Reactive Arthritis

1 What is Reactive Arthritis?

Reactive arthritis is a type of arthritis characterized by inflammation of joints due to a reaction to infection in some part of the body. 

It mostly occurs in response to infection in genitals or gastrointestinal region. Symptoms of reactive arthritis are usually seen in knees, ankles and foot. In some cases it may also affect eyes, skin, and urethra. 

Reiter's syndrome is a specific type of reactive arthritis in which the symptoms are seen in eyes, urethra, and joints. It is prevalent in males in the age group of 20-40. 

Treatment of reactive arthritis depend on the site of inflammation and the organ affected.

2 Symptoms

Symptoms of reactive arthritis affect joints and other tissues and organs. It usually appears within three weeks of exposure to the particular trigger. 

Pain and stiffness of the joints are the two most common symptoms of reactive arthritis. Pain is usually seen in knees, ankles, and feet. It may also affect heels and lower back. 

Inflammation of the tendon insertion points makes it tender and painful, over a period of time, particularly after physical exercise. 

Non-joint areas where symptoms of reactive arthritis is seen include eye, genitals, urinary tract, skin, lining of mouth, large intestine, and aorta. Inflammation of eye and iris, called conjunctivitis and iritis, are also seen as symptoms of this condition. 

Inflammation of urethra causes burning sensation on passing urine. Bladder and prostate gland also may become inflamed. Swelling in toes and fingers is another symptom of the condition.

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3 Causes

Reaction to infection in another part of the body, like urinary tract or intestine, causes reactive arthritis. The infection may cause only mild symptoms in the body and is often ignored. 

Some common causative organisms that cause reactive arthritis include Chlamydia, Salmonella, Shigella, Yersinia, and Campylobacter. In some rare cases, these bacteria may be transmitted by sexual intercourse and contaminated food. 

Major risk factors for the development of reactive arthritis include hereditary factors, age, and gender. This form of arthritis is most commonly found in people between 20-40 years. 

Men are more susceptible to develop reactive arthritis in response to sexually transmitted infections. Food infections cause reactive arthritis in men and women, almost in equal proportions. 

Certain genetic factors are also linked to reactive arthritis. 

4 Making a Diagnosis

Diagnosis of reactive arthritis is based on signs and symptoms, and other tests. Physical examination reveals swelling, warmth, and stiffness in the affected joints. Doctors may assess the range of motion in the spine and joints. 

Evaluation of eyes and skin reveal symptoms of inflammation, if present. Blood tests are used to check for infections, signs of inflammation, and presence of antibodies. Genetic test checks the presence of specific markers that indicate reactive arthritis. 

Analysis of fluid sample from the affected joint is used to test the presence of infection and inflammation. Increase in the level of white blood cells in the joint fluid indicates infection or inflammation. 

Presence of bacteria in the joint fluid helps to differentiate septic arthritis, as it is an indication of infection in the joint. Urate crystals in the fluid is an indication of gout, another form of arthritis. 

More detailed visuals of the joints, particularly the lower back, is obtained by imaging techniques like x-ray. These images also help to rule out chances of other conditions that have similar symptoms.

5 Treatment

Treating the underlying infection is the main step in the treatment of reactive arthritis. Antibiotics are prescribed to treat the infection that triggered arthritis. 

Joint inflammation is treated with medications like: 

  • Non-steroidal anti-inflammatory medications (NSAIDs) – this includes aspirin, indomethacin, and sulindac.
  • Corticosteroids – like prednisone is used to reduce inflammation for a short term, either orally or as injections. 
  • Immune system suppressors – these medications are prescribed for aggressive inflammation in reactive arthritis. 
  • Tumor necrosis factor (TNF) blockers – TNF is considered to be an inflammatory agent in arthritis. TNF blockers inhibit the activity of these factors, thus helping in controlling inflammation. 
  • Anti-inflammatory drops – these medications are used to treat eye inflammation. Local injections of cortisone is also recommended in some serious eye inflammation. 

Physical therapy helps to improve the strength and the range of motion of the affected joint. The specific set of exercises in this therapy help to provide ample support and strength to the joint. 

It also reduces stiffness associated with the condition. 

6 Prevention

Limiting the exposure to infectious bacteria that trigger reactive arthritis is the only way to prevent this condition. 

Preventing contamination of food, and using condoms during sexual intercourse help in preventing the transmission of infections.

7 Alternative and Homeopathic Remedies

Top homeopathic remedies for reactive arthritis include:

  • abrotanum,
  • kali bichromicum,
  • asclepias tuberosa,
  • medorrhinum,
  • thuja occidentalis,
  • pulsatilla nigricans. 

These medications are recommended based on the specific symptoms. Turmeric has been used in many cultures to treat arthritis because of its anti-inflammatory properties. 

Herbs like garlic, uva ursi, ginger, and oregano are also used in the treatment of reactive arthritis. Probiotics help to rebuild the immune system and to prevent recurrence.

8 Lifestyle and Coping

Lifestyle modifications like regular exercise, healthy diet, and limiting exposure to the causative organism are very important steps in controlling reactive arthritis.

9 Risks and Complications

Reactive arthritis may lead to complications like:

  • secondary glaucoma,
  • cataract,
  • chronic arthritis,
  •  cystoid macular edema.
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