Understanding Reactive Arthritis

Reactive arthritis is a form of inflammatory arthritis that arises as a reaction to an infection in the body. This condition most commonly follows a sexually transmitted infection or a bacterial infection in the intestines. It is classified as an autoimmune disease, part of the broader spondyloarthritis group. Interestingly, symptoms of reactive arthritis may not appear until after the triggering infection has been successfully addressed.

Individuals typically report joint pain and inflammation, predominantly affecting the larger joints of the lower body. Reactive arthritis, historically referred to as Reiter’s syndrome, is characterized by a triad of symptoms: arthritis itself, eye inflammation known as conjunctivitis, and urinary tract inflammation, termed urethritis. Once considered rare, current prevalence data shows that men are diagnosed with reactive arthritis more frequently than women, although diagnosing women can be more challenging. The average age of onset is around 30 years, with men often experiencing more intense pain than women.

Causes of Reactive Arthritis

The primary trigger for reactive arthritis is a bacterial infection in the urinary tract or intestines. The bacterium Chlamydia trachomatis, known for causing chlamydia infections, is notably associated with this condition. Transmission typically occurs through sexual contact. Additionally, bacteria responsible for foodborne illnesses such as Shigella and Salmonella can lead to reactive arthritis symptoms.

Genetics may also play a significant role in the development of this condition. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), individuals possessing the HLA B27 gene exhibit a greater likelihood of developing reactive arthritis following an infection, although it’s important to note that not everyone with this gene will develop the condition.

Symptoms of Reactive Arthritis

Reactive arthritis is characterized by three main groups of symptoms:

Musculoskeletal Symptoms

Joint pain and swelling are the hallmark musculoskeletal symptoms of reactive arthritis. The condition primarily impacts the knees, ankles, and sacroiliac joints in the pelvis. It may also cause tightness and inflammation in other locations such as the fingers, back, buttocks, and even the heels.

Urinary Symptoms

Urethritis, or inflammation of the urethra, leads to urinary symptoms. These symptoms can include painful urination and a frequent urge to urinate. Men may experience prostatitis, which is the inflammation of the prostate gland, while women may experience cervicitis, an inflammatory condition affecting the cervix.

Ocular and Dermatological Symptoms

Eye inflammation is a significant feature of reactive arthritis, often causing conjunctivitis. Other symptoms may involve the skin and mouth, presenting as painful, itchy rashes and, occasionally, sores.

Diagnosing Reactive Arthritis

Diagnosis of reactive arthritis typically involves a comprehensive evaluation by a healthcare provider. This includes a thorough medical history, a physical examination of the symptoms, and laboratory tests to detect signs of infection or inflammation. A blood test can help ascertain the presence of the HLA B27 gene.

To rule out sexually transmitted infections, doctors may swab the urethra in men and perform pelvic examinations with cervical swabs in women. Additionally, an arthrocentesis procedure might be conducted to analyze joint fluid.

Treatment Options for Reactive Arthritis

Treatment strategies for reactive arthritis depend largely on the underlying cause. Antibacterial medications are prescribed to address any existing infections. For symptoms like conjunctivitis or skin rashes, additional medications may be necessary.

Medication Management

Post-infection, the focus shifts to managing inflammation and alleviating pain. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are commonly employed for pain relief. In cases where over-the-counter options prove insufficient, stronger alternatives like corticosteroids may be prescribed, either orally or via injection directly into the affected joints. For severe cases resistant to standard treatments, immunomodulating agents and biologics may be considered.

Physical Activity

Incorporating regular exercise into your routine can significantly enhance joint health by increasing flexibility and maintaining range of motion. If you experience stiffness or pain that limits movement, consult your doctor about potential referrals to physical therapy, focusing on gradually restoring mobility without discomfort.

Long-term Prognosis

The prognosis for individuals with reactive arthritis is generally favorable. Most patients experience a complete recovery, although the recovery timeline can vary, spanning anywhere from a few months to nearly a year. NIAMS notes that 15 to 50 percent of those afflicted may experience recurrences of symptoms after initial treatment.