Reactive arthritis is an autoimmune disease in which joints are swollen and painful, brought on by an infection elsewhere in the body (cross-reaction). The triggering infection is usually of intestines, urinary tract or genitals. The joints affected most commonly are knee and ankle joints, and joints in the feet.
In addition, skin, eyes and urethra may also show signs of inflammation. In most people the symptoms are episodic, eventually disappearing after a year. Reiter’s syndrome is one of the types of reactive arthritis.
Risk Factors Of Reactive Arthritis
Men, whites and individuals between the ages of 20-40 years are more susceptible to it. Hereditary factors in the form of certain genes predispose one to it.
Other risk factors are sexual promiscuity and bacterial infection causing dysentery.
Causes Of Reactive Arthritis
Reactive arthritis occurs due to cross-reactivity to infection in intestines, urinary tract or genitals. Typically, it occurs 1-3 weeks after contracting the infection. The infection may not even come to your attention because even mild and asymptomatic infection can cause the disease. By the time you have symptoms of reactive arthritis the infection may not be present.
The bacteria responsible for reactive arthritis are usually Salmonella, Shigella, Campylobacter, Chlamydia and Yersinia. The bacteria can be transmitted through contaminated food or sexually. But bacteria are not found in cultures of affected joint fluid. This suggests that reactive arthritis may be caused by overstimulation of autoimmune response or it may be due to deposition of bacterial antigens in the joints.
Signs And Symptoms
The joints that tend to get inflamed in reactive arthritis are knees, wrists, ankles and feet. Joints may be affected simultaneously or one after another. Sometimes, the arthritis is migrating, that is, as one involved joint becomes normal, another is affected. The involved joints become swollen, painful, red, warm and stiff. If joints of the spine are involved, the back and neck can be painful and stiff. Tendons can get inflamed and tender.
The white of the eye could be inflamed (conjunctivitis) or the coloured part of the eye could be inflamed (iritis). If iritis occurs, looking at bright lights can cause pain in the eye (photophobia). If inflammation of urethra occurs (urethritis), then you can have burning sensation when passing urine and frequency of urination can be increased.
Tip of the penis could develop a rash. Fluid-filled blisters can occur on palms and soles. Skin of palms and soles can start to peel off. Ulcers may develop in mouth and on the tongue. Heart failure can occur if the aorta is involved, leading to breathlessness and fluid accumulation in ankles and feet.
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Treatment Of Reactive Arthritis
If bacterial infection is still present, you may need to take an antibiotic depending on the bacterial organism responsible. For the inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen and indomethacin are effective. If arthritis is severe, corticosteroids are indicated, either orally or injected directly into the affected joints.
Sulfasalazine is effective in a few patients. TNF blockers like etanercept and infliximab are helpful to counter the inflammation in some people. You may also need some form of physiotherapy, such as strengthening exercises for muscle groups around the affected joints and range-of-motion exercises.
The symptoms may last anywhere from 3-12 months. Most people respond to treatment within 2-6 months. In 15-50% of the people there can be a relapse of the symptoms, with repeated attacks over many years.