Reactive Arthritis

Symptoms

After exposure to the triggering infection, reactive arthritis signs and symptoms will begin to appear in about 1 to 4 weeks. The common ones are:

• Pain and stiffness: The pain in the joints related to reactive arthritis is frequently experienced in the feet, ankles, and knees. Pain might also affect the buttocks, lower back, or heels.
• Eye inflammation: Most individuals with reactive arthritis can experience eye inflammation (or conjunctivitis).
• Urinary disorders: Problems like increased frequency and pain when urinating are likely to occur. Inflammation in the cervix or prostate gland can also develop.
• Inflammation of the tendons and ligaments (enthesitis): This often occurs in the soles of the feet and the heels.
• Swollen toes and fingers: Toes and fingers sometimes become so severely swollen that they resemble sausages.
• Low back pain: Pain that may be severe during the night or in the morning can occur.
• Skin problems: Reactive arthritis might impact the skin in different ways, such as rashes on the palms of the hands and soles of the feet, and sores in the mouth.

Causes

Reactive arthritis occurs as a response to an infection in the body, mostly in the genitals, intestines, or urinary tract. Sometimes, it is difficult to recognize the infection triggering the condition, especially if it has mild or no symptoms at all. Various bacteria can lead to reactive arthritis, including those that are sexually transmitted or foodborne. The common bacteria linked with this condition are:

• Chlamydia
• Escherichia coli
• Salmonella
• Campylobacter
• Yersinia
• Shigella
• Clostridioides difficile

Although reactive arthritis is not transmittable, the bacteria causing it can be spread through contaminated food or sexual contact. Only a small fraction of individuals exposed to the bacteria will develop reactive arthritis.

Risk factors

These factors are likely to increase the possibility of developing reactive arthritis:

• Age: The condition develops mostly among adults aged between 20 and 40 years.
• Gender: Both men and women have equal chances of developing reactive arthritis from foodborne infections. However, men have a higher risk of reactive arthritis resulting from sexually transmitted bacteria compared to women.
• Hereditary factors: A certain genetic marker is associated with reactive arthritis. However, most persons with this marker do not get this condition.

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Prevention

The possibility of developing reactive arthritis seems to be influenced by genetic factors. Even though it’s impossible to alter inherited makeup, one can limit exposure to the bacteria triggering the condition. Therefore, it’s important to cook food properly and store it at the right temperature. This helps prevent several foodborne bacteria that cause reactive arthritis, like Campylobacter, Yersinia, Salmonella, and Shigella. Also, consider using a condom to minimize the risk, as certain sexually transmitted infections can cause the condition.

Diagnosis

The doctor may conduct a physical examination to assess the joints for warmth, tenderness, and swelling and examine the range of motion in the affected joints and spine. In addition, they can check the skin for signs of rashes and eyes for any inflammation.

Blood tests

The doctor can order blood samples to test for:

• Signs of current or previous infection
• Inflammatory signs
• Antibodies related to other forms of arthritis
• A genetic marker associated with reactive arthritis

Joint fluid test

The doctor can perform this test using a needle to remove the fluid sample from the affected joint. The obtained fluid will then be assessed for:

• White blood cell count: Increased levels of white blood cells can be a sign of an infection or inflammation.
• Infections: The presence of bacteria in the joint fluid can signify septic arthritis, which can lead to severe damage to the joint.
• Crystals: If the joint fluid has uric acid crystals, it might be a sign of gout, which is an excruciating kind of arthritis, mostly affecting the big toe.

Imaging tests

The doctor can suggest X-rays of the joints, pelvis, and lower back to look for any characteristic indicators of reactive arthritis and rule out other forms of arthritis.

Treatment

Treatment of reactive arthritis focuses on managing symptoms and treating any present infection. The options include:

Medications

For cases where reactive arthritis is caused by a bacterial infection, the doctor can recommend an antibiotic if there are signs of a continuous infection. The type of antibiotic prescribed is determined by the bacteria present. Reactive arthritis signs and symptoms might be relieved with these medications:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Prescribed NSAIDs like indomethacin (Indocin) might help ease the pain and inflammation of reactive arthritis.
• Steroids: The doctor can inject steroids into the affected joint to ease inflammation and enable you to resume your normal activity level. Steroid creams can help with skin rashes, and steroid eye drops can relieve eye symptoms.
• Rheumatoid arthritis drugs: There is inadequate evidence showing that medications like etanercept (Enbrel), sulfasalazine (Azulfidine), or methotrexate (Trexall) can ease stiffness and pain in some persons with reactive arthritis.

Physical therapy

Physical therapists may guide you through exercises that target muscles and joints. These strengthening workouts enhance the support of the joints by building muscles surrounding the affected joints. Also, range-of-motion exercises can help reduce the stiffness of your joints and increase their flexibility.

Preparing For Your Appointment

You will typically begin by visiting your primary caregiver, who can recommend that you see a rheumatologist (an expert specializing in arthritis) for further evaluation.

What you can do

When scheduling an appointment, inquire if any advance preparations are required, like fasting before undergoing a particular test. Create a list including the following:

• All symptoms, even those not related to your reason for making an appointment.
• Key personal information, including your medical history and that of your family.
• All medicines, vitamins, or additional supplements you are taking, with doses.
• Relevant questions to discuss with the doctor.

If possible, a friend or a family member should accompany you during your visit to help you recall the information provided. Questions about reactive arthritis you should ask your doctor include:

• What is the likely cause of my condition or symptoms?
• What other possible causes are there?
• What types of tests do I require?
• What is the recommended treatment approach?
• How soon will my symptoms get better with treatment?
• What can I do now to relieve my joint pain?
• Am I at risk of long-term complications from my condition?
• How can I best manage this condition along with my other health issues?

You should always feel free to ask any other questions that come to your mind.

What to expect from your doctor

Your doctor may ask you several questions, including:

• When did you start experiencing the symptoms?
• Have your symptoms been occasional or continuous?
• How serious are your symptoms?
• Is there anything that seems to improve your symptoms?
• Is there anything that seems to exacerbate your symptoms?
• Have you recently had an infection?