Reactive Arthritis: Symptoms, Causes, Treatment

What are the symptoms of reactive arthritis?

Reactive arthritis, also known as Reiter’s syndrome, is an autoimmune condition that typically develops in response to an infection elsewhere in the body, often in the urinary tract, gastrointestinal system, or genitals. The symptoms can vary, but they commonly involve the joints, eyes, urinary tract, and skin. Here are the typical symptoms of reactive arthritis:

Joint Symptoms:

• Joint Pain and Swelling: The most common symptom is pain and swelling in the joints, particularly in the knees, ankles, and feet. This can affect one or multiple joints and may come and go.
• Lower Back Pain: Pain in the lower back or buttocks is common, especially if the sacroiliac joints (located at the base of the spine) are affected.
• Heel Pain: Pain and tenderness in the heels, often due to inflammation of the Achilles tendon or plantar fascia.
• Stiffness: Joints may feel stiff, especially in the morning or after periods of inactivity.

Eye Symptoms:

• Conjunctivitis: Inflammation of the eyes, known as conjunctivitis or “pink eye,” can cause redness, itching, and discharge.
• Uveitis: A more serious eye inflammation affecting the uvea (middle layer of the eye), leading to eye pain, redness, blurred vision, and sensitivity to light.

Urinary and Genital Symptoms:

• Painful Urination: Dysuria, or pain during urination, is common, especially if the urethra is inflamed (urethritis).
• Frequent Urination: An increased need to urinate, often with discomfort, may occur.
• Genital Discharge: Males may experience penile discharge, while females might have vaginal discharge or discomfort.

Skin and Mucous Membrane Symptoms:

• Skin Rashes: A rash on the palms of the hands or soles of the feet, known as keratoderma blennorrhagicum, can develop. It may appear as small, painless, red or brown bumps that can become scaly.
• Mouth Sores: Painless sores or ulcers may develop in the mouth or on the tongue.
• Nail Changes: Reactive arthritis can sometimes cause changes in the nails, such as thickening or discoloration.

General Symptoms:

• Fatigue: Many people with reactive arthritis experience significant fatigue and a general feeling of being unwell.
• Fever: A low-grade fever may accompany the other symptoms.

Other Symptoms:

• Cardiac Symptoms: In rare cases, inflammation may affect the heart, leading to symptoms like chest pain or shortness of breath.
• Gastrointestinal Symptoms: Diarrhea or gastrointestinal discomfort can occur, especially if the reactive arthritis is triggered by a gastrointestinal infection.

Reactive arthritis usually occurs several weeks after the triggering infection and can last for several months, though symptoms may recur. The severity and duration of symptoms can vary from person to person.

What are the causes of reactive arthritis?

Reactive arthritis is primarily caused by an abnormal immune response to an infection in another part of the body. The exact mechanism is not fully understood, but it is believed that the immune system mistakenly attacks the body’s own tissues, particularly the joints, eyes, and urinary tract, in response to the initial infection. Here are the common causes and factors associated with reactive arthritis:

Infections Triggering Reactive Arthritis:

• Gastrointestinal Infections:
• Certain bacteria that cause gastrointestinal infections can trigger reactive arthritis. Common bacterial culprits include:
  • Salmonella
  • Shigella
  • Campylobacter
  • Yersinia
• These infections are often associated with food poisoning and can lead to symptoms like diarrhea, abdominal pain, and fever.
• Genitourinary Infections:
• Reactive arthritis can also be triggered by infections in the urinary tract or genital tract. The most common bacteria associated with this are:
  • Chlamydia trachomatis (a sexually transmitted infection)
  • Ureaplasma urealyticum
• These infections can cause symptoms such as painful urination, genital discharge, and, in some cases, asymptomatic infections.
• Respiratory Infections:
• Although less common, respiratory infections caused by bacteria like Chlamydia pneumoniae can also trigger reactive arthritis.

Genetic Predisposition:

• HLA-B27 Gene:
• There is a strong genetic component associated with reactive arthritis. Many people with reactive arthritis carry a specific gene called HLA-B27. This gene is present in about 70-80% of those affected by reactive arthritis, compared to only 6-8% of the general population.
• While the presence of the HLA-B27 gene increases the risk of developing reactive arthritis, not everyone with the gene will develop the condition, and not everyone with reactive arthritis has this gene.

Other Factors:

• Age and Gender:
• Reactive arthritis most commonly affects young adults, typically between the ages of 20 and 40. It is more prevalent in men, particularly when triggered by sexually transmitted infections.
• Immune System Response:
• The exact reason why the immune system begins to attack the body’s own tissues following an infection is not fully understood. It is believed that certain components of the infecting bacteria may mimic the body’s tissues, leading to an autoimmune response.
• Environmental Factors:
• Certain environmental factors, such as poor sanitation or exposure to specific bacteria in food or water, may increase the risk of developing the infections that can trigger reactive arthritis.

Autoimmune Response:

• Molecular Mimicry:
• A possible explanation for the autoimmune response in reactive arthritis is molecular mimicry, where the immune system’s response to the bacteria inadvertently targets proteins in the body’s own tissues that resemble bacterial proteins.

In summary, reactive arthritis is generally triggered by a bacterial infection, with gastrointestinal and genitourinary infections being the most common causes. Genetic predisposition, particularly the presence of the HLA-B27 gene, plays a significant role in an individual’s susceptibility to the condition.

What is the treatment for reactive arthritis?

The treatment for reactive arthritis focuses on relieving symptoms, addressing the underlying infection (if still present), and managing inflammation. The specific treatment plan may vary depending on the severity of symptoms and the individual’s overall health. Here’s an overview of common treatments:

Medications:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):
• Purpose: NSAIDs, such as ibuprofen or naproxen, are used to reduce pain, swelling, and inflammation in the affected joints.
• Examples: Ibuprofen, naproxen, indomethacin.
• Disease-Modifying Antirheumatic Drugs (DMARDs):
• Purpose: In cases where symptoms are severe or persistent, DMARDs may be used to help control inflammation and prevent joint damage.
• Examples: Sulfasalazine or methotrexate.
• Corticosteroids:
• Purpose: Corticosteroids can be used for more severe inflammation or when NSAIDs are not effective. They can be taken orally or injected directly into affected joints.
• Examples: Prednisone, hydrocortisone.
• Antibiotics:
• Purpose: If an underlying infection is still present or if it is determined to be the cause, antibiotics are prescribed to treat the specific bacterial infection.
• Examples: Doxycycline or azithromycin, depending on the infection.
• Biologic Agents:
• Purpose: For cases that do not respond well to other treatments, biologic agents that target specific immune system components may be considered.
• Examples: Tumor necrosis factor (TNF) inhibitors, such as infliximab or adalimumab.

Physical Therapy and Exercise:

• Purpose: Physical therapy can help improve joint function, strengthen muscles around the affected joints, and maintain mobility.
• Exercises: Tailored exercises may be recommended to improve flexibility and reduce stiffness.

Lifestyle and Self-Care:

• Rest and Joint Protection:
• Purpose: Resting affected joints and avoiding activities that exacerbate symptoms can help manage pain and inflammation.
• Heat and Cold Therapy:
• Purpose: Applying heat or cold packs to inflamed joints can help reduce pain and swelling.
• Healthy Diet:
• Purpose: A balanced diet can support overall health and may help reduce inflammation. Some individuals find that avoiding certain foods may alleviate symptoms.

Regular Monitoring:

• Purpose: Regular check-ups with a healthcare provider are important to monitor the condition, adjust treatments as needed, and manage any potential side effects from medications.

Treatment of Complications:

• Eye Symptoms:
• Purpose: If reactive arthritis causes conjunctivitis or uveitis, treatment by an eye specialist may be required. Eye drops or other medications may be prescribed to manage these symptoms.
• Genitourinary Symptoms:
• Purpose: If there are ongoing symptoms in the urinary or genital tract, further evaluation and treatment by a specialist may be necessary.

The treatment plan for reactive arthritis should be tailored to the individual’s specific needs and may involve a combination of medications, physical therapy, and lifestyle modifications. Working closely with a healthcare provider is crucial for effective management of the condition.