Reactive arthritis

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

Reactive Arthritis is the combination of three seemingly unlinked symptoms—an inflammatory arthritisof large joints, inflammation of the eyes (conjunctivitisand 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 cartilagesof 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 HIVhave 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 infectionwith Chlamydia trachomatis. Other bacteria known to cause Reactive arthritis are gonococcus and Ureaplasma urealyticum. A bout of food poisoningby enteric bacteriasuch as Salmonella, Shigella, Yersinia, or Campylobacter, or a gastrointestinalinfection such as Crohn's diseasemay 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 (polyuriaor frequency). Other urogenital problems may arise such as prostatitisin men, and cervicitis, salpingitisand/or vulvovaginitisin women.

The arthritisthat follows usually affects the large joints such as the kneescausing painand swellingwith 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. Conjunctivitisand uveitiscan 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 circinataon the end of the penis. A small percentage of men and women develop small hard nodulescalled keratoderma blennorrhagicaon 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 regurgitationand pericarditis.

Diagnosis

There are countless clinical symptoms, but the clinical picture is dominated by polyarthritis. There is pain, swelling, redness, and heat in the joints.

Swabs of the urethra, cervixand throatmay be done looking for the causative organisms. Cultures may be done on urineand stoolsamples. An aspiration of synovial fluidfrom an affected knee may be done to look at the fluid under the microscope and for culture.

Treatment

The goal of treatment is firstly to identify and eradicate the underlying infectious source with the appropriate antibiotics. Otherwise, treatment is symptomatic for each problem. Steroidsand analgesicsmay be given for severe joint inflammation. Immunosuppressants may be needed for patients with severe Reactive arthritis which do not respond to any other treatment.

Prognosis

Reactive Arthritis may be self limiting, frequently recurring or develop continually. Most patients have severe symptoms lasting weeks to six months. Approximately 15-50 percent of cases have recurrent bouts of arthritis. Chronic arthritis or sacroiliitis occurs in 15-30 percent of cases. Repeated attacks over many years is common, and more than 40 percent of the patients end up with chronic and disabling arthritis, heart diseaseor impaired vision. However, most people with Reactive Arthritis can expect to live normal life spansand maintain a near-normal lifestyle with modest adaptations to protect the involved joints.

External links

• Types of arthritis
• Arthritis informationfr:Syndrome oculo-uréthro-synovial

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Reactive+arthritis Wikipedia article Reactive arthritis.