Summary about Disease
Non-specific Reactive Arthritis (ReA) is a type of inflammatory arthritis that develops as a reaction to an infection in another part of the body. Often, the infection is in the genitourinary tract or the gastrointestinal tract. It's characterized by joint pain and swelling, often accompanied by inflammation of the eyes (conjunctivitis or uveitis) and urinary tract (urethritis). The term "non-specific" indicates that the specific causative agent might not be identifiable, even though the arthritis follows an infection.
Symptoms
Joint pain and swelling (typically in knees, ankles, and feet)
Enthesitis (pain where tendons and ligaments attach to bone, especially at the heel)
Dactylitis ("sausage digits" - swelling of fingers or toes)
Urethritis (inflammation of the urethra, causing painful urination and discharge)
Conjunctivitis (inflammation of the eyes, causing redness, itching, and discharge)
Uveitis (inflammation inside the eye, causing pain, blurred vision, and light sensitivity)
Skin rashes (e.g., keratoderma blennorrhagicum, circinate balanitis)
Mouth sores (usually painless)
Lower back pain (sacroiliitis or spondylitis)
Causes
ReA is triggered by an infection. Common triggering infections include:
Chlamydia trachomatis (genitourinary infection)
Gastrointestinal infections (e.g., Salmonella, Shigella, Campylobacter, Yersinia)
Mycoplasma genitalium (less common) The exact mechanism by which these infections trigger arthritis is not fully understood, but it is believed to involve an abnormal immune response. Genetic predisposition, particularly the presence of HLA-B27, increases the risk of developing ReA after exposure to these infections.
Medicine Used
Nonsteroidal anti-inflammatory drugs (NSAIDs): To reduce pain and inflammation.
Corticosteroids: To control inflammation (may be given as injections into joints or systemically).
Disease-modifying antirheumatic drugs (DMARDs): Such as sulfasalazine or methotrexate, to suppress the immune system and control the arthritis long-term.
Antibiotics: To treat the underlying infection, if still present.
Topical corticosteroids: For skin rashes.
Eye drops: For conjunctivitis or uveitis.
Is Communicable
Reactive arthritis itself is not communicable. However, the infections that trigger reactive arthritis (like Chlamydia, Salmonella, Shigella, Campylobacter, Yersinia) are communicable and can be spread through sexual contact or contaminated food or water.
Precautions
Practice safe sex to prevent sexually transmitted infections like Chlamydia.
Wash hands thoroughly and frequently, especially after using the restroom and before preparing food.
Cook food thoroughly, especially meat and poultry, to prevent foodborne infections.
Avoid drinking untreated water.
If you have symptoms of an infection, seek medical treatment promptly to prevent complications like reactive arthritis.
How long does an outbreak last?
The duration of reactive arthritis varies. It can be:
Acute: Lasting for a few weeks to several months (typically 3-12 months).
Chronic: Persisting for more than 6 months.
Recurrent: Symptoms may come and go over a longer period.
How is it diagnosed?
Diagnosis involves:
Medical history: Assessing symptoms, recent infections, and risk factors.
Physical examination: Evaluating joints, skin, eyes, and genitourinary tract.
Blood tests:
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP): To measure inflammation.
HLA-B27 testing: To assess genetic predisposition.
Tests for infections: Such as Chlamydia, Salmonella, Shigella, Campylobacter, Yersinia.
Joint fluid analysis: To rule out other forms of arthritis.
Imaging studies: X-rays, MRI, or ultrasound to assess joint damage.
Timeline of Symptoms
The typical timeline is: 1. Infection: An infection occurs (genitourinary or gastrointestinal). 2. Latent period: A period of 1-4 weeks after the infection during which there are no arthritis symptoms. 3. Onset of arthritis: Joint pain and swelling develop, often affecting the knees, ankles, and feet. 4. Associated symptoms: Urethritis, conjunctivitis, skin rashes, and mouth sores may appear around the same time as the arthritis. 5. Resolution: In acute cases, symptoms gradually resolve over several months. 6. Chronic or recurrent: In some cases, symptoms persist or recur over a longer period.
Important Considerations
Early diagnosis and treatment are important to prevent long-term joint damage.
Reactive arthritis can sometimes be difficult to distinguish from other forms of arthritis.
Even if the initial infection has resolved, the inflammatory response can persist.
Long-term follow-up with a rheumatologist is recommended, especially for chronic or recurrent cases.
Physical therapy and exercise can help maintain joint function and reduce pain.