Reactive Arthritis (Reiter's Syndrome)

Reactive arthritis is a form of arthritis that affects the eyes, urethra (the tube that carries urine from the bladder outside the body) and the skin as well as the joints.

Reactive arthritis disease may be acute (sudden and severe) or chronic (long-lasting), with sudden remissions or recurrences. It affects different organs of the body. Different symptoms may appear at different times.

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Symptoms

Symptoms of reactive arthritis are:

  • Inflammation of the urethra. This can make it painful to urinate. In men, there is sometimes a discharge from the penis.
  • Mouth ulcers
  • Redness and swelling of the eye
  • Patches of scaly skin on the palms, soles, trunk or scalp
  • Intestinal tenderness
  • Joint pain that comes four to 28 days after the other symptoms. The arthritis usually affects the fingers, toes, ankles, hips and knee joints.

 

Causes and Risk Factors

The cause of reactive arthritis is still unknown. Research suggests the disease is caused by both genetic and other factors.

More than 80% of Caucasians with the condition, and 50% to 60% of African-Americans, have a positive blood test for the genetic marker HLA-B27. This suggests the disease has a genetic component.

The disease primarily affects sexually active men between the ages of 20 and 40. Most cases of reactive arthritis follow infection with Chlamydia trachomatis or Ureaplasma urealyticum (both are common sexually transmitted diseases). Those with human immunodeficiency virus (HIV) are at a particularly high risk. With the exception of using condoms during sexual activity, there is no known way to prevent reactive arthritis.

Other people develop the symptoms following an intestinal infection by the bacteria that cause food poisoning. Most women and children who develop reactive arthritis generally get the intestinal form of the disease.

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Diagnosis

Diagnosing reactive arthritis can be complicated because the symptoms often occur several weeks apart. If a person has symptoms of arthritis that appear with or shortly after an inflammation of the eye and the urinary tract - and that last a month or longer, a doctor may diagnose the condition as reactive arthritis.

While there is no specific test for diagnosing this disease, a doctor may order:

  • Blood tests to check for genetic markers for reactive arthritis, inflammation and anemia (iron-poor blood)
  • Tests of any discharge from the urethra to rule out sexually transmitted diseases.

If a person has had repeated episodes of reactive arthritis, X-rays may show eroded areas of the joints, bony spurs or signs of osteoporosis.

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Treatments

There is no specific treatment for reactive arthritis. Joint pain is usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin. Skin eruptions and eye inflammation can be treated with steroids.

Patients with chronic arthritis also may be referred to a physical therapist and may be advised to exercise regularly.

Most people with reactive arthritis recover in three to four months. The condition comes back in about half the people who reactive arthritis.

Complications including inflammation of the heart muscle, inflammation and stiffening of the spine, glaucoma, progressive blindness, abnormalities of the feet or a build up of fluid in the lungs may occur.

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