Summary about Disease
Reiter's Syndrome, now more commonly referred to as Reactive Arthritis, is a type of arthritis that develops as a reaction to an infection in another part of the body. Often, the infection is in the urinary tract, genitals, or intestines. It is characterized by a triad of symptoms: arthritis, inflammation of the eyes (conjunctivitis or uveitis), and urinary or genital inflammation (urethritis or cervicitis). However, not all individuals experience all three symptoms. Reactive arthritis is an autoimmune condition, meaning the body's immune system mistakenly attacks its own tissues.
Symptoms
Symptoms of Reactive Arthritis vary, but common ones include:
Joint Pain and Stiffness: Typically affects the knees, ankles, and feet, but can occur in any joint.
Inflammation of the Eyes (Conjunctivitis/Uveitis): Redness, itching, burning, and blurred vision.
Urinary Problems: Painful urination, increased frequency, and discharge.
Skin Rashes: Keratoderma blennorrhagicum (painless skin lesions on the palms and soles) and circinate balanitis (small, painless ulcers on the penis).
Mouth Sores: Small, painless ulcers.
Enthesitis: Inflammation where tendons and ligaments attach to bone, causing pain and stiffness.
Back Pain: Inflammation of the sacroiliac joints (sacroiliitis).
Dactylitis: Swelling of entire fingers or toes (sausage fingers/toes).
Causes
Reactive Arthritis is triggered by an infection, most commonly:
Sexually Transmitted Infections (STIs): Chlamydia trachomatis is a frequent trigger.
Foodborne Infections: Bacteria like Salmonella, Shigella, Campylobacter, and *Yersinia* can cause intestinal infections that lead to reactive arthritis. Genetic predisposition plays a role, with the HLA-B27 gene being a significant risk factor. However, not everyone with the HLA-B27 gene develops the condition.
Medicine Used
Treatment focuses on relieving symptoms and managing the underlying infection:
Antibiotics: To treat the triggering infection (e.g., Chlamydia).
Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Like ibuprofen or naproxen, to reduce pain and inflammation.
Corticosteroids: Such as prednisone, to reduce inflammation (used more sparingly due to side effects).
Disease-Modifying Antirheumatic Drugs (DMARDs): Like sulfasalazine or methotrexate, for chronic or severe cases to suppress the immune system.
Tumor Necrosis Factor (TNF) Inhibitors: Biologic medications, such as etanercept or infliximab, for cases unresponsive to DMARDs.
Topical Corticosteroids: For skin rashes and eye inflammation.
Eye Drops: For conjunctivitis or uveitis.
Pain Relievers: Medications such as tramadol and topical agents such as capsaicin.
Is Communicable
Reactive Arthritis itself is not communicable. You cannot "catch" it from someone. However, the triggering infection (e.g., *Chlamydia*, *Salmonella*) *can* be communicable. Therefore, preventing the spread of these infections is crucial.
Precautions
Precautions focus on preventing the infections that trigger Reactive Arthritis:
Safe Sex Practices: Use condoms to prevent STIs like Chlamydia.
Food Safety: Practice proper food handling and cooking techniques to avoid foodborne illnesses. Wash hands thoroughly before preparing food and after using the bathroom.
Avoid Contact with Infected Individuals: If you know someone has an infection that can trigger Reactive Arthritis, minimize close contact.
If you have reactive arthritis: Avoid foods, conditions, and activities that may trigger the condition
How long does an outbreak last?
The duration of a Reactive Arthritis outbreak varies:
Acute Reactive Arthritis: Symptoms usually last for a few weeks to several months (3-12 months).
Chronic Reactive Arthritis: In some individuals, symptoms can persist for more than a year, and may even become chronic. Some people can experience relapses over many years.
How is it diagnosed?
Diagnosis involves:
Medical History and Physical Examination: Reviewing symptoms, recent infections, and family history.
Blood Tests: To check for HLA-B27, inflammatory markers (ESR, CRP), and antibodies related to possible infections.
Urine Tests: To screen for Chlamydia or other infections.
Joint Fluid Analysis: To rule out other forms of arthritis and infection in the joint.
Imaging Studies: X-rays, MRI, or ultrasound to assess joint damage and inflammation. Diagnosis is primarily based on clinical findings, as there is no single definitive test.
Timeline of Symptoms
The timeline can vary, but a typical progression might look like this:
1-4 Weeks After Infection: Initial infection (e.g., diarrhea from Salmonella or urethritis from *Chlamydia*).
1-4 Weeks After Initial Infection: Arthritis symptoms begin to develop, often in the knees, ankles, or feet.
Around the Same Time or Shortly After Arthritis: Eye inflammation (conjunctivitis or uveitis) may appear.
Concurrent with Arthritis: Urinary symptoms, skin rashes, and mouth sores may develop.
Resolution: Symptoms gradually improve over weeks or months. Chronic cases can persist longer.
Important Considerations
HLA-B27: While HLA-B27 is a risk factor, its presence doesn't guarantee Reactive Arthritis will develop. Conversely, Reactive Arthritis can occur in individuals without HLA-B27.
Differential Diagnosis: It's important to rule out other conditions with similar symptoms, such as rheumatoid arthritis, psoriatic arthritis, and other spondyloarthropathies.
Long-Term Management: Regular follow-up with a rheumatologist is crucial for managing chronic cases and preventing long-term joint damage.
Individual Variability: The course of Reactive Arthritis is highly variable. Some people have mild, self-limiting symptoms, while others experience severe, chronic disease.
Prevention: Preventing the initial infection is key to preventing reactive arthritis.