Summary about Disease
Reactive arthritis is a type of arthritis that develops in response to an infection in another part of the body, most often the genitals or intestines. It is an autoimmune condition, meaning the body's immune system mistakenly attacks healthy tissues. It typically affects the joints, eyes, and urinary tract. Reactive arthritis is not contagious.
Symptoms
Symptoms vary but often include:
Joint pain and stiffness: Commonly affects knees, ankles, and feet.
Eye inflammation (conjunctivitis or uveitis): Redness, pain, and blurred vision.
Urinary problems (urethritis or cervicitis): Painful urination, discharge.
Enthesitis: Pain at the sites where tendons and ligaments attach to bone, such as the heel.
Dactylitis (sausage fingers or toes): Swelling of the entire digit.
Skin rashes: Such as keratoderma blennorrhagicum (painless blisters on the palms and soles).
Mouth sores: Painless ulcers.
Causes
Reactive arthritis is triggered by an infection, most commonly by bacteria that cause:
Sexually transmitted infections (STIs): Chlamydia trachomatis is a common trigger.
Gastrointestinal infections: Bacteria such as Salmonella, Shigella, Campylobacter, and Yersinia can trigger the condition. The exact mechanism by which infection triggers arthritis is not fully understood, but genetic factors, particularly the HLA-B27 gene, increase susceptibility.
Medicine Used
Treatment aims to relieve symptoms and manage the underlying infection. Common medications include:
Antibiotics: To treat the triggering infection (e.g., Chlamydia).
Nonsteroidal anti-inflammatory drugs (NSAIDs): To relieve pain and inflammation. Examples include ibuprofen, naproxen, and indomethacin.
Corticosteroids: To reduce inflammation. May be given orally or injected into affected joints.
Disease-modifying antirheumatic drugs (DMARDs): For chronic or severe cases. Examples include sulfasalazine and methotrexate.
Biologic agents: TNF inhibitors, in some severe cases unresponsive to other treatments.
Is Communicable
Reactive arthritis itself is not communicable. However, the infections that trigger it (like Chlamydia, Salmonella, etc.) can be contagious.
Precautions
Practice safe sex: To prevent sexually transmitted infections that can trigger reactive arthritis.
Food safety: Wash hands thoroughly and cook food properly to prevent gastrointestinal infections.
Prompt treatment of infections: Seek medical attention for any suspected infections.
Regular check-ups: If you have a history of reactive arthritis or related infections, consider regular check-ups with your doctor.
How long does an outbreak last?
The duration of a reactive arthritis outbreak varies. It can be:
Acute: Lasting for a few weeks to several months (typically 3-12 months).
Chronic: Persisting for more than six months.
Recurrent: Occurring sporadically over several years.
How is it diagnosed?
Diagnosis typically involves:
Medical history and physical examination: Assessing symptoms and risk factors.
Blood tests: To check for inflammation markers (ESR, CRP), HLA-B27 gene, and antibodies related to infections.
Urine tests: To check for signs of infection (e.g., Chlamydia).
Joint fluid analysis: To rule out other forms of arthritis and infection.
Imaging studies: X-rays or MRI to assess joint damage.
Timeline of Symptoms
The timeline varies, but generally follows this pattern:
1-4 weeks after infection: Initial infection (e.g., Chlamydia) occurs. May be asymptomatic.
1-4 weeks after infection confirmation (if applicable): Arthritis symptoms begin to appear (joint pain, swelling).
Alongside Arthritis: Eye inflammation (conjunctivitis or uveitis) and/or urinary symptoms (urethritis) may develop.
Weeks to Months: Symptoms peak and gradually subside (in acute cases).
Important Considerations
HLA-B27: While not everyone with reactive arthritis has this gene, its presence increases the likelihood of developing the condition and can influence the severity and chronicity of symptoms.
Differential diagnosis: It's crucial to rule out other conditions that can mimic reactive arthritis, such as rheumatoid arthritis, psoriatic arthritis, and septic arthritis.
Long-term management: Even after an acute episode resolves, some individuals may experience persistent or recurrent symptoms, requiring ongoing management.
Uveitis Risk: The uveitis component of Reactive Arthritis is vision threatening and early treatment is crucial to save vision. Follow up with ophthalmology is very important.
Cardiovascular and other systemic risks: Reactive arthritis can, in rare cases, involve the heart or other organ systems.