Reactive Arthritis diagnosis & treatment in Bhubaneswar

• Most often the infection involves the intestines — causing dysentery or diarrhoea — or the urinary tract, causing a urine infection.
• Reactive arthritis usually causes swelling and pain in the knees, ankles and feet, but it can also affect the eyes, skin and urethra.
• It usually affects young individuals, although it can cause joint swelling at any age.

• Joint pain and swelling — most commonly in the knees, ankles and feet. There may also be pain in the heels, low back or buttocks.
• Inflammation of the eyes — around 20 per cent of people who have reactive arthritis may develop eye inflammation (uveitis).
• Urinary tract problems — increased frequency and discomfort during urination may occur. This can also cause inflammation of the prostate gland or cervix.
• Enthesitis — inflammation of ligaments or tendons where they attach to bone.
• Dactylitis — swelling of whole toes or fingers, which resemble sausages.
• Skin problems — some patients may have a rash on the soles and palms, and mouth sores.
• Low back pain — in some cases pain may involve the low back and tends to be worse at night or in the morning.

• Reactive arthritis is an autoimmune disease in which there is inflammation of the joint synovium because of an immune attack.
• Normally our immune system attacks outside invading organisms like bacteria and viruses, and is designed to protect our own body parts such as the joints. In reactive arthritis, the immune system becomes dysregulated and attacks one’s own joints — usually triggered by an infection of the 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 fewer than 1 out of every 10 in the general population.
• However, having the HLA-B27 gene does not mean that you will automatically develop reactive arthritis. Most people with this gene do not develop the disease.

Joint aspiration & steroid injection

If the joints are very swollen and painful, the doctor may advise joint aspiration and a steroid injection, which is very effective at reducing pain and inflammation.

Painkillers (NSAIDs)

You may be prescribed painkillers (NSAIDs), which are the first-line treatment for most reactive arthritis patients and often have to be continued for several months. All patients are different — some respond to a particular drug while others feel no benefit, and some drugs may cause severe gastritis or other complications in one person but none in another. So drug response and side effects differ from patient to patient, and treatment has to be continued under the supervision of a trained rheumatologist.

DMARDs

The drugs that are useful in treating reactive arthritis are known as DMARDs (Disease Modifying Antirheumatic Drugs). They include Methotrexate, Sulfasalazine, Hydroxychloroquine, Leflunomide etc. They are particularly useful for knee or ankle joint swelling, but not for upper or lower back problems. If taken properly under supervision, these drugs help to control joint inflammation and give the patient a normal life.

Supervision & monitoring

These drugs should be prescribed and taken under the supervision of a rheumatologist, as they are trained to periodically monitor your blood tests to look for any side effects of these drugs.

Biologic drugs

Biological drugs are new drugs that target specific molecules like TNF and other cytokines such as IL-17 which incite inflammation in reactive arthritis. They are very effective but, because of high costs, are usually given after failure of other drugs. Biologic drugs effective in reactive arthritis include Etanercept, 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 the risk of heart attack.
• The hip joint may be fused, leaving the patient unable to walk or sit, and may require joint replacement therapy.

Questions to ask your doctor

• Could a recent stomach or urine infection have triggered my joint pain?
• Do I need an HLA-B27 test, and what would the result mean for me?
• Is my reactive arthritis likely to be a single episode or become long-term?
• Which treatment is right for me now — a steroid injection, NSAIDs or DMARDs?
• What side effects should I watch for, and how often will my blood tests be monitored?