Reactive Arthritis

Reactive arthritis is a type of arthritis where joint pain and swelling triggered by an infection. Most often the infection involve intestines causing dysentery or diarrhea and urinary tract causing urine infection. Although Reactive arthritis usually cause swelling and pain in your knees , ankles and feet joints but. it can also affect your eyes, skin and urethra This usually affects young individuals although it can cause joint swelling at any age
  • Reactive arthritis is usually an arthritis following infection elsewhere in body and affect young individuals
  • It usually involve joints, especially of the knees or ankles but it can affect the heels, toes, fingers, low back etc.
  • It is usually an episodic disease which means that it often goes away on its own but in some cases it may be chronic and reactive can be prolonged and severe enough to require longterm follow up with rheumatologist.
  • Reactive arthritis mostly occur in men between ages 20 and 50 but it can affect any age and gender.
  • The most common bacteria responsible for causing this disease are in the genitals (Chlamydia trachomatis) or the bowel (Campylobacter, Salmonella, Shigella and Yersinia).
  • Previously known as “Reiter’s syndrome.” , now it belongs to the family of arthritis called “spondyloarthritis.”
The signs and symptoms of reactive arthritis generally start one to eight weeks after exposure to a triggering infection. They might include:
  • Joint pain and swelling – Usually this most commonly occurs in knees, ankles and feet. One might have pain in heels, low back or buttocks.
  • Inflammation of Eyes – Around 20 % people who have reactive arthritis may develop eye inflammation (uveitis).
  • Problems of urinary tract : Increased frequency and discomfort during urination may occur. This also can cause inflammation of the prostate gland or cervix.
  • Enthesitis – Inflammation of ligaments or tendons where it attaches to bone
  • Dactylitis – Swolling of whole toes or fingers which resemble sausages.
  • Skin problems – Some patients may have a rash on soles and palms and mouth sores.
  • Low back pain – In some cases pain may involve low back and tends to be worse at night or in the morning.
  • Reactive arthritis is an autoimmune disease where there is inflammation of joint synovium because of Immune attack.
  • Normally our Immune system attack outside invading organism like bacteria and Viruses etc and designed to protect our own body parts like Joints. In Reactive arthritis, immune system become dysregulated and attacks one’s own joints. Usually this arthritis is triggered by infection of intestine or urinary tract.
  • There is a strong hereditary (genetic) tendency. For example, there is a strong association with a gene called HLA-B27. About 6 out of every 10 people with Reactive arthritis have this gene compared with less than 1 out of every 10 in the general population.
  • However, having only HLA B27 gene does not mean that you will automatically develop Reactive arthritis. Most people with this gene do not develop Reactive arthritis.
Most cases of reactive arthritis can be diagnosed clinically by the acute onset severe arthritis of knee and ankle in a young individual. The diagnosis becomes easy if the patient has similar history in the past. Rheumatologists are experts in diagnosing arthritis and other rheumatic diseases. Other doctors may feel less comfortable diagnosing reactive arthritis. Some patients give a prior history of urine or intestine infection within 2-3 months of onset of joint pain. If indicated, doctors might order HLA B27 test and if is positive there is chance of recurrent or long term arthritis.
Usually reactive arthritis treatment depends on the stage of reactive arthritis.
  • If the joints are very much swollen and painful, the doctor may advise for joint aspiration and giving a steroid injection which is very effective to decrease pain and inflammation
  • You may be prescribed with pain killers (NSAIDs) which has to be continued for many months as they are the 1st line treatment for most AS patients
  • All patients are different and some may respond to a particular drug whereas others don’t feel any benefit. Some drugs may cause severe gastritis or other complications where as they don’t cause any problems in others . So the drug response and side effects differ in different patients and it has to be continued under supervision of a trained rheumatologist
  • The drugs that are useful in treating AS are known as DMARDs(Disease modifying antirheumatic drugs). They Include Methotrexate, sulfasalazine, Hydroxycholoroquine, leflunamide etc. They are particularly useful for knee or ankle joint swelling but not for upper or lower back problems
  • These drugs should be prescribed and taken under supervision of a rheumatologist as they are trained to periodically monitor your blood test to look for any side effects of these drugs.
  • If taken properly under supervision, these drugs helps to control joint inflammation and give patient a normal life
  • Biological drugs are new drugs that target specific molecules like TNF and other cytokines like IL 17 which incite inflammation in Reactive arthritis. They are very effective drugs but because of high costs, usually given after failure of other drugs
  • Biologic drugs that are effective in Reactive arthritis include – Eternacept, Adalimumab, Infliximab, Golimumab, Secukinumab etc
  • With Proper treatment, a reactive arthritis patient can lead a normal life without pain and deformity.
  • But if not treated properly from an early stage, there may be fusion of bones leading to loss of natural movements and severe joint deformity
  • This may increase risk of heart attack
  • The hip joint may be fused for which the patient will be unable to walk or sit and may require joint replacement therapy.
At OARC, we offer holistic care to patients suffering from all kind of arthritis and autoimmune diseases by our renowned rheumatologist. Because of chronic illness of the disease, we spend some time with the patient helping them to know about their disease, and demystify the myths regarding the disease and treatment. We have collaboAStion with NABL accredited laboAStory where all kind of blood tests can be done at reasonable costs. We also have patient support system where patient can approach in case of any emergency. We believe in a friendly relation with patients so that they can share all their sufferings and get the best possible treatment.