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Reactive Arthritis

Reactive Arthritis is a painful form of inflammatory arthritis that can affect the joints, heels, toes, fingers, and knees. This disorder typically develops as a complication from an infection in another part of the body, such as Shigella, Campylobacter, Salmonella, Yersinia, or Clostridium foodborne illnesses. The condition can be temporary or last for months or even years.

In a study done by Washington state, 29% of patients developed arthritis following Salmonella gastroenteritis infection. The study found that children were less susceptible to reactive arthritis than adults. In another study, the frequency of developing the disorder was reported to be 1-4% for Campylobacter and Shigella infections. And yet another study reported the chances of development between 1.5% – 7% for Shigella and 0.6% – 24% for Campylobacter.

Reactive Arthritis Fast Facts

  • Reactive Arthritis is an autoimmune disorderthat occurs when the body’s immune system mistakenly attacks healthy tissue.
  • Reactive Arthritis at its core is joint pain and swelling that occurs as a result of an infection in another part of the body (such as a foodborne illnesses).
  • The inflammation can begin in days to weeks after the onset of an infection.
  • Common symptoms of reactive arthritis, include: inflammation of joints especially knees, ankles and feet which can lead to joint pain, stiffness, swelling, warmth and redness.
  • Another type of reactive arthritis, that is also known as Reiter’s syndrome, causes discomfort during urination as well as eye inflammation.
  • There is no single laboratory test that can be done to pinpoint reactive arthritis.
  • Some doctors use the HLA-B27 genetic marker, most commonly found in the blood, as a guideline to diagnose the disorder.
  • Treatment for this condition involves treating the symptoms, as opposed to the condition itself. The treatment includes anti-inflammatory medication and steroids that are targeted towards the specific part of the body affected.
  • There is no cure for Reactive Arthritis, and no vaccines for it.

What is Reactive Arthritis?

Reactive Arthritis is a chronic and systemic rheumatic disease. It is referred to as ‘reactive’ because it happens when the immune system seems to be ‘reacting’ to the presence of (or recovery from) a bacterial infection in another body system. Some infected people’s immune systems react in a peculiar manner to the infections and causes a spontaneous inflammation of the joints and the eyes.

It was initially named ‘Reiter’s Syndrome’ after Hans Reiter, a soldier suffered from the classic triad of urethritis, conjunctivitis, and arthritis.

What are Some of the Risk factors for Reactive Arthritis?

  • Reactive Arthritis is more frequent in men than women.
  • Because women may be underdiagnosed, the exact incidence of reactive arthritis is difficult to estimate.
  • It typically affects people between the ages of 20-40.
  • Inherited genes, such as HLA-B27, can increase the risk of developing Reactive Arthritis.
  • Those with HIV are at a particularly high.
  • Those who have recently recovered from a severe foodborne illness (such as Salmonella infection) are also at high risk.

What are the Signs and Symptoms of Reactive Arthritis?

Reactive Arthritis has a classic triad of symptoms that only affect one third of the patients diagnosed with the condition. These symptoms include:

  • Non-Infectious urethritis
  • Arthritis
  • Conjunctivitis

Of these, the most common symptoms of Reactive Arthritis include:

  • Pain and Stiffness: The joint pain mostly occurs in knees, ankles, and feet. The pain can be asymmetrical, which means that one of knees might be affected more by the inflammation than the other.
  • Eyes and Skin: Eye inflammation is quite a common symptom of Reactive Arthritis. It causes an inflammation of the eye membranes and can result in pain, swelling, and discharge.
  • The skin on the palms and soles of the feet can develop tiny fluid filled blisters. The skin inflammation can be quite similar to psoriasis.
  • Swollen Toes and Fingers: An affected person’s toes and fingers can swell a lot and cause pain.
  • Edema of the Lower Extremities: An affected person may notice swelling in their ankles and legs.
  • Low Back Pain: Lower back pain is typical and can get worse in the night and in the morning.
  • Inflammation of Soft Tissues: Also known as enthesitis, the inflammation affects muscles, tendons, and ligaments.

Around 20% of the people who develop Reactive Arthritis will have chronic or long-term symptoms. Studies have also shown that around 15-50% of the victims will develop the symptoms again once the initial flare has gone down.

How is Reactive Arthritis Diagnosed?

The diagnosis of Reactive Arthritis depends on history and physical examinationcompleted by the healthcare provider. A doctor will check an affected person’s joints (knees and ankles) for the signs and symptoms of inflammation, such as swelling, tenderness, etc. During this time, an affected person should notify their doctor about the pain or any other symptoms that they might be experiencing.

The following laboratory studies may also be ordered:

  • White blood cell and Red blood cell counts
  • Erythrocyte Sedimentation Rate (ESR)
  • C-Reactive Protein and IgA antibodies
  • Human Leukocyte Antigen
  • Tuberculin Skin Test
  • Urinalysis

Imaging Modalities that can also be considered to assist in diagnosis include:

  • Plain Radiography (ordered in 40-70% of the cases)
  • Magnetic Resonance Imaging (MRI)— especially of the joints
  • Computed Tomography
  • Electrocardiography (ECG)

Blood tests can help to reveal evidence of past and current infection, signs of inflammation, antibodies that might be present due to other types of arthritis, and show the presence of the genetic marker that would be linked to Reactive Arthritis.

Joint fluid tests will help in revealing whether or not the body’s white blood cell count has increased – an increase indicates inflammation or an infection, bacteria in joint fluid indicates septic arthritis, uric acid crystals in joint fluid can indicate gout.

How is Reactive Arthritis Treated?

No specific treatmentexists for Reactive Arthritis, and treatment basically aims at relieving the symptoms. The medication prescribed for an affected person is based on the severity of their inflammation and symptoms. Around two-thirds of the patients have a self-limited course, meaning that they get better on their own. Around 30% of the individuals can develop chronic symptoms due to Reactive Arthritis. This could pose a therapeutic challenge in the treatment.

The treatment first focuses on the underlying infection that is the root cause of the development of Reactive Arthritis. Then, eventually, the drugs and subsequent therapy focus on pain relief and management. Some common drugs that are prescribed include:

  • Non-steroidal Inflammatory Drugs: Ibuprofen and Naproxen can help relieve pain and reduce inflammation.
  • Corticosteroids: These are synthetic drugs that can mimic cortisol, a hormone that is naturally produced by the body. They suppress the inflammation in the body and are used as a short-term treatment of inflammation when someone has Reactive Arthritis symptoms.
  • Antibiotics: These are prescribed only if someone is still recovering from an infection that causes Reactive Arthritis.
  • Disease modifying anti-rheumatic drugs: These drugs are given when NSAIDs are ineffective. For chronic joint inflammation, methotrexate can be given orally by injection. It requires regular monitoring of blood counts and blood liver tests and can be given weekly.

How Can Someone Prevent Developing Reactive Arthritis?

Prevention of Reactive Arthritis relates to prevention of infection. Foodborne illnesses can contribute to the development of Reactive Arthritis, so it is always to practice good food safety behaviors. Regular handwashing and good hygiene are also recommended to help reduce the likelihood of infections.

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