Reactive Arthritis 

Reactive Arthritis — Know It All!

Editorial

All you need to know about Reactive Arthritis.

Reactive Arthritis 

Know your ailment well, so you can manage it better!!

Here we come with Reactive Arthritis today!

Overview:

Reactive arthritis is a type of spondyloarthritis, a group of disorders that (especially in the spine) may cause inflammation throughout the body. Inflammation of the joints, eyes, and urinary tract and its associated genital structures is associated with reactive arthritis. Such symptoms may happen alone, together, or not at all. All of these signs may be so mild that they may not be detected by you.

The symptoms of reactive arthritis typically last several months, but in a small percentage of people, symptoms can return or evolve into a long-term disease.

Reactive arthritis is not contagious; that is, arthritis will not be passed on to anyone else by a person with the condition. The bacteria that can cause reactive arthritis can, however, be transferred from person to person.

Many individuals with reactive arthritis completely recover from the initial flare of symptoms. They may have symptoms of mild arthritis that last for up to a year, although symptoms normally do not interfere with everyday activities. Some individuals may have moderate, long-term arthritis. There will be long-term, serious arthritis in a few patients that is difficult to manage with medication and can cause joint damage.

Some patients will experience symptoms again after the initial flare has passed, such as back pain and arthritis. Reinfection can cause these relapses.

What Happens in the disease:

Reactive arthritis is caused in many patients by an infection of the bladder, urethra, or vagina that is often transmitted through sexual contact. Another type of reactive arthritis is due to an intestinal infection triggered by consuming food or handling bacteria-contaminated substances.

Who gets the disease:

“Men are nine times more likely to develop reactive arthritis” arising from sexually transmitted infections than women. However, as a result of food-borne illnesses, women and men are equally likely to develop reactive arthritis. There are also milder symptoms for women with reactive arthritis than for men.

It is very normal to have bacteria that cause reactive arthritis. In principle, reactive arthritis might be produced by someone who becomes infected with these germs. But very few individuals with bacterial diarrhoea currently have extreme reactive arthritis. What remains unknown is the position that no symptoms play in Chlamydia infection. Some cases of arthritis with an uncertain cause may be due to Chlamydia.

Reactive arthritis in men between the ages of 20 and 50 appears to occur more frequently. Some reactive arthritis patients bear a gene called HLA-B27. A more rapid and extreme onset of symptoms is also seen in patients who test positive for HLA-B27. They are more likely to have chronic symptoms (long-lasting) as well. Yet, after exposure to an organism that induces it, patients who are HLA-B27 negative (do not have the gene) may still get reactive arthritis.

Reactive arthritis may also be produced by patients with compromised immune systems due to AIDS and HIV.

Symptoms:

It is possible to separate the symptoms of reactive arthritis into those that affect the joints and those that affect the non-joint areas.

Knees, ankles, and feet are the classic joints that can become inflamed in reactive arthritis. The individual joints involved are typically asymmetric, that is, signs and symptoms impact one side of the body or the other, rather than both sides simultaneously. Inflammation contributes to discomfort, rigidity, swelling, warming, and redness in the joints. Patients may experience whole finger or toe inflammation that can give the appearance of a “sausage digit.” This feature is also seen in patients with another form of arthritis called psoriatic arthritis associated with psoriasis skin inflammation. This feature is also seen in patients with another form of arthritis. Inflammation of the spine, resulting in swelling and joint pain in the back or neck (characteristic of all spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis), may be associated with reactive arthritis.

Cartilage, especially around the breastbone where the ribs meet in the front of the chest, can also become inflamed; this condition is called costochondritis. Muscles are bound by tendons to the bones. The tendon insertion points in reactive arthritis can become inflamed (enthesitis), tender, and painful when exercised. Achilles tendinitis with reactive arthritis is prevalent.

The eyes (conjunctivitis), genitals, urinary tract (urethra, bladder and prostate gland), teeth, mouth lining, large intestines, and the aorta are non-joint areas that become inflamed and cause symptoms of pain and inflammation in patients with reactive arthritis.

Inflammation is commonly seen early in reactive arthritis of the white portion of the eye (conjunctivitis) and the iris of the eye (iritis) and can be sporadic. There may be no discomfort when the whites of the eye are inflamed, causing conjunctivitis. When the coloured part of the eye (iris) is inflamed, causing iritis and uveitis, it can be very painful (medically referred to as photophobia) and particularly worse when looking at bright lights.

Inflammation of the urinary tract usually concerns the urethra, the tube that drains urine from the bladder. This inflammation (urethritis) can be related to urinary burning and/or drainage of pus from the end of the penis. It can inflame and peel the skin around the penis. It may also inflame the bladder and prostate gland, leading to an urge to urinate from cystitis and prostatitis.

Tiny fluid-filled blisters that are often filled with old blood may grow from the skin of the palms of the hands and/or the soles of the feet. The skin affected may peel and may mimic psoriasis. Medically, the classic presentation is referred to as keratoderma blennorrhagica. Similar inflammation of the tip of the penis in males, referred to as circinate balanitis, can cause irritating rash.

On the tough and soft palate and even on the tongue, the mouth can develop open sores (ulcerations). These can go unnoticed, as they are often painless, by the patient. Diarrhea or pus or blood in the stool can be caused by inflammation of the broad bowel (colitis). Aorta inflammation (aortitis) can be seen in a small number of reactive arthritis patients. It can lead to failure of the heart’s aortic valve, which can lead to failure of the heart. In reactive arthritis, the electrical conduction pathway of the heart may also become scarred, leading to irregular heartbeats (arrhythmias) that may require a pacemaker to be inserted to stabilise the heartbeat.

Reactive Arthritis 

Causes:

Reactive arthritis is caused by a bacterial infection of the bladder, urethra or vagina in many patients, and is also spread via sexual contact. Another type of reactive arthritis is due to an intestinal infection triggered by consuming food or handling bacteria-contaminated substances. After infection, reactive arthritis usually starts within 2 to 4 weeks.

Numerous bacteria can cause reactive arthritis. Some are transmitted sexually, and others are foodborne. The most common ones include:

  • Chlamydia
  • Salmonella
  • Shigella
  • Yersinia
  • Campylobacter
  • Clostridium difficile

Doctors do not know precisely why reactive arthritis is produced by certain individuals exposed to these bacteria while others do not. One gene, human leukocyte antigen (HLA) B27, increases the risk for reactive arthritis to occur in an individual. Inheriting the HLA B27 gene, however, does not necessarily mean that you are going to get reactive arthritis.

A person with the condition is unable to pass arthritis on to anyone else. The bacteria that can cause reactive arthritis can, however, be transferred from person to person.

Risk factors:

Certain factors increase your risk of reactive arthritis:

  • Age. Reactive arthritis occurs most frequently in adults between the ages of 20 and 40.
  • Sex. 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.
  • Hereditary factors. A specific genetic marker has been linked to reactive arthritis. But many people who have this marker never develop the condition.
Reactive Arthritis 

Diagnosis:

Your doctor will probably examine your joints for signs and symptoms of inflammation during a physical examination, such as swelling, warmth and tenderness, and measure the range of motion in your spine and affected joints. It is also possible for your doctor to search your eyes for inflammation and your skin for rashes.

Blood Tests:

Your doctor might recommend that a sample of your blood be tested for:

  • Evidence of past or current infection
  • Signs of inflammation
  • Antibodies associated with other types of arthritis
  • A genetic marker linked to reactive arthritis

Joint Fluid Tests: Your doctor might use a needle to withdraw a sample of fluid from within an affected joint. This fluid will be tested for:

  • White blood cell count. An increased number of white blood cells might indicate inflammation or an infection.
  • Infections. Bacteria in your joint fluid might indicate septic arthritis, which can result in severe joint damage.
  • Crystals. Uric acid crystals in your joint fluid might indicate gout. This very painful type of arthritis often affects the big toe.

Imaging Tests: X-rays of your low back, pelvis and joints can indicate whether you have any of the characteristic signs of reactive arthritis. X-rays can also rule out other types of arthritis.

Reactive Arthritis 
Reactive Arthritis — Know It All!

Treatment Options:

NSAIDs, Corticosteroids, Immunosuppressants and antibiotics are commonly used.

Reactive arthritis therapy is focused on where the body has manifested itself. Patients are usually initially treated with nonsteroidal anti-inflammatory drugs (NSAIDs) for joint inflammation. Aspirin, indomethacin (Indocin), tolmetin (Tolectin), sulindac (Clinoril), piroxicam (Feldene), and others are involved in these NSAIDs. Gastrointestinal discomfort, including ulceration and bleeding, are among their possible side-effects. To mitigate this risk, non-steroidal anti-inflammatory drugs should be taken along with food. Corticosteroids, such as prednisone, may be effective for inflammation reduction and are used in reactive arthritis to manage inflammation in the short term. They may be injected into the joint by mouth or by local injection. In certain types of tendinitis, corticosteroids are often used to decrease tendon inflammation.

If one still has the infection that causes reactive arthritis, antibiotics may be administered.

In some patients with chronic reactive arthritis, sulfasalazine (Azulfidine) has been shown to be safe. Sulfa rash reaction and suppression of the bone marrow involve possible side effects of this sulfa-based drug. Blood counts are also tracked when long-term use of Azulfidine occurs.

Medications that suppress the immune system, including the disease-modifying anti-rheumatic drug (DMARD) methotrexate (Rheumatrex, Trexall), are used for the vigorous inflammation of chronic joint inflammation in reactive arthritis. By injection, methotrexate can be administered orally. It is given on a weekly basis and, due to possible toxicity to the bone marrow and liver, involves daily monitoring of blood counts and blood liver tests.

Tumor necrosis factor blockers (TNF): In rheumatoid arthritis, the cell protein TNF acts as an inflammatory agent. There is some evidence that TNF blockers in reactive arthritis may be beneficial as well.

In association with HIV infection (AIDS virus), reactive arthritis has been documented. In this case, because of the potential to exacerbate HIV disease, immune-suppression medication is usually avoided.

With anti-inflammatory decreases, eye inflammation may be alleviated. In certain patients with extreme iritis, local cortisone injections are required to avoid damaging eye inflammation, which can lead to blindness.

Cortisone creams (such as Topicort) can help with the inflammation around the penis. Antibiotics specific for such bacteria are provided when bacteria are present in the bowel or urine.

Exercise has been shown to help individuals with arthritis. For your knees, you should have a physical therapist teach you unique exercises.

How to cope up:

Exercise can minimise pain and stiffness in the joints and improve flexibility, the strength of the muscles, and endurance. Exercise also allows individuals to lose weight, which decreases tension on sore joints. You should talk about a healthy, well-rounded exercise programme with your doctor, which may include:

  • With weights or resistance bands to strengthen muscles that sustain joints damaged by arthritis, strengthening exercises can be done.
  • Exercises for muscle tightening do not move any muscles, so even though you have inflammation and discomfort, they can be performed.
  • Range-of — motion tasks increase movement and flexibility and decrease joint rigidity.
  • If you have spine pain or arthritis, exercises to stretch the back and aquatic workouts will help.

References:

https://www.mayoclinic.org/diseases-conditions/reactive-arthritis/diagnosis-treatment/drc-20354843

https://www.niams.nih.gov/health-topics/reactive-arthritis/advanced#tab-living-with

https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Reactive-Arthritis

https://www.medicinenet.com/reactive_arthritis/article.htm

By,

Gopala Krishna Varshith,

Content Developer & Editor,

Clipo.

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