Definition
Reactive Arthritis (or Reiter's syndrome)
is a group of symptoms consisting of arthritis (inflammation
of the joints), urethritis
(inflammation of the urethra), conjunctivitis (inflammation
of the lining of the eye), and lesions of the skin
and mucous membranes.
Causes,
incidence, and risk factors
The exact cause of Reactive Arthritis
is unknown, but it likely caused by an interaction
between a genetic factor (HLAB27) and trigger by
some environmental factor (such as an infection).
The disorder is rare in younger children,
but may occur in adolescents. It occurs most commonly in men before the age
of 40. It may follow an infection with Chlamydia,
Campylobacter, Salmonella, or Yersinia.
The symptoms of urethritis
usually appear within days or weeks of infection
followed by a low-grade fever, conjunctivitis, and
arthritis developing over the next several weeks.
The arthritis may be mild or severe with involvement
being asymmetric and in more than one joint.
Symptoms
- urinary urgency
- urethral discharge
- burning or stinging on urination
- redness of the eye
- discharge from the eye
- burning eye pain
- joint pain in the large joints
(hip pain, knee pain, and ankle pain are common)
- low back pain
- heel pain
- Achilles tendon pain
- small, painless ulcers in the
mouth, tongue, and glans
penis
- skin lesions on the palms and
soles that may resemble psoriasis
Additional
symptoms that may be associated with this disease:
- urinary hesitancy
- skin redness or inflammation
- penis pain
- incontinence
- genital lesions (male)
- arthritis
Signs
and tests
The diagnosis is based on symptoms,
exam findings, labs, and sometimes x-ray. Since
the symptoms may occur at different times, the diagnosis
may be delayed. A physical examination may reveal
conjunctivitis or typical skin lesions.
Tests that may be performed include:
- joint X-rays (knees, Sacroiliac
joints, etc)
- urinalysis
- HLA-B27 antigen
- Blood test (Sedimentation Rate,
CRP)
Treatment
The objective of treatment is to alleviate
the symptoms associated with the syndrome and to
treat any underlying infection. In general, the
conjunctivitis and skin lesions associated with
the syndrome do not require treatment, and will
resolve on their own.
Any underlying infection should be
treated with antibiotics, although this has not
been shown to affect the course of the arthritis.
The arthritis is treated with nonsteroidal
anti-inflammatory medications (NSAIDS) and pain
relievers. These medications are tolerated better when they are taken with food. Local administration
of corticosteroids may help relieve the symptoms
associated with persistent inflammation in one joint.
In severe case stringer immunosuppressant agents
such as sulfasalazine,
methotrexate, or biological
agents (such a TNF inhibitors)
may be helpful.
Physical therapy exercises for specifically
involved areas and the back are helpful in relieving
pain, maintaining mobility of the affected joints,
and maintaining muscular strength. Adjustments in
occupational tasks may be required if lifting or
strenuous use of the back is required.
Therapy to suppress the immune system
may be considered for individuals with a severe
case of the disease, but this treatment is not used
in most people because of the toxic side effects.
Prognosis
The illness may resolve in 3 to 4
months, but up to one-half of those affected experience
recurrences of the arthritis or other symptoms of
the syndrome over a period of several years. The
condition may become chronic in which case the immunosuppressant
medication can be used.
Complications
- aortic insufficiency (rare)
- arrhythmias caused by defects
of the heart's electrical conduction system
(rare)
- uveitis
Prevention
The prevention of sexually transmitted
diseases through condom use, and the prevention
of gastrointestinal infection through hand washing
and careful food preparation, may affect the prevalence
of this disease.
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