Symptoms Of Reactive Arthritis

                                                                                         

Reactive arthritis is also known as Reiter's syndrome, although this latter term is losing ground gradually to reactive arthritis. It is associated with gastrointestinal infections by Salmonella and other organisms, and with genitourinary infections such as with Chlamydia. There is a significant connection with the human leucocyte antigen, HLA B27, which links reactive arthritis to other arthritic diseases such as ankylosing spondylitis which puts it in the group of conditions known as seronegative spondyloarthropathies. Although conjunctivitis and urethritis are commonly connected with this form of arthritis, the arthritis can occur without these infections.

About 2 to 4 weeks after an infection of the genitourinary system or the gastrointestinal system there may be onset of a reactive arthritis, with a Chlamydia infection of the respiratory system also a potential precipitating factor. About 10% have no infection preceding the arthritis. Many bodily structures can be afflicted by the inflammation, including the skin, eyes and mucous membranes, gastrointestinal system, the spine, the joints and the entheses (where the tendons and ligaments insert into the bone). There is an increased likelihood of fifty times of getting this arthritis in anyone who is HLAB27 positive, with 75% of sufferers being positive.

The arthritis can last longer and be more severe if the person has a strong history in the family or they are HLAB27 positive. Of those having an infection of the gut between one and four percent may develop a reactive arthritis, but this varies greatly even with the same biological agent responsible. It is not understood how the host body and the antigen react to cause the arthritic condition and the samples of joint fluids do not exhibit the infectious organisms. Antibodies have been isolated in the joints and it is possible an inflammatory condition mediated by the immune system is implicated in the development of this condition.

The natural history of reactive arthritis is of a self-limiting condition and the symptoms gradually resolve over three to twelve months despite the symptoms being severe in some patients. Recurrence of the arthritis is a significant probability and this is increased if the patient is HLAB27 positive. Re-exposure to triggering factors or infections can cause a new episode. The arthritis can become severe, disabling and destructive of the joints in around fifteen percent of sufferers. Twenty to forty years of age is the typical range for this condition, with males and females equally represented after gut infections, but males predominating by nine to one after urogenital infections.

Reactive arthritis usually comes on quickly as an acute presentation with patients presenting with tiredness, high temperature and a feeling of being unwell. Lower extremity arthritis of a few joints, arranged non symmetrically (unlike rheumatoid arthritis) is common. Heel pain from inflammation of the insertion of the Achilles tendon into the heel bone is common and low back pain is present in half of the patients. Lower limb joints involved in weight bearing are typically affected, with more severely affected patients exhibiting hands and feet symptoms. Back pain symptoms are commonly reported but examination shows few findings apart from a reduction in lumbar flexion.

Reactive arthritis treatment is determined by how difficult the arthritic symptoms are for the patient, with a mainstay of treatment being non-steroidal anti-inflammatory drugs which are taken regularly to keep up a level of anti-inflammatory action. The maintenance and restoration of muscle power, control of pain and protection of joint ranges of motion can be effected by referral to physiotherapy. Intra-articular injections with corticosteroids are a useful treatment and can give long term relief of an inflamed joint. If anti-inflammatory drugs are not effective then systemic corticosteroids can be given and while antibiotic drugs may be prescribed at times they do not affect the disease course.

Chronic and ongoing joint arthritis and poorly limited inflammatory reactions may mean a rheumatologist will prescribe drugs known as DMARDS or disease modifying anti-rheumatoid drugs. These have been tested on conditions such as rheumatoid arthritis or ankylosing spondylitis but their usefulness in reactive arthritis has not been shown. Typical examples are methotrexate and sulphasalazine. The newer biological drug treatments have been effective in some conditions but have not yet been shown to be useful in this condition.

About the author:
Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in Bolton visit his website.

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