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Reactive arthritis, previously known as Reiter’s syndrome, is rare type of arthritis caused by bacterial infections, most often in the genital, urinary or gastrointestinal tract. It can cause joint pain and inflammation that may last for three to twelve months.
Reactive arthritis symptoms can be minor at first and then worsen with time. It commonly affects the knees, ankles, and feet and the inflammation can also affect the eyes, skin, and urethra. In most cases, the signs and symptoms may come and go and typically goes away within a year.
Symptoms
The symptoms of reactive arthritis can vary from person to person, and typically appear within one to four weeks after an infection. They may include:
- Joint pain and stiffness: People with reactive arthritis may experience pain on certain joints, mostly on the hips, knees, ankles, and feet.
- Low back pain: Persistent low back pain, which becomes worse at night or in the morning.
- Inflammation of the eye: People with reactive arthritis may experience conjunctivitis.
- Urinary problems: The prostate gland or cervix may become inflamed. Urination may become more frequent and painful or with a burning sensation.
- Enthesitis: This condition caused by reactive arthritis, is characterized by inflammation at the point where the tendons and ligaments attach to bone, which may cause soles and heel discomfort.
- Swelling of fingers or toes: Sausage-like toes or fingers due to severe swelling may occur in severe cases of reactive arthritis.
- Skin problems: Sores and rash on the palms of the hands, soles of the feet, or penis are the common skin problems caused by reactive arthritis.
In some cases, people with reactive arthritis may also experience diarrhea and abdominal pain.
If any symptoms of reactive arthritis persist for a month, especially diarrhea and genital infection, or if they keep recurring, it is important to consult a healthcare provider.
Causes
According to researchers, reactive arthritis is an autoimmune condition. Autoimmune disorders occur when the body attempts to attack germs or viruses but instead attacks healthy tissue. Reactive arthritis occurs as a result of an infection in the body, most commonly in the intestines, genitals, or urinary tract.
Reactive arthritis itself is not contagious; however, the bacteria that can cause it can be transmitted through sexual contact or contaminated food. Only a small percentage of people who are exposed to these bacteria actually develop reactive arthritis. Additionally, the initial infection may not be noticeable, especially if it causes only mild or no symptoms.
Reactive arthritis can be triggered by a variety of bacteria, with some of the most common being Campylobacter, Chlamydia, Clostridioides difficile, Escherichia coli, Salmonella, Shigella, and Yersinia. While some of these bacteria can be sexually transmitted, others are typically foodborne.
Risk factors
Several factors may contribute to the risk of developing reactive arthritis:
- Age: People ages 20 to 40 is more likely to get reactive arthritis.
- Sex: Reactive arthritis caused by foodborne infections can equally affect both men and women. However, men are nine times more likely than females to develop reactive arthritis as a result of sexual interaction.
- Hereditary: Although a particular genetic marker has been associated with reactive arthritis, the majority of individuals with this marker do not develop the condition.
Diagnosis
The diagnosis for reactive arthritis starts with an assessment of medical history, including any recent illnesses or infections, performing a physical examination and several tests.
During a physical examination for reactive arthritis, the doctor will check for signs of joint inflammation (swelling, warmth and tenderness) as well as assess the range of motion of the spine and affected joints. The doctor may also check for any signs of eye inflammation and skin rashes.
- Imaging tests: The doctor may request for an X-ray to confirm the diagnosis. Other kinds of arthritis can be ruled out with X-rays. X-rays of the low back, pelvis, and joints can reveal any of the significant signs of reactive arthritis. Other imaging tests such as CT scan and MRI may be required in some cases.
- Blood tests: To aid in the diagnosis, a laboratory analysis of the blood may be required to check for inflammation signs, presence of genetic marker associated with reactive arthritis, antibodies linked to various kinds of arthritis, or evidence of a previous or ongoing infection.
- Joint aspiration tests: Joint aspiration, also known as arthrocentesis, can help the doctor determine the cause of swollen and painful joints. A needle may be used to extract fluid from an afflicted joint. This fluid will be sent to the lab for analysis to test for:
- White blood cell count: Elevated levels of white blood cells may signify presence of inflammation or infection in the body.
- Infections: Other joint infections may cause similar symptoms and potentially result in serious joint damage. If bacteria are present in the joint fluid, this could indicate septic arthritis.
- Crystals: This is to rule out other possible reasons of pain, such as gout. Gout is an extremely painful type of arthritis that commonly affects the big toe. Gout may be indicated by the presence of uric acid crystals in the joint fluid.
Treatment
The goal of treating reactive arthritis is to reduce symptoms and address the underlying bacterial infection. Typically, symptoms of reactive arthritis improve within three to six months of starting treatment. However, if new symptoms develop or the initial treatment is ineffective, the treatment plan may be modified over time.
- Medications: Several medications may be needed to treat the infection and manage the symptoms. Antibiotics may be prescribed for reactive arthritis caused by a bacterial infection.
Common medications used for reactive arthritis are:
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- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs can help alleviate the inflammation and pain associated with reactive arthritis. Indomethacin is a commonly prescribed NSAID.
- Steroids. Steroid eye drops and creams may be used to treat eye problems and skin rashes, respectively. A steroid injection into the afflicted joints can lessen swelling and enables resumption of regular physical activity.
- Rheumatoid arthritis drugs. Prescribed drugs on rheumatoid arthritis such as sulfasalazine, methotrexate, and etanercept may help with symptoms of reactive arthritis. It should be noted that there is still limited research to support the effectiveness of the treatment for reactive arthritis.
- Physical therapy: Strengthening exercises may improve joint function by strengthening the muscles surrounding the affected joints. To help the joints become more flexible and less stiff, range-of-motion exercises may be performed. For proper guidance, it is recommended to seek the advice of a physical therapist.
