Reactive Arthritis

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Reactive arthritis (or Reiter’s Syndrome) is a type of arthritis that occurs as a reaction to an infection somewhere in the body. Most infections that cause this disease originates in the genitourinary tract (the bladder or urethra) and are spread through sexual intercourse, a form of the disease called “genitourinary Reiter’s syndrome”, or “urogenital Reiter’s syndrome”.

It occurs when bacteria enter the bloodstream and causes your body to react with inflammation in different parts of the body. The types of bacteria that cause reactive arthritis are normally contracted through sexual contact or by eating spoiled food. The inflammatory reaction usually begins within 2-4 weeks after infection. Reactive arthritis isn’t contagious, however, the bacteria that trigger the disease can pass from person to person. This disease may also affect the joints, eyes, and skin.

Fortunately, reactive arthritis isn’t very common. For most patients, signs and symptoms linked to reactive arthritis come and go, eventually disappearing within 12 months. In addition, the prognosis for reactive arthritis varies. Most people recover in 3-4 months, but about half have recurrences for several years.

Some patients develop complications that may include inflammation of the heart muscle, inflammation with stiffening of the spine, glaucoma, blindness, feet abnormalities, or accumulation of fluid in the lungs. In severe cases, the most common infection causing reactive arthritis is the sexually transmitted disease (STD) chlamydia.

Causes & Symptoms

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Generally, reactive arthritis is not contagious, but it is caused by some infection that can be contagious to the human body. The infections that most often cause the disease are spread through sexual contact from the bacterium chlamydia trachomatis. It can cause infections in the bladder, urethra, penis, or vagina.

Another infection that can cause reactive arthritis to infect the bowel is salmonella. This type of infection can come from eating contaminated food or handling contaminated objects that contain harmful bacteria. Reactive arthritis may also be linked to genes. People with reactive arthritis often have a gene known as HLA-B27. Although, many people have this gene without developing reactive arthritis.

In rare cases, the bacterium chlamydia pneumonia (which causes respiratory infections), may also cause reactive arthritis. Therefore, the bacteria typically enter your body in one of two ways:

 

  • Gastrointestinal (GI) tract – Bacteria can enter the body if you eat spoiled food or food that came into contact with contaminated surfaces.

 

  • Urogenital tract – Bacteria can enter through the vaginal area or urethra during sexual contact and spread to the bladder.

 

The most common symptoms of reactive arthritis are inflammation in the joints, eyes, bladder, and urethra (the tube that helps remove urine from the body). Oftentimes, mouth sores and skin rashes may occur. Some of the following possible symptoms linked to reactive arthritis include:

 

Joint symptoms

 

  • Pain and swelling in knees, ankles, feet, fingers, and wrists.

 

  • Lower back and buttock pain.

 

  • Inflammation in the spine (spondylitis) or in the lower back that connects the spine to the pelvis.

 

  • Heel pain and / or heel spurs.

 

  • Swelling of the tendons or where the tendons attach to the bone.

 

Eye symptoms

 

  • Blurred vision.

 

  • Eye pain and irritation.

 

  • Redness of the eyes.

 

Urinary symptoms

 

  • Pain during urination.

 

  • Need to urinate more frequently.

 

Other certain symptoms include:

 

  • Skin problems – Reactive arthritis can affect your skin in a variety of ways, including a rash on your soles and palms.

 

  • Swollen toes or fingers – In some cases, your toes or fingers might become so swollen that they may resemble sausages.

 

  • Diarrhea – This can occur before arthritis.

 

Reactive arthritis symptoms can be very mild and come and go over several weeks to months, or they can be more severe. Symptoms may not be noticeable in the early stages. Urinary symptoms normally appear first but may be absent in women. Arthritis is usually the last symptom to appear.

Who gets Reactive Arthritis?

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Risk factors that can increase your risk of reactive arthritis include the following below:

 

  • Gender – Women and men are equally likely to develop reactive arthritis in response to foodborne infections. However, men are more likely than are women to develop reactive arthritis in response to sexually transmitted bacteria.

 

  • Age – Reactive arthritis occurs most frequently in adults between the ages of 20 and 40 years.

 

  • Hereditary – A specific genetic marker has been linked to reactive arthritis. But many people who have this marker never develop the condition.

 

  • Infections – in the digestive system, such as salmonella, shigella, yersinia, and campylobacter.

 

  • HIV – Reactive arthritis is common in people who are living with HIV. As a result, a doctor may wish to test for HIV in patients showing new symptoms of reactive arthritis.

How Does it Affect You? How Serious is it?

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The main symptoms of reactive arthritis will often go away in a few months. Some people may have mild arthritic symptoms for up to a year. Others may develop mild, long-term arthritis.

Up to half of patients will have a flare-up of reactive arthritis in the future. In rare cases, the condition may lead to chronic, severe arthritis (which can lead to joint damage).

While not common, reactive arthritis, particularly chronic reactive arthritis, can lead to heart problems. These problems include an abnormal heart rhythm, aortic value insufficiency, or the inflammation of certain tissues lining the heart, which can cause stabbing chest pain.

Recommended Treatment & Rehabilitation

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Throughout the diagnosis for reactive arthritis, a doctor will begin a physical examination by examining a patient, listening to the patient’s heart, and checking for things such as swollen joints, swollen fingers and toes, tender spots, and skin and eye abnormalities. If a sexually transmitted disease (STD) or infection of the urethra is suspected, the doctor may also look at the patient’s genitals to note any rashes, sores, or abnormal discharge.

Afterward, your doctor will swab the area to run the following lab tests that are capable of checking for infection:

 

  • Joint fluid – Most joints contain a small amount of fluid called joint fluid or synovial fluid. This fluid can be extracted using a needle and syringe and then tests for signs of an infection or crystal arthritis, such as gout. This procedure is known as joint aspiration.

 

  • Confirm infection – After an infection, the blood will contain certain antibodies. A doctor who suspects reactive arthritis may order a blood test to help determine the presence of these antibodies; however, these tests may take several days and are not always accurate.

 

  • Inflammatory markers – When a person has an inflammatory condition like reactive arthritis, signs of inflammation are present in the blood. A blood sample may be taken to test for inflammatory markers such as C-Reactive Protein (CRP) or Erythrocyte sedimentation rate (ESR). An abnormally high CRP level and ESR support the notion that symptoms are caused by reactive arthritis or another inflammatory condition.

 

Doctors may recommend an X-ray or magnetic resonance imaging (MRI) of the painful joint. An X-ray may suggest joint swelling or other irregularities. An MRI can provide much more detailed images than an X-ray. Doctors perform these imaging tests to rule out other conditions that can produce the same or similar symptoms. For instance, a gonorrhea infection that has spread to the bloodstream, septic arthritis, and Lyme disease can also cause joints to feel painful and swollen.

Generally, arthritis occurs when your immune system is misdirected to attack your joints, causing swelling, and pain. Reactive arthritis is a type of inflammatory arthritis that can be triggered by an infection somewhere in your body. This infection causes a misdirected immune system response.

There isn’t any cure for reactive arthritis. But the symptoms can go into remission and not require treatment unless a subsequent flare occurs. The following treatments for reactive arthritis can help relieve your symptoms:

 

NSAIDs

Non-steroidal anti-inflammatory drugs, such as ibuprofen and aspirin, may be taken to help reduce inflammation and pain. These drugs are available over-the-counter or by prescription in higher strengths. Long-term daily use of NSAIDs can have side effects, including stomach, kidney, and liver damage, so patients and doctors should discuss other options if symptoms are prolonged.

 

Steroid injections

Your doctor may recommend a steroid injection into the painful joint. Steroid injections are not recommended more than once over 3 months.

 

Oral steroids

Oral steroids reduce inflammation. Patients are advised to discuss possible side effects with their doctors before taking oral steroids.

 

DMARDs

Patients who have had symptoms for several months and have already tried NSAIDs and steroids may be advised to take disease-modifying antirheumatic drugs (DMARDs). This type of medication helps decrease inflammation by suppressing the immune system. The most common DMARD used to treat reactive arthritis is called sulfasalazine.

 

Biologics

Examples of biologics used to treat reactive arthritis include etanercept and infliximab. These drugs target and prevent a specific biochemical reaction from occurring in the body, stopping the inflammatory process in its tracks before inflammation can be seen or felt.

 

Exercise can help improve your joint function. A physiotherapist can give you exercise routines to help build up your strength. Some of these exercises include the following:

 

Range-of-motion exercises

These exercises relieve stiffness and increase your ability to move your joints through their full range of motion. These exercises might include movements such as raising your arms over your head or rolling your shoulders forward and backward. In most cases, these exercises can be done on a regular daily basis.

 

Strengthening exercises

Strengthening exercises help you build strong muscles that help support and protect your joints. Weight training is an example of a strengthening exercise that can help you maintain or increase your muscle strength.

 

Aerobic exercise

Aerobic or endurance exercises help with your overall fitness. They can improve your cardiovascular health, help you control your weight, and give you more stamina and energy.

 

Other activities

Any movement, no matter how small, can help. Body awareness exercises, such as gentle forms of yoga or tai-chi, can help you improve balance, prevent falls, improve posture and coordination, and avoid positions or movements that can cause pain.

Alternative & Homeopathic Treatment

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Below are several homeopathic treatments that can help reduce your arthritic symptoms naturally, such as:

 

  • Epsom salt bath – Epsom salt baths are proven to relieve pain, including arthritis pain and inflammation, psoriasis, sore muscles, and swollen feet. If your feet and ankles hurt, soaking them in a deep bucket may help. If your arthritis pain is more widespread, a warm bath with Epsom salt can help relax muscles and relieve pain.

 

  • Massage – A moderate pressure massage can help relieve arthritis pain. It should be noted that research has found that light pressure causes the heart rate and blood pressure to rise while moderate pressure causes the heart rate and blood pressure to decrease.

 

  • Meditation – Meditation can improve pain and depression symptoms, as well as quality of life.