Inflammation that has not healed can spread to the body and subsequently lead to complications. One such subsequent reaction is reactive arthritis and its special form, Reiter’s syndrome.
What is reactive arthritis?
Reactive arthritis is joint inflammation as a secondary reaction to another inflammation in the body, such as the airways, intestines, urinary tract, or reproductive organs. Reactive arthritis usually develops a few weeks after an infection. A trigger often can no longer be identified (often salmonella or STDs such as chlamydia or gonorrhea). Reactive arthritis is associated with characteristic symptoms: Joint pain/swelling and hyperthermia in the shoulder, elbow, knee or hip. In Reiter’s syndrome (also known as Reiter’s triad), a special form of reactive arthritis, the patient suffers from conjunctivitis and urethritis in addition to joint symptoms.
Causes
Both reactive arthritis and Reiter’s syndrome are caused by a previous bacterial infection (intestinal, urinary, genital). Both can develop, on the one hand, if an infection is not treated or not treated completely. Bacterial residues then remain in the body, which are recognized and fought by the immune system. On the other hand, the immune system can also react to the body’s own antigens if these resemble the structures of the bacteria (molecular mimicry). Joint inflammation can then occur even if bacteria are no longer present. In this case, doctors speak of non-septic arthritis. In the body of affected patients, the antigen HLA-B27 is detectable, which triggers the defense reaction.
Symptoms, complaints, and signs
Characteristic signs of reactive arthritis include swelling, redness, and pain associated with joint inflammation that occur about two to four weeks after a respiratory, urinary, reproductive, or intestinal infection. The hip, knee or ankle joints are usually affected, but joint inflammation occasionally develops in the wrists, elbows or shoulders. The inflammation of a finger or toe joint known as “sausage finger” is also typical. As a rule, the symptoms occur only on one side of the body and are limited to one joint; only very rarely do several joints swell up at the same time: However, successive inflammations of different joints can occur. An affection of the spine or pelvis becomes noticeable by back pain that radiates into the buttocks and worsens at night. Other symptoms include scaly skin changes, especially on the palms of the hands and soles of the feet, and occasionally painful blue-red nodules (erythema nodosa) on the ankles and lower legs. Eye inflammation associated with reactive arthritis is noticeable by redness, burning, pain and increased sensitivity to light; visual disturbances are also possible. Both the conjunctiva and cornea or iris may be affected. In men, there is occasionally inflammation of the glans with pustule formation and redness. Mild fever and a general feeling of illness are often reported as nonspecific signs.
Diagnosis and course
If reactive arthritis or Reiter’s syndrome is suspected, a physician uses various examinations and tests to confirm the diagnosis of reactive arthritis. In the medical history, he first asks about symptoms. He then examines the patient physically and draws blood, and may also take a urine or stool sample. If inflammation of the eyes and urethra occur at the same time as the reactive arthritis, this is an indication of Reiter’s syndrome. A blood test can be used to determine if there is further evidence of reactive arthritis or Reiter’s syndrome:
- Detection of the antigen HLA-B27 in the blood.
- Inflammatory markers present
- No rheumatoid factors detectable
In addition to the blood test, the diagnosis of reactive arthritis can be confirmed by other tests:
- Urine examination
- Stool examination
- Swab of the urethra
- Joint puncture
- X-ray examination
- Ultrasound examination
- Scintigraphy
If left untreated, both reactive arthritis and Reiter’s syndrome can take a severe course. In most cases, reactive arthritis is cured within a year.In more severe cases – especially if several joints are affected and Reiter’s syndrome also occurs – healing can take a very long time. As a complication, joint function may be impaired or tissue may be destroyed as a result of the inflammation. If the eye is affected, vision may decrease.
Complications
Complications can occur when existing inflammation spreads to other parts of the body as part of reactive arthritis. For example, joint inflammation can affect the entire joint and permanently impair joint function or even destroy it. Any conjunctivitis that may be present can spread to adjacent eye structures and thus impair vision. Depending on the type of underlying inflammation, these “transitional processes” can occur throughout the body, causing serious complications. Reiter’s syndrome is a special form of reactive arthritis that leads to conjunctivitis and urethritis in addition to joint symptoms. In their course, both forms cause severe pain, movement restrictions and permanent joint damage. Due to the complaints, some patients develop psychological suffering such as depression and anxiety. The trigger itself can also cause discomfort and late effects. In the treatment of reactive arthritis, antibiotics and rheumatic drugs are the main triggers for complications. Diclofena, ibuprofen and similar preparations, for example, can cause gastrointestinal discomfort, headache, muscle and limb pain, skin irritation and kidney or liver damage. Alternative treatments such as cold applications and physical therapy are relatively free of complications aside from minor frostbite or temporary muscle pain.
When should you see a doctor?
This type of arthritis should always be treated by a doctor. There can be no self-healing in this process, so the affected person is always dependent on medical treatment to prevent further complications and discomfort. The life expectancy of the affected person is limited by this arthritis in some cases. A doctor should be consulted if the patient suffers from inflammation of the joints or severe respiratory infections. These complaints usually occur suddenly. Furthermore, swelling of the joints may also indicate this disease. Those affected suffer from very severe back pain and are therefore significantly restricted in their everyday life. The inflammations can also affect the eyes, so that the affected persons react very sensitively to light and can also have visual disturbances. Furthermore, fever or generally a permanent feeling of illness also often indicates this type of arthritis and must be examined by a doctor. The diagnosis of this arthritis can be made by the general practitioner. However, further treatment depends heavily on the exact symptoms and on their severity and is usually carried out by a specialist.
Treatment and therapy
Treatment of reactive arthritis, as well as Reiter’s syndrome, depends on pain relief and healing of the inflammation, as with other inflammatory diseases. Usually, non-stereoid rheumatic drugs such as ibuprofen, acetylsalicylic acid or diclofenac are prescribed. If there is evidence of inflammation in the body, antibiotics are given. If an STD is present, the partner is treated as well. Often, however, in reactive arthritis, inflammatory parameters are no longer present, in which case antibiotics are not needed. In this case, cold applications to relieve pain and physiotherapy to maintain or restore joint mobility are very effective against joint pain. If several joints are affected or the inflammation has spread, cortisone is administered to prevent secondary damage. Eye inflammation must be treated quickly because of the risk of visual impairment.
Prevention
The best prevention of reactive arthritis is to guard against infections of the intestines, urinary tract, and reproductive organs, which are the cause of reactive arthritis. Therefore, it is important to follow hygiene rules in the household:
- Clean hands and clean cookware when cooking.
- Be careful with raw meat and raw eggs
- Wash fruit
Aftercare
Condoms help to prevent sexually transmitted diseases. Reactive arthritis is considered cured after six months of therapy. However, the risk of recurrence is very high.After successful therapy, it is important to observe the further course of the disease over time during follow-up care. This is because in up to 50 percent of patients, joint inflammation or other disease-related symptoms recur after a few years. The relapse-related course of the disease is on average 3 years. Rarely, disease courses of up to 15 years are possible. Relapsing inflammation of the joints must then be treated quickly in order to avoid permanent joint damage or changes. For this reason, the inflammation marker must be determined regularly – at least every six months – by blood sampling during follow-up care. Depending on the medical findings, X-ray and ultrasound examinations should also be performed. Joint damage in the early stages can thus be detected and treated in good time. To minimize the risk of relapse, sexual contacts should only be entered into with “medically confirmed” persons during the relapse-related progression period of three years. In addition to the high risk of relapse, chronic arthralgias, arthritides or tendon problems may manifest in up to 40 percent of those affected. The focus of aftercare here is on physiotherapeutic measures. Movement exercises and regular endurance sports can maintain or even improve joint mobility and musculature. In addition, drug therapy is continued regularly during follow-up care.
What you can do yourself
In the context of self-help, suffered inflammations should always be completely cured. The organism is not fully capable of bearing loads if a present disease is not completely healed. To support the healing process, a healthy lifestyle and diet are important. The food intake should be balanced and rich in vitamins so that the immune system can mobilize sufficient defenses in case of an illness. The intake of harmful substances such as alcohol and nicotine should always be avoided. Excess weight is to be avoided and, in addition, sufficient daily exercise should take place. Regular intake of fresh air is just as helpful as doing sports. Sufficient sleep and good sleep hygiene also help the body to stay healthy or, in the case of existing diseases, to promote the healing process. People with reactive arthritis should refrain from heavy physical exertion. As soon as the body sends signals of fatigue, these should be taken into account. Rest and sparing necessary so that regeneration can take place. A restructuring of everyday life can be helpful in many people to improve the overall well-being. Care should be taken to redistribute tasks and obligations to be fulfilled to people in the close environment as soon as these can no longer be adequately performed by the affected person himself.
