Seronegative spondylarthropathies in HIV-infected patients: further evidence of uncommon clinical features.

Reiter's syndrome and reactive arthritis in individuals with human immunodeficiency virus (HIV) infection are characterized by severe and persistent arthritis, intense enthesopathy, and poor response to treatment. These uncommon clinical features suggest a direct role of HIV in the pathogenesis of seronegative spondylarthropathies. We report on widely differing clinical features in two HIV-infected patients with undifferentiated seronegative spondylarthropathy or reactive arthritis. Both patients were HLA-B27-positive. The first patient presented with heel swelling and dactylitis ("sausage" toes). Subsequently he developed polyarticular erosive arthritis. The clinical course was complicated by fulminant ulcerative colitis leading to hemicolectomy. After hemicolectomy, a temporary resolution of arthritis occurred. In the second patient, heel swelling and polyarticular arthritis occurred 2 months after Shigella dysentery. After 3 years of continuing joint inflammation, he presented with a Jaccoud-like arthropathy. In a cohort of 700 HIV-infected patients receiving continuous care in our department, these were the only patients with seronegative spondylarthropathy observed between 1984 and 1992.