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Reactive Arthritis

Alternate Names

  • reactive arthritis

Definition

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.

What is going on in the body?

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.

Risks

What are the causes and risks of the condition?

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:
  • Campylobacter
  • Chlamydia
  • HIV
  • Salmonella
  • Shigella
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.

Prevention

What can be done to prevent the condition?

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.

Diagnosed

How is the condition diagnosed?

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.

Long Term Effects

What are the long-term effects of the condition?

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.

Other Risks

What are the risks to others?

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.

Treatments

What are the treatments for the condition?

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 condition
  • nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen (i.e., Motrin, Advil) and aspirin, to help control joint pain
  • corticosteroids injected into the joints to control the swelling and pain
  • corticosteroid ointments applied to skin lesions
  • medications, such as methotrexate or sulfasalazine (i.e., Azulfadine), to suppress the immune system response

Side Effects

What are the side effects of the treatments?

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.

After Treatment

What happens after treatment for the condition?

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.

Monitor

How is the condition monitored?

Repeated physical examinations and blood tests help monitor reactive arthritis. Any new or worsening symptoms should be reported to the healthcare provider.

Sources

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

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