Reactive arthritis (formerly Reiter's syndrome) is a rheumatic disease that causes many symptoms. As a result, it is difficult to diagnose, but even harder to find its causes. However, it has been noted that reactive arthritis most often develops after infections, including genitourinary system (e.g. chlamydiosis). What are the causes and symptoms of reactive arthritis? How is the treatment going?

Reactive arthritis(reactive arthritis - ReA), also known as Reiter's syndrome, Fiessinger-Leroy syndrome or post-infectious arthritis, is a disease that is both systemic as well as seronegative spondyloarthropathies - a group of rheumatic diseases in the course of which arthritis occurs with accompanying spondylitis, i.e. the same group of diseases which include, among others ankylosing spondylitis, psoriatic arthritis and Whipple's disease. The essence of reactive arthritis is non-purulent inflammation of the joints, which is associated with a past infection of the digestive, genitourinary or, less frequently, respiratory systems. In addition, there are symptoms from other systems and organs.

The global prevalence of reactive arthritis is estimated at 30-200 / 100,000.

Reactive arthritis - causes and risk factors

The exact causes of reactive arthritis are unknown, but two factors play an important role in its development - infectious (bacteria) and genetic (HLA B27 gene).

According to the observations of doctors, the disease is most often a complication after a bacterial infection of the digestive, genitourinary or, less frequently, the respiratory system, which is most often caused by bacteria such as:Chlamydia trachomatis ipneumoniae ,Ureaplasma urealyticum, Salmonella ,Shigellaor Campylobacter.

The presence of the HLA B27 antigen also plays an important role (it occurs in 65-80% of patients). It is a protein that helps the immune system recognize its own cells and distinguish between self and non-self antigens. Its presence is associated with the risk of developing several autoimmune diseases (those in which the body attacks itself). It is believed that the risk of reactive developmentarthritis is 50 times greater in people with the HLA B27 antigen than in people who do not. However, its role in the development of the disease is not fully understood.

In turn, the risk factors are gender (symptoms of reactive arthritis occur 15 times more often in men than in women) and age (the disease most often occurs in people aged 20-40).

Reactive arthritis - symptoms

  • arthritis - single-joint or asymmetric multi-joint inflammation (usually knee and ankle joints or wrists and interphalangeal joints of the hands) - increasing pain in the knee, ankle or foot or pain and swelling of the fingers (so-called sausage fingers) is characteristic;
  • enthesitis - symptoms include heel pain, symptoms of Achilles tendon enthesitis, symptoms of the so-called tennis elbow or golfer's elbow;
  • spine inflammation - lower back pain (low back pain), spine stiffness, buttock pain;

U about 15-30 percent patients develop chronic arthritis or recurrent sacroiliitis and / or spine arthritis.

  • inflammatory changes in the organ of vision, most often conjunctivitis (less often corneal ulceration, iritis or uveitis) - red eyes, conjunctival swelling and lacrimation appear;

The HLA B27 antigen is responsible for a more severe course and more frequent occurrence of symptoms related to the spine and eyes.

  • urethritis and / or cystitis - manifested by pain and burning when urinating, urinating with cloudy white-yellow discharge;

Women may develop vaginitis or cervicitis, and men may become inflamed with testicles, epididymis, seminal vesicles or prostate gland (usually after a history of chlamydiosis).

  • inflammation of the intestine, which manifests itself, inter alia, in diarrhea and abdominal pain;
  • changes in the cardiovascular system - may appear in the form of myocarditis with impaired atrioventricular conduction;
  • changes in the mucous membranes and on the skin - maculo-scaly eruptions with hyperkeratosis (especially on the plantar surface of the feet), acne. Trophic changes on the nails. Erosions within the oral cavity, located on the hard palate, soft palate, gums, tongue and cheeks;

In addition, systemic ailments may appear, such as fever, weakness, chills, etc.

Reactive arthritis - diagnosis

Blood tests are performed,urine, feces, synovial fluid and synovial testing, X-ray imaging of joints and determination of the HLA-B27 antigen.

Reactive arthritis treatment

Patients should limit their physical activity (especially affected joints). Rehabilitation is recommended. Physical therapy and kinesiotherapy are also helpful.

The patient is given non-steroidal anti-inflammatory drugs (to minimize pain). In more severe cases, your doctor may order you to administer glucocorticosteroids (but only for a short time). If disease symptoms persist for more than 3 months or non-steroidal anti-inflammatory drugs are ineffective, it is recommended to add disease modifying antirheumatic drugs (DMARDs), e.g. sulfasalazine, methotrexate, azathioprine. Antibiotic therapy is indicated only in the case of active infection and mainly affectsChlamydia.

Skin lesions can be treated topically with glucocorticosteroids and keratolytic agents (they soften the thickened stratum corneum). Oral mucosa changes spontaneously and do not require treatment.

In the case of inflammatory changes in the eye, treatment should be carried out by an ophthalmologist.

Category:

Spine, bones, joints