Reactive arthritis refers to a form of peripheral arthritis often accompanied by one or more extra-articular manifestations that appear shortly after certain infections of the genitourinary or gastrointestinal tracts. The majority of affected individuals are those who have inherited the HLA B27 (Human leukocyte antigen) gene from their families. Cases have also been observed following epidemics or sporadic outbreaks of diarrheal illnesses caused by Shigella, Salmonella, and Campylobacter microorganisms, as well as by venereally acquired genitourinary infections, usually Chlamydia. This condition typically begins acutely 2-4 weeks after venereal infections or bouts of gastroenteritis.
Who Is At Risk for Reactive Arthritis?
Most venereally acquired cases of reactive arthritis occur in young men. Cases following food-borne enteric infections affect both genders equally. Whites are affected more commonly than African Americans or other racial groups that have a lower frequency of the HLA-B27 gene.
What Are the Symptoms?
The diagnosis of reactive arthritis is made on clinical grounds, based on disease manifestations. Urethritis usually is the first manifestation and occurs in both postveneral and postenteric forms of the disease. Mild dysuria and a purulent discharge are the most typical symptoms in men, but occasionally prostatitis and/or epididymitis are present. Women may have dysuria, vaginal discharge, and purulent cervicitis and/or vaginitis. Symptoms may include fever, chills, increased need to urinate, and a burning sensation when urinating.
Conjunctivitis, when present, usually accompanies urethritis or develops within several days. Some patients develop subtle crusting of the eyelids in the morning, while others develop obvious conjunctival redness, and a burning sensation with exudation. Acute anterior uveitis (iritis) can occur and is associated with severe ocular erythema, pain and photophobia.
Articular manifestations typically appear last, often after symptoms of urethral and ocular inflammation have subsided. In cases following gastroenteritis, the bowel symptoms usually have resolved 1-3 weeks earlier.
Articular Manifestations in Reactive Arthritis
Articular manifestations are characteristically additive, asymmetric and oligoarticular, affecting an average number of four joints. The affected joints are typically swollen, warm, tender, and painful. The arthritis associated with reactive arthritis typically affects the knees, ankles, and feet. Also, inflammation occurs at bony sites where tendons, ligaments or fascia have their attachments or insertions (enthuses). Low back pain and buttock pain are common, occurring in approximately 50% of cases.
Lower back symptoms are probably caused by sacroiliac or other spinal-joint involvement. However, sacroiliitis develops in only 20% of patients. Reactive arthritis runs a self-limited course of 3-12 months in the majority of patients. Relapses may occur in up to 15% of cases. Approximately 15% of patients continue to have chronic, often destructive and disabling arthritis or enthesitis.
How Is Reactive Arthritis Treated?
In general, people with reactive arthritis experience significant improvement in joint inflammation after administration of non-steroidal, anti-inflammatory drugs (NSAIDS). If your arthritis doesn’t respond to NSAIDS, second-line agents which are more potent can be used.
Education is a key element in the care of a person with reactive arthritis. If the condition has been preceded by a sexually transmitted disease, safer sex practices should be employed.
Treatment for Reactive Arthritis In Thousand Oaks
If you think you may be suffering from reactive arthritis, we’re here to help. Offering his patients the most up to date and efficacious treatments, Dr. Cohen at Cohen Medical Centers is ready to help you feel like yourself again. To learn more about treatments in Ventura County, simply call us at (805) 449-8781 to schedule your consultation.
