Reactive Arthritis - diagnosis, causes, symptom, treatment of Reactive Arthritis
What is Reactive Arthritis?
Reactive arthritis is an acute or subacute, aseptic, nonsuppurative, inflammatory arthritis occurring in an immunologically sensitized and genetically predisposed individual secondary to a primary infectious process elsewhere in the body. Nonproliferating microbial products or antigens may be present in the joint, but there is absence of the traditional evidence of sepsis in Reactive arthritis.
Reactive arthritis is typically asymmetric and oligoarticular, more often affecting the joints of the lower extremities, and occurs within a month of an episode of a primary infectious trigger. Reactive arthritis is frequently associated with characteristic extraarticular features, such as urethritis, ocular inflammation (conjunctivitis or acute iritis), enthesitis (Achilles tendonitis and plantar fasciitis), dactylitis ("sausage digits"), or mucocutaneous lesions.
What Forms of Arthritis can be decribed as Reactive?
Several forms of arthritis can be described as "reactive" (or postinfectious), such as acute rheumatic fever, but the term "reactive arthritis" is restricted to acute arthritis that usually, but not exclusively, appears shortly after certain infections of the genitourinary or gastrointestinal tracts. The preferred term, "reactive arthritis," is more inclusive, and encompasses both complete and incomplete Reiter's syndrome; most patients with reactive arthritis do not present with the classical triad.
However, reactive arthritis may itself turn out to be a transitory term as the etiopathogenesis of this disease becomes better understood in the near future. Reactive arthritis belongs to a cluster of interrelated and overlapping chronic inflammatory rheumatic diseases, termed the "spondyloarthropathies" or "spondyloarthritides," which also includes ankylosing spondylitis, arthritis associated with psoriasis and inflammatory bowel diseases, and undifferentiated forms of these diseases
Diagnosis of Reactive Arthritis
Reactive arthritis must be distinguished from other forms of acute arthritis, such as septic arthritis (especially gonococcal arthritis), crystal-induced arthritis, erythema nodosum, acute sarcoidosis (Löfgren syndrome), acute rheumatic fever, Lyme arthritis, and seronegative rheumatoid arthritis on clinical grounds and after appropriate laboratory tests and synovial fluid analyses. Laboratory results are consistent with an inflammatory process; there are moderate to marked elevations of the erythrocyte sedimentation rate and C-reactive protein, and there may be thrombocytosis, leukocytosis, and a mild normochromic, normocytic anemia.
Sign and Symptom of Reactive Arthritis
The earliest manifestation of reactive arthritis is usually the occurrence of one or more of the extraarticular features, and arthritis is usually the most prominent, although often the last to appear. But it usually occurs within 4 weeks of the triggering event, often when the symptoms of genitourinary and ocular inflammation are subsiding or have resolved.
Reactive Arthritis is typically acute, asymmetric and additive inflammatory oligoarthritis. At the onset, the involvement of the joints of the lower extremity (knees, ankles, and toes) is most common
Cause of Reactive Arthritis
Reactive arthritis occurs at a frequency of 1% to 4% after nongonococcal urethritis secondary to C. trachomatis. It is 5 to 6 times more common in males than females, and most commonly affects young individuals who are sexually promiscuous, with peak onset during the third decade of life.
Treatment of Reactive Arthritis
Treatment of Reactive Arthritis should be directed at relief of pain, suppression of inflammation, maintenance of function, optimal joint protection, and, when appropriate, eradication of infection.