Reactive arthritis is a condition characterized by joint swelling, tenderness, and pain in people who are genetically susceptible. It may also affect the eyes and the urethra, the tube that drains urine from the bladder.
Reactive arthritis is an acute condition that develops in response to an infection. The joints affected by the arthritis are not infected. Rather, the immune system causes inflammation of the joints in response to an infection that occurs elsewhere in the body.
Typically the symptoms of reactive arthritis begin 7 to 14 days after the initial infection. The first symptom is often inflammation of the urethra (the tube through which urine passes out of the body).There may also be a discharge from the penis or vagina. The person may experience pain or burning when urinating.The conjunctiva, or membrane that covers the eyeball, can become red and inflamed. This causes pain and excessive tearing.Several joints, often the toes, ankles, knees, hips, and back, experience inflammation, swelling, and pain usually at the same time.Small, painless sores may develop in the mouth, on the tongue, and on the end of the penis.Occasionally, a distinctive rash of hard, thickened spots may develop on the skin on the palms and the soles of the feet. Yellow deposits may develop under the fingernails and toenails.
For unknown reasons, certain people are genetically susceptible to reactive arthritis. Eighty percent of the people with the type of reactive arthritis known as Reiter's Syndrome have a gene known as HLA-B27. These individuals are at risk for reactive arthritis following an infection with certain bacteria or viruses, including: CampylobacterChlamydiaHIVSalmonellaShigella
Reiter's syndrome is most commonly seen in men between the ages of 20 and 40 years. While women can develop the condition, they usually have milder symptoms than the men do.
Practicing safer sex can eliminate those cases of Reiter's syndrome that are caused by a sexually-transmitted disease. Reactive arthritis that follows food poisoning can be avoided by using good food-handling techniques.
Reactive arthritis may be suspected when someone develops arthritis following an infection. The organism may be cultured from the throat, intestinal tract, or genitourinary tract. Blood tests can help confirm the diagnosis. In some cases, a joint aspiration is done to remove fluid from the joints by a needle. The fluid is then examined under a microscope in the laboratory.
Although most people recover completely from reactive arthritis, about 20% may be left with ongoing joint pain. Some individuals may develop chronic eye irritation known as uveitis,. Ten percent of the people who have reactive arthritis will develop heart valve problems, including aortic regurgitation. Rarely, the syndrome may cause severe arthritis and disability.
The original infection, which triggers reactive arthritis, can be spread to others. However, not all people will develop reactive arthritis as a result of the infection.
When first diagnosed, a short period of bed rest may be recommended to reduce pain and inflammation in the joints. The healthcare provider may then recommend strengthening and range-of-motion exercises .
Following are some of the medications used to treat reactive arthritis: antibiotics to treat the underlying infection that triggered the conditionnonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen (i.e., Motrin, Advil) and aspirin, to help control joint paincorticosteroids injected into the joints to control the swelling and paincorticosteroid ointments applied to skin lesionsmedications, such as methotrexate or sulfasalazine (i.e., Azulfadine), to suppress the immune system response
Antibiotics may cause stomach upset, diarrhea, and allergic reaction. NSAIDs can cause stomach upset and allergic reactions. Steroids may cause weight gain, high blood pressure, and an increased risk of infection.
Arthritis symptoms may continue for up to six months. Most people recover in 2 to 16 weeks, but some have recurrent flare-ups and remissions.
Repeated physical examinations and blood tests help monitor reactive arthritis. Any new or worsening symptoms should be reported to the healthcare provider.
The Merck Manual of Medical Information, Home edition, 1997
Professional Guide to Diseases, Sixth Edition. Springhouse: Springhouse Corporation, 1998
Tierney, Lawrence, editor, "Current Medical Diagnosis and Treatment, 39th edition", 2000
