Reactive arthritis, also known as Reiter's syndrome, is a painful form of inflammation that can cause swelling, heat, and redness in the feet, ankles, knees, and back.
It is considered a form of spondyloarthritis, which is a general term for inflammatory diseases that attack the places where ligaments and tendons connect muscles to the bones and joints.
One of the most notable characteristics of this condition is that it can also affect the eyes, bladder, and urethra.
- The condition is called "reactive" because it develops in response to a bacterial infection somewhere else in the body.
- Although reactive arthritis is not contagious, the bacteria that cause the trigger diseases can spread.
- Most people with reactive arthritis recover completely over time.
The symptoms of reactive arthritis usually appear 2-4 weeks after these triggering infections of the urogenital or digestive tracts.
The range of symptoms associated with reactive arthritis includes:
- sore and swollen toes, fingers, knees, ankles, and other joints
- pain in the lower back and buttocks, reported by roughly 50 percent of people
- pain in the heels
- blurry vision
- irritated eyes
- conjunctivitis, or inflammation of the eyes, seen in 20 percent of cases
- urethritis, inflammation of the urinary tract
- rashes or crusty sores on the hands, feet, and penis, experienced by 5-10 percent of people
- frequent, painful urination
Urinary problems are often the first symptoms to appear for men, but they might not be seen in women at all. Arthritis symptoms are typically the last to appear and the last to go away, although they can be mild.
Symptoms recur in some people, and, in rare cases, reactive arthritis can become a chronic disease.
Reactive arthritis is found most frequently among people 20-40 years old, and males are three times more likely to get the disease than females. Symptoms may also be more severe in men.
Chlamydia, which causes infections and usually spreads through sexual contact, is the bacteria most often associated with reactive arthritis.
Infections in the digestive system or the bladder, urethra, or vagina can also cause these "trigger" diseases.
Eating contaminated food, or food that was poorly handled, can also trigger diseases of the digestive tract that result in reactive arthritis. The bacteria responsible are usually:
Men and women get reactive arthritis through digestive tract illnesses at about the same rate.
Not everyone exposed to these bacteria develops reactive arthritis. In fact, the condition is listed by the Genetic and Rare Diseases Information Center, which means that no more than 200,000 people in the United States are affected by it.
Genetics appears to be a factor in the disease. Reactive arthritis is also one of the first symptoms of HIV infection shown by people who are HIV positive.
Specific laboratory tests for reactive arthritis do not currently exist. Doctors base their decisions on their observations and experience. The process will involve:
- taking a medical history, including past and current symptoms, especially symptoms like diarrhea or discharge from the genitals
- examining inflamed areas, plus the pelvic area, genitals, eyes, and skin
- inspecting joints for swelling, inflammation, and range of motion
- doing blood tests for the HLA B27 gene, rheumatoid factor, antinuclear antibody, red blood cell sedimentation rate
- testing for chlamydia
- testing samples of throat, urethra, and cervix tissue for bacteria
- analyzing urine and stool samples
- studying the synovial fluid found in joints, such as the knee
- taking X-rays of the spine, pelvis, and joints
Because reactive arthritis is difficult to diagnose, less severe cases might not be discovered and reported. Some researchers think the condition is more widespread than is commonly believed.
Medical care for reactive arthritis includes the following:
- curing the triggering infection with antibiotics
- treating genital symptoms
- caring for eye symptoms
- controlling skin symptoms
- managing pain
Seeking medical treatment for reactive arthritis can involve working with many different doctors, starting with a rheumatologist, a specialist in arthritis. Other doctors may include a gynecologist or urologist, ophthalmologist (eyes), dermatologist (skin), and potentially an orthopedic surgeon.
Doctors have found that, if a case of reactive arthritis is due to chlamydia, early treatment can be particularly helpful and limit the progression of the disease.
- Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen or naproxen, to reduce swelling and discomfort.
- Corticosteroids, which are powerful drugs used to reduce inflammation. The medication can also be injected into the joints or taken by mouth.
- Disease-modifying anti-rheumatic drugs (DMARDs) for chronic cases or cases that are particularly severe.
- Sulfasalazine, especially if a gastrointestinal infection kicked off the original episode.
- Combination therapy, involving multiple antibiotics.
Maintaining a healthy level of physical activity is one of the most important things people with reactive arthritis can do.
Easing into exercise is very important for people with arthritis, as is incorporating a range of different activities. Many people with arthritis have found water exercise classes to be both accessible and beneficial.
Preventing repeat infections that can trigger reactive arthritis is also important for self-care. Patients should use condoms to reduce the risk of acquiring a sexually transmitted infection. Store and cook food at recommended temperatures to stop the spread of food-borne bacteria.
Both heating pads and ice, applied indirectly and never placed right on the skin, can provide relief from the pain associated with reactive arthritis.
The Genetic and Rare Disease Information Center report most people see their symptoms gradually disappear within 3 months to 1 year.
However, according to the Arthritis Foundation, 15-50 percent of people who have this disease may show symptoms again, usually involving pain in the low back and other arthritis symptoms. These flare-ups may be due to re-infection.
Some individuals may suffer long-term problems with arthritis after developing reactive arthritis.