Reactive arthritis causes inflammation, pain and swelling of the joints, and usually develops after an infection, often in the bowel or genital areas. Being an auto-immune condition, the infection awakens the immune system, the normal role being to fight off infections to keep you healthy, however, this immune system activity continues after the infection has been cleared. Hence the name "reactive" as the condition is reacting to the presence of bacterial infections. This leads to swelling of the joints, although the joints themselves are not infected. About one in 10 people with specific types of bacterial infections will get reactive arthritis. Reactive arthritis was formerly known as Reiter's syndrome.
Symptoms:
Reactive arthritis usually begins a few weeks after an infection, affecting many parts of the body and commonly include:
* pain, swelling and stiffness of joints, often the knees and ankles * pain and stiffness in the buttocks and back (also known as spondylitis, meaning inflammation of the spine) * pain in tendons, such as at the back of the heel (tendons are the strong cords that attach muscles onto bones) * rash on the palms of the hands or soles of the feet * pain and redness in the eyes.
Causes:
Only specific bacteria may result in reactive arthritis. The most common are:
* chlamydia bacteria, which are transmitted during sexual activity * salmonella, shigella, yersinia or campylobacter bacteria, which cause food poisoning.
It is not known why some people who get these infections develop reactive arthritis and some do not. A certain gene called HLA-B27 is associated with reactive arthritis, especially inflammation of the spine. It most commonly strikes individuals aged 20-40, is more common in men than in women, and is more common in white men than in black men. This is owing to white individuals' being more likely to have tissue type HLA-B27 than black individuals.
Diagnosis:
Your doctor will diagnose reactive arthritis from your symptoms and a physical examination. Your doctor may also order blood tests for inflammation, such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tests. Blood tests may also help to rule out other types of arthritis. There are countless clinical symptoms, but the clinical picture is dominated by polyarthritis (any type of arthritis which involves five or more joints). There is pain, swelling, redness, and heat in the joints. MRI is effective for diagnosis. The urethra, cervix and throat may be swabbed in an attempt to culture the bacterial culprit. Cultures may be carried out on urine and stool samples. Synovial fluid from an affected knee may be aspirated to look at the fluid under the microscope and for culture. Also, a blood test for the genetic marker HLA-B27 may be given to determine if the patient has the gene. About 75 percent of all patients with Reiter's Syndrome have the gene.
Signs and symptoms:
For most people reactive arthritis disappears completely with time and causes no permanent joint problems. More than four out of five people with reactive arthritis will recover completely within three to 12 months. During this time you may find that your symptoms are worse some days and better other days. Most patients have severe symptoms lasting a few weeks to six months. 15 to 50 percent of cases have recurrent bouts of arthritis. While most people need some form of treatment, usually medicines, while symptoms are present, about one in five people need long-term treatment as their arthritis does not improve, or returns.
Treatments:
The main goal of treatment is to identify and eradicate the underlying infectious source with the appropriate antibiotics if still present. Otherwise, treatment is symptomatic for each problem. Analgesics, steroids and immunosuppressants may be needed for patients with severe reactive symptoms that do not respond to any other treatment. Your doctor will tailor your treatment to your symptoms and the severity of your condition. There is no way of predicting exactly which treatment will work best for you. Your doctor may need to trial several different treatments before finding the one that is right for you and will be able to supply you with more information about reactive arthritis
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