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Reactive arthritis

Reactive arthritis is a condition with symptoms similar to arthritis or rheumatism. It is caused by another illness, such as Crohn's disease, and is thus "reactive", i.e. dependent on the other condition. more...

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Reactive Arthritis is the combination of three seemingly unlinked symptoms—an inflammatory arthritis of large joints, inflammation of the eyes (conjunctivitis and uveitis) and urethritis. It is also known as arthritis urethritica, venereal arthritis, seronegative spondyloarthropathy, Reiter's , polyarteritis enterica.

Reactive arthritis is a seronegative, HLA-B27-linked spondyloarthropathy (autoimmune damage to the cartilages of joints) often precipitated by genitourinary or gastrointestinal infections. It is more common in men than in women and more common in white men than in black men. People with HIV have an increased risk of developing Reactive arthritis as well.

It is set off by a preceding infection, the most common of which would be a genital infection with Chlamydia trachomatis. Other bacteria known to cause Reactive arthritis are gonococcus and Ureaplasma urealyticum. A bout of food poisoning by enteric bacteria such as Salmonella, Shigella, Yersinia, or Campylobacter, or a gastrointestinal infection such as Crohn's disease may also set off Reactive arthritis. Reactive Arthritis usually manifests about 1-3 weeks after a known infection.

Signs and symptoms

Symptoms generally appear within 1-3 weeks but can range from 4-35 days from onset of inciting episode of disease.

The classical presentation is that the first symptom experienced is a urinary symptom such as burning pain on urination (dysuria) or an increased need to urinate (polyuria or frequency). Other urogenital problems may arise such as prostatitis in men, and cervicitis, salpingitis and/or vulvovaginitis in women.

The arthritis that follows usually affects the large joints such as the knees causing pain and swelling with relative sparing of small joints such as the wrist and hand.

Eye involvement occurs in about 50% of men with urogenital Reactive Arthritis and about 75% of men with enteric Reactive Arthritis. Conjunctivitis and uveitis can cause redness of the eyes, eye pain and irritation, and blurred vision. Eye involvement typically occurs early in the course of Reactive Arthritis, and symptoms may come and go.

Roughly 20 to 40 percent of men with Reactive Arthritis develop penile lesions called balanitis circinata on the end of the penis. A small percentage of men and women develop small hard nodules called keratoderma blennorrhagica on the soles of the feet, and less often on the palms of the hands or elsewhere. In addition, some people with Reactive Arthritis develop mouth ulcers that come and go. In some cases, these ulcers are painless and go unnoticed.

About 10 percent of people with Reactive Arthritis, especially those with prolonged disease, will develop cardiac manifestations including aortic regurgitation and pericarditis.


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What You Should Know About Reactive Arthritis
From American Family Physician, 8/1/99

What is reactive arthritis?

Reactive arthritis is an uncommon disease that can make your joints hurt and swell. It can also cause rash, fever, weight loss, heart problems, red eyes and blurry vision. Since pain in the joints is one of the most common symptoms, this condition is called reactive arthritis. It's "reactive" because your immune system is reacting to an infection you already had. Reactive arthritis is also called Reiter's (say: rite-erz) syndrome.

Who gets reactive arthritis?

Reactive arthritis is most common in men who are 20 to 40 years old. You might get it a few weeks after having food poisoning. You can also get it after having some kinds of sexually transmitted diseases (STDs) such as gonorrhea, chlamydia or HIV infection. Most people who get reactive arthritis were born with a gene, called HLA-B27, that makes them more likely to get this kind of arthritis.

How can my doctor tell I have reactive arthritis?

You probably have swelling in a knee, ankle or toe. Sometimes your heel or Achilles tendon will hurt. (The Achilles tendon is on the back of your ankle, right above your heel.) You may feel pain or burning when you urinate. You could have a discharge from your penis or vagina. You also might get pinkeye (redness and burning in the white part of your eye). You may have eye pain or blurred vision.

After talking to you and checking you, your doctor may do some tests to see if you have reactive arthritis. No one test can tell that you have the disease. Your doctor will put all the information together to decide if you have it. You may also need to be tested for STDs, since some people can have an STD and not know it.

How is reactive arthritis treated?

Your doctor may give you a strong medicine for the pain and swelling. Also, you need antibiotics if you have an STD. Some STDs don't cause any symptoms. It's important that you and your sex partner get tested and treated to keep the STD from coming back.

The good news is that in most people, reactive arthritis goes away in three to four months. In a few people, the joint pains come back again and again. These people might need a different medicine.

What can I do to get better?

* Take your medicines.

* Have your partner(s) tested if you have an STD.

* Practice safe sex.

* Make sure you don't get food poisoning (cook meat completely, and keep food cold so it doesn't spoil).

* Do light exercises (ask your doctor what you can safely do).

COPYRIGHT 1999 American Academy of Family Physicians
COPYRIGHT 2000 Gale Group

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