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GET THE SECOND OPINION FOR REACTIVE ARTHRITIS

 
 

INTRODUCTION


Reactive arthritis or Reiter’s Syndrome is a chronic form of arthritis with three conditions: 
  1. Inflammation of the joints
  2. Inflammation of the eyes (conjunctivitis
  3. Inflammation in the genital area, urinary tract or gastrointestinal tract.
This form of arthritis is "reactive arthritis" because it is like the immune system that is reacting to the presence of bacterial infections in the genital tract, urinary or gastrointestinal tract. As a result, due to faulty genes the immune system of some people readily responds when they are exposed to certain bacteria resulting in inflammation in the joints and eyes.
Reactive arthritis often affects patients in their 30s or 40s, but can occur at any age. The form of reactive arthritis, which occurs following a genital infection (STI), occurs more frequently in men. The arthritis that develops after intestinal infections (dysentery) occurs at the same frequency in men and women.
Reactive arthritis is considered a systemic rheumatic disease. This means it can also affect other organs or the joints, causing inflammation in tissues such as skin, eyes, mouth, kidney, heart and lungs. Reactive arthritis can be associated with other diseases such as psoriatic arthritis, ankylosing spondylitis and rheumatoid arthritis, Crohn's disease and ulcerative colitis. Each of these conditions can cause similar arthritic inflammation of the spine and other joints, eyes, skin, mouth and other bodies. Because of the similarities and tendency to affect the spine, these conditions are collectively referred to as "spondyloarthropathies."
 

SIGNS AND SYMPTOMS OF REACTIVE ARTHRITIS


The symptoms of reactive arthritis includes:-
  1. Affecting the joint: 
    1. Knees, ankles, feet and wrists are commonly affected. These joints are usually affected asymmetrically, ie one or the other side is affected neither both sides simultaneously. The inflammation leads to stiffness, pain, swelling, heat and redness of the affected joints. Patients may develop "sausage digit." This feature is also seen in patients with other types of arthritis called psoriatic arthritis. Reactive arthritis may be associated with an inflammation of the spine, causing stiffness and pain in the back or neck like other spondyloarthropathies.
    2. Cartilage can also become inflamed, especially around the breastbone where the ribs meet in front of the chest, a condition called Tietze syndrome. Muscles attach to bones by tendons. In reactive arthritis, the points of insertion of the tendon can become inflamed (tendonitis), sensitive and painful when it is exercised.
  2. Affecting non joint areas: 
    1. The eyes, genitals, urinary tract (urethra, bladder and prostate), skin, mucous membranes, mouth, intestine and aorta maybe affected in reactive arthritis. Inflammation of the eyes (conjunctivitis) and the iris of the eye (iritis) are frequently observed in the early reactive arthritis and can be intermittent. Inflammation of the eye can be very painful, especially under bright light.
    2. Urinary tract infection usually affects the urethra, the tube that passes urine from the bladder to the penis in males or vestibule in females. This inflammation (urethritis) leads to burning sensation during urination and / or pus from the penis. The skin around the penis begins to swell and peel. The bladder and prostate may also be affected leading to cystitis, prostatitis, respectively.
    3. The skin may show the classic look which is medically known as keratoderma gonorrhea. The mouth can develop painless sores (ulcers) in the hard and soft palate. Inflammation of the bowel (colitis) may cause diarrhea or pus or blood in the stool. Inflammation of the aorta (aortitis) can be observed in a small percentage of patients with reactive arthritis. It can lead to failure of the aortic valve of the heart, leading to heart failure. The path of the electrical conductivity of the heart can be affected in reactive arthritis, leading to an irregular heartbeat (arrhythmia) that may need a pacemaker to regulate heartbeat.
 

CAUSES & RISK FACTORS OF REACTIVE ARTHRITIS


Reactive arthritis have genetic factor which leads to abnormal response of the immune system. There are certain genetic markers that are much more common in patients with reactive arthritis than in the normal population. For example, HLA-B27 is frequently observed in patients with reactive arthritis. For even in patients who have a genetic basis and who are predisposed to the development of reactive arthritis, they however need exposure to certain infections to trigger the onset of the disease.
Reactive arthritis can occur after infection with Chlamydia trachomatis which is a common bacteria for STD’s. Reactive arthritis also occurs after infectious diseases like dysentery, with bacterial organisms such as Salmonella, Shigella, Yersinia and Campylobacter. In general, arthritis develops 1-3 weeks after the start of a bacterial infection.
 

DIAGNOSIS AND INVESTIGATIONS OF REACTIVE ARTHRITIS


There is no single laboratory test to diagnose reactive arthritis. Reactive arthritis diagnosis is based on recognition of the combination of arthritis with inflammation of the eyes and genital systems, urinary and / or gastrointestinal tract.
  1. Blood test like “ESR” is available to document the presence of inflammation in the body. 
  2. Rheumatoid factor (RA factor), which is usually present in rheumatoid arthritis, usually is negative in reactive arthritis. T
  3. he test HLA-B27 gene marker blood may be useful, especially in the diagnosis of patients with disease of the spine.
  4.  X-rays of the spine and other joints may reveal, changes typical of inflammation in these areas, but overall it will not until late in the disease. Sometimes unusual areas of calcification can be seen in the places where tendons attach to bone which can be seen on X-ray. 
  5. Patients with eye inflammation require ophthalmological assessment to document the involvement of the inflammation of the iris. 
  6. Stool cultures can be used for the presence of infection of the intestine, urinalysis and urine culture may be necessary to detect a bacterial infection in the urinary tract. The prostate, which can be affected in a patient with reactive arthritis, can be examined for tenderness.
 

TREATMENT OF REACTIVE ARTHRITIS


The treatment of reactive arthritis depends on the affected part in the body. 
  1. In arthritis, the patients are usually initially treated with nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs include aspirin, Ibuprofen, indomethacin etc.  Potential side effects include gastrointestinal irritation, including stomach ulcers and bleeding. This should be taken with food to minimize this risk. 
  2. Corticosteroids such as prednisone, may be useful to reduce inflammation and are short-term treatment of inflammation in reactive arthritis. Can be administered orally or by injection. They are also used to reduce inflammation of the tendon in some forms of tendinitis.
  3.  Sulfasalazine can be tried in patients with persistent reactive arthritis. Possible side effects of this drug include skin rash due to drug reaction and bone marrow suppression. 
  4. Other drugs include TNF inhibitors such as etanercept and infliximab, methotrexate. Methotrexate can be administered orally, by injection. It is administered once a week and requires regular monitoring of blood counts and liver profile because of the potential toxicity on the bone marrow and liver. However, these drugs are to be avoided in HIV patients.
  5. Inflammation of the eyes can be alleviated with anti-inflammatory drops. To prevent severe iritis, cortisone injections can be tried.
  6. The inflammation around the penis can be treated with corticosteroid creams. If the bacteria in the intestines or urine are found, appropriate antibiotics are given.
 

REFERENCES


  1. Ruddy, Shaun (2001). Kelley's Textbook of Rheumatology, 6th Ed. W. B. Saunders. pp. 1055–1064
  2. Hill Gaston JS, Lillicrap MS (2003). "Arthritis associated with enteric infection". Best pract ice & research. Clinical rheumatology17 (2): 219–239
  3. http://www.medicinenet.com/reactive_arthritis
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