the use of corticosteroids or other immunosuppressive therapies.

Front 116

Indicated for patients diagnosed with or suspected of having relapsing polychondritis to evaluate for large upper airway involvement.

Back 116

PFTs with flow volume loops

Front 117

Indicated for acute digital ischemia in the setting of limited cutaneous systemic sclerosis.

Back 117

IV Epoprostenol

Front 118

Tx for patients with frequently recurring gout attacks.

Back 118

Colchicine and Allopurinol

Gout is associated with hyperuricemia, and patients with recurrent episodes (≥2 attacks in 1 year) require urate-lowering therapy to prevent both future attacks and occult urate deposition. However, the addition of urate-lowering therapy transiently increases the risk for acute gout attacks for at least 3 to 6 months; accordingly, prophylaxis with an anti-inflammatory agent such as colchicine, at least during that period, is indicated concurrent with urate-lowering therapy.

Front 119

Tx of patients with Churg-Strauss syndrome who have cardiac, GI, renal or CNS involvement

Back 119

High dose steroid + Cyclophosphamide

Front 120

Warranted in patients with Raynaud phenomenon in whom cold avoidance does not provide sufficient relief.

Back 120

Dihydropyridine CCB (e.g. Amlodipine)

Front 121

Tx of CNS lupus

Back 121

Methylprednisolone + Cyclophosphamide

Front 122

1st line tx for psoriatic arthritis

Back 122

Methotrexate (as long as no e/o liver injury or alcoholism)

Front 123

Most common reason for greasy diarrhea in a patient with limited or diffuse systemic sclerosis?

Back 123

Bacterial Overgrowth

Front 124

Helpful diagnostic test in patients with persistent proximal muscle myopathy (CKemia)?

Back 124

MRI of the thighs to assess of inflammation is present.

Front 125

In patients with dermatomyositis on long term steroid tx, what drug can be added to further taper the dose of steroids?

Back 125

Methotrexate

Front 126

Patient on a TNF-alpha inhibitor develops cancer; next step?

Back 126

D/c TNF-alpha inhibitor

Front 127

Autoimmune inflammatory disorder characterized by nonsyphilitic keratitis and audiovestibular dysfunction that results in progressive hearing loss.

Back 127

Cogan Syndrome

Front 128

Important points regarding Reactive Arthritis

Back 128

presence of inflammatory arthritis that manifests within 2 months of an episode of bacterial gastroenteritis or nongonococcal urethritis or cervicitis in a genetically predisposed patient. This patient’s history of conjunctivitis preceding her musculoskeletal symptoms is also consistent with this condition. Historically, what is now called reactive arthritis was previously called Reiter syndrome, which referred to the co-incidence of arthritis, conjunctivitis, and urethritis (or cervicitis). However, only one third of affected patients have all three symptoms. Reactive arthritis usually has an asymmetric oligoarticular pattern and involves the lower extremities; inflammatory back pain also may be present. Reactive arthritis also may be associated with enthesitis, which commonly manifests as Achilles tendinitis (as seen in this patient), plantar fasciitis, and spondylitis. Reactive arthritis also is associated with numerous cutaneous manifestations, including keratoderma blenorrhagicum, oral ulcerations, and circinate balanitis.