Reactive Arthritis (ReA), also known as Reiter's syndrome, is a type of inflammatory arthritis that develops as a reaction to an infection in another part of the body. It typically occurs after a bacterial infection in the intestines, genitourinary tract, or other areas. The condition is characterized by joint pain and swelling, especially in the lower limbs, along with inflammation in other parts of the body, such as the eyes, urinary tract, and skin.
Key Features of Reactive Arthritis:
- Joint Involvement: The main feature of reactive arthritis is inflammation of the joints. It usually affects the knees, ankles, and feet but can also involve the spine and other joints. The arthritis is often asymmetric, meaning it affects joints on one side of the body more than the other.
- Preceding Infection: Reactive arthritis is triggered by an infection, typically a bacterial infection, that occurs in the days or weeks before the onset of symptoms. Common infections that can trigger reactive arthritis include:
- Gastrointestinal infections: Caused by bacteria such as Salmonella, Shigella, Campylobacter, or Yersinia.
- Genitourinary infections: Often caused by sexually transmitted bacteria like Chlamydia trachomatis.
- Classic Triad of Symptoms: The symptoms of reactive arthritis are often grouped into a classic triad:
- Arthritis: Joint pain and swelling, especially in the knees, ankles, and feet.
- Conjunctivitis: Inflammation of the eyes, leading to redness, irritation, and discharge.
- Urethritis: Inflammation of the urinary tract, which may cause pain during urination or frequent urination.
- Enthesitis: Inflammation where tendons or ligaments attach to bones, commonly seen in the heels (Achilles tendonitis) or bottom of the feet (plantar fasciitis).
- Skin Manifestations: Some people with reactive arthritis develop skin rashes, such as keratoderma blennorrhagicum (scaly, wart-like lesions on the palms and soles) or circinate balanitis (sores on the penis).
Causes:
The exact cause of reactive arthritis is not fully understood, but it is believed to be triggered by an infection, particularly by certain bacteria. It is thought that the immune system mistakenly attacks the joints and other tissues after being exposed to these infections. Factors that may increase the risk of developing reactive arthritis include:
- Infection: A preceding gastrointestinal or genitourinary infection, most often bacterial.
- Genetics: A gene called HLA-B27 is found in a large percentage of people with reactive arthritis. People with this gene are more likely to develop the condition, especially after certain infections.
Symptoms:
The symptoms of reactive arthritis can vary in severity, but they generally include:
- Joint Pain and Swelling: This is the hallmark symptom, particularly in the knees, ankles, and feet.
- Swelling, warmth, and redness may occur around the affected joints.
- Painful and swollen toes (called sausage toes) or fingers may develop.
- Conjunctivitis: Red, irritated eyes that may discharge.
- Urethritis: Painful urination, frequent urination, or discomfort in the genital area due to inflammation of the urinary tract.
- Skin Changes: Rashes, including wart-like lesions on the soles and palms, and sores on the genitals.
- Tendon and Ligament Inflammation (Enthesitis): Pain and swelling at sites where tendons attach to bones, such as the heels (Achilles tendonitis) or the bottoms of the feet (plantar fasciitis).
- Fever: Some people may experience low-grade fever during the acute phase of the illness.
- Mouth Ulcers: Sores may develop in the mouth in some cases.
- Fatigue: General fatigue and malaise may accompany the illness.
Diagnosis:
There is no single test for reactive arthritis, but the diagnosis is often made based on the following:
- Medical History: A history of a recent bacterial infection, particularly gastrointestinal or genitourinary infections, is a key clue.
- Physical Examination: Joint inflammation, skin rashes, and eye irritation are examined to assess the extent of the symptoms.
- Laboratory Tests: Blood tests may show elevated markers of inflammation (such as ESR or CRP). Testing for the HLA-B27 gene may help confirm the diagnosis, though its presence alone is not enough for diagnosis.
- Cultures and Tests for Infections: If an infection is suspected as the trigger, stool, urine, or throat samples may be taken to identify the bacteria responsible.
- Imaging: X-rays may be used to rule out other conditions or to check for joint damage in chronic cases.
Treatment:
The goal of treatment is to relieve symptoms, control inflammation, and address the underlying infection if present. Treatment options may include:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications like ibuprofen or naproxen are commonly used to reduce inflammation, pain, and swelling in the joints.
- Disease-Modifying Anti-Rheumatic Drugs (DMARDs): In cases of severe or persistent arthritis, drugs such as sulfasalazine or methotrexate may be used to suppress the immune response.
- Corticosteroids: Oral or injectable corticosteroids, such as prednisone, may be prescribed to reduce inflammation, especially in acute flare-ups.
- Antibiotics: If the infection is still present, antibiotics may be given, but antibiotics are not typically used to treat the arthritis itself once the infection has resolved.
- Physical Therapy: A physical therapist may help with exercises and stretches to maintain joint mobility and reduce stiffness.
- Eye Drops: If conjunctivitis is present, lubricating eye drops or other medications may be used to relieve eye irritation.
- Treatment for Urethritis: If the urinary tract is involved, medications to address the symptoms and reduce inflammation may be prescribed.
Prognosis:
The outlook for reactive arthritis varies. In many people, symptoms improve within a few months, and the condition resolves with no long-term complications. However, for some individuals, the arthritis may become chronic or recurrent, leading to long-term joint damage. If untreated or poorly managed, it can lead to complications, such as:
- Chronic arthritis: Ongoing pain and joint damage, particularly in the spine and peripheral joints.
- Spondylitis: Inflammation of the spine, which can lead to stiffness and reduced mobility.
In most cases, the condition is manageable with treatment, and many people can lead normal lives with appropriate management.
Complications:
- Chronic arthritis: Some people may develop persistent or recurring arthritis that can cause joint damage over time.
- Spondylitis: Long-term inflammation in the spine.
- Inflammation of the heart or lungs: Although rare, some people may experience inflammation of the heart (endocarditis) or the lungs (pleuritis).
- Eye problems: Chronic conjunctivitis or other eye issues may persist.
If you think you have reactive arthritis or have had an infection followed by joint pain or other related symptoms, it's important to consult a healthcare provider for proper diagnosis and treatment.
