| Reactive arthritis, referred to also as Reiter's | | | | disabling changes in the joints in a small group of |
| syndrome although this name is lapsing, is an arthritic | | | | fifteen percent of sufferers. The usual age range for |
| condition related to infections such as Salmonella in the | | | | onset of this condition is between 20 and 40 years, gut |
| gastro-intestinal system and Chlamydia in the | | | | infections giving a 50:50 male to female ratio and |
| genito-urinary system. Reactive arthritis has a strong | | | | urogenital infections giving a 9 to 1 ratio. |
| link with a human leucocyte antigen known as HLAB27 | | | | Reactive arthritis usually comes on quickly as an acute |
| which is well known to be related to another arthritic | | | | presentation with patients presenting with tiredness, |
| condition called ankylosing spondylitis. This link puts both | | | | high temperature and a feeling of being unwell. Lower |
| these conditions into a group classified as seronegative | | | | extremity arthritis of a few joints, arranged non |
| spondyloarthropathies. The arthritis usually occurs with | | | | symmetrically (unlike rheumatoid arthritis) is common. |
| infections such as urethritis or conjunctivitis but can | | | | Heel pain from inflammation of the insertion of the |
| occur also without them. | | | | Achilles tendon into the heel bone is common and low |
| Once a person has an infection of the genitourinary | | | | back pain is present in half of the patients. Lower limb |
| system or the gastrointestinal system then the arthritis | | | | joints involved in weight bearing are typically affected, |
| can come on around two to four weeks later, with a | | | | with more severely affected patients exhibiting hands |
| respiratory infection with Chlamydia also a possible | | | | and feet symptoms. Back pain symptoms are |
| causative factor. There may be no apparent | | | | commonly reported but examination shows few |
| preceding infection in around ten percent of patients. | | | | findings apart from a reduction in lumbar flexion. |
| Many anatomical structures can be affected by the | | | | Reactive arthritis treatment is determined by how |
| inflammation, including the mucous membrane, the | | | | difficult the arthritic symptoms are for the patient, with |
| eyes, the joints, the spine, the ligament-bone and | | | | a mainstay of treatment being non-steroidal |
| tendon-bone junctions and the gastro-intestinal system. | | | | anti-inflammatory drugs which are taken regularly to |
| Patients with HLAB27 are fifty times more likely to | | | | keep up a level of anti-inflammatory action. The |
| develop reactive arthritis than those without it. | | | | maintenance and restoration of muscle power, control |
| The arthritis can last longer and be more severe if the | | | | of pain and protection of joint ranges of motion can be |
| person has a strong history in the family or they are | | | | effected by referral to physiotherapy. Intra-articular |
| HLAB27 positive. Of those having an infection of the | | | | injections with corticosteroids are a useful treatment |
| gut between one and four percent may develop a | | | | and can give long term relief of an inflamed joint. If |
| reactive arthritis, but this varies greatly even with the | | | | anti-inflammatory drugs are not effective then |
| same biological agent responsible. It is not understood | | | | systemic corticosteroids can be given and while |
| how the host body and the antigen react to cause the | | | | antibiotic drugs may be prescribed at times they do |
| arthritic condition and the samples of joint fluids do not | | | | not affect the disease course. |
| exhibit the infectious organisms. Antibodies have been | | | | Chronic and ongoing joint arthritis and poorly limited |
| isolated in the joints and it is possible an inflammatory | | | | inflammatory reactions may mean a rheumatologist will |
| condition mediated by the immune system is implicated | | | | prescribe drugs known as DMARDS or disease |
| in the development of this condition. | | | | modifying anti-rheumatoid drugs. These have been |
| The self limiting nature of this kind of arthritis means | | | | tested on conditions such as rheumatoid arthritis or |
| that the condition settles down over a 3-12 month | | | | ankylosing spondylitis but their usefulness in reactive |
| period whether the severity of the symptoms is | | | | arthritis has not been shown. Typical examples are |
| greater or lower. The chance of the condition recurring | | | | methotrexate and sulphasalazine. The newer biological |
| is significant, with a higher incidence if a patient is | | | | drug treatments have been effective in some |
| positive for HLAB27, and a new episode is potentially | | | | conditions but have not yet been shown to be useful in |
| triggered by infections or other agents. The arthritic | | | | this condition. |
| process can be mild or can cause destructive and | | | | |