Reiters Arthritis Or Reactive Arthritis

Published: 25th September 2009
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Reiter's syndrome is another name for reactive arthritis, although the latter is being used more commonly now. Genitourinary infections with organisms such as Chlamydia and gastrointestinal infections such as with Salmonella are known to be associated with the incidence of this condition. HLAB27, a human leucocyte antigen, which is well known to be associated with the condition ankylosing spondylitis, is also connected with reactive arthritis and places it with AS in the conditions called seronegative spondyloarthropathies. Urethritis and conjunctivitis are common findings in these conditions but the arthritis can occur without them.

Once a person has an infection of the genitourinary system or the gastrointestinal system then the arthritis can come on around two to four weeks later, with a respiratory infection with Chlamydia also a possible causative factor. There may be no apparent preceding infection in around ten percent of patients. Many anatomical structures can be affected by the inflammation, including the mucous membrane, the eyes, the joints, the spine, the ligament-bone and tendon-bone junctions and the gastro-intestinal system. Patients with HLAB27 are fifty times more likely to develop reactive arthritis than those without it.

Longer lasting and more damaging arthritis is suffered by those patients who are HLAB27 positive or have a strong familial tendency to this condition. From 1 to 4 percent of those suffering a gut related infection may develop reactive arthritis but this number varies greatly even with the same infecting agent. How the biological agent and the person's body react to cause the arthritis is not known and none of the infecting agents are found in the joint fluids. Immune reaction to the infectious agents does occur and antibodies have been isolated from joint fluids, suggesting this might be an immune mediated inflammatory condition.

The course of reactive arthritis tends to be self limiting with the symptoms settling down over a period from three to twelve months even in patients who are badly disabled by the arthritis. There is a significant tendency for the arthritis to recur, with recurrence higher in people who are HLAB27 positive, and recurrence can be triggered by another infection or other factor. In 15% of patients the reactive arthritis continues into a longer term and at times joint destructive arthritis or similar problem. Most patients with this condition are between twenty and forty years old, with food related infections equally shared between males and females, while urogenital infections causing arthritis are nine times more common in men.

There is usually an acute and sudden onset of reactive arthritis and patients typically exhibit fatigue, fever and malaise with arthritis of a few joints in the lower extremity in a non-symmetrical manner. Low back pain occurs in half the patients with reactive arthritis and heel pain is a common symptom due to inflammation of the Achilles insertion into the heel bone. The weight bearing joints are mostly affected but others can be, with hands and feet affected in more severe and long term cases. Whilst spinal involvement is common there are typically few examination findings apart from some loss of lumbar flexion.

Reactive arthritis treatment is determined by how difficult the arthritic symptoms are for the patient, with a mainstay of treatment being non-steroidal anti-inflammatory drugs which are taken regularly to keep up a level of anti-inflammatory action. The maintenance and restoration of muscle power, control of pain and protection of joint ranges of motion can be effected by referral to physiotherapy. Intra-articular injections with corticosteroids are a useful treatment and can give long term relief of an inflamed joint. If anti-inflammatory drugs are not effective then systemic corticosteroids can be given and while antibiotic drugs may be prescribed at times they do not affect the disease course.

In the presence of chronic arthritic conditions or when the symptoms of inflammation are badly controlled and ongoing, then doctors may prescribe DMARDS or disease-modifying anti-rheumatoid drugs. Mostly tested on more common arthritic conditions these drugs have not been clearly identified as useful in reactive arthritis. Methotrexate and sulphasalazine are examples of this group and whilst biological drugs are used their effectiveness has also not been established against reactive arthritis.

Jonathan Blood Smyth is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in Bolton visit his website.

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