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My doctor told me that I am suffering from Reactive Arthritis. What is a Reactive arthritis?
Reactive arthritis is a condition where there is pain and swelling of one or two joints of body (usually the knees or ankles) that often begins 3 weeks to 3 months after an infection of the body. These infections are usually in form of Viral Fever, Flu, Common Cold, Urinary Tract Infections, Diarrhoeal Illness or Genitourinary Infections. Usually reactive arthritis is a self limiting disease that usually gets cured by 6 to 9 months of it’s onset
Is it a chronic rheumatic disease? Is there a cure for this?
Actually in many individuals this problem gets cured by next 6 to 9 months with or without medicines. Approximately 18 to 24% of individuals get back to normal after 1 month of treatment. However, in among 35% of individuals this can turn into a chronic course which may last for years and these individuals will need chronic treatment with medicines for control of the disease.
Why does such arthritis occur? Who can get affected?
As the name suggests, it is a reaction to an action. This problem arises because the our immune system is triggered first by an external infection as mentioned above which may be a common viral illness or a genitourinary infection. After the offending bacteria or virus are killed by the immune defence system, the immune system keeps an eye for similar microbes in the body. Unfortunately, the defence mechanism misidentifies some proteinacous molecules on the surface of out ligaments, bones and joints and start destroying this healthy tissue by mistaking them as microbes, thus, reactive arthritis results. This indeed is an autoimmune disease.
Reactive arthritis can occur in any age but it is common in young and adults of both the sexes. There is indeed a genetic linkage with this disease and it has been found that approximately 65% of the individuals suffering from this disease have HLA B27 gene in their blood. Thus, presence of this gene is often sought for but testing for it is not necessary for diagnosis.
How would I know that my joint pain is due to reactive arthritis?
Reactive arthritis usually is abrupt in onset. One fine morning you may find that your knee or ankle of a small joint of foot or hand may be swollen and painful. There may slight redness too. In most of the cases there may be a history of infectious event within past 3weeks to 3 months such as flu, urinary tract infections, genital infections or diarrhoeal illness. Dengue and Chickunguniya may also cause such a problem after one has recovered from it.
The joint is more stiff and painful after a period of prolonged rest or early morning after getting up from bed.
What are the other symptoms apart from arthritis?
In my experience, I have seen most of the persons complain of involvement of a single or may be two joints but, there are other symptoms of significance too.
There may be red eyes which are caused due to uveitis or conjunctivitis. Sometimes there are skin rashes occurring on palms and sole characterised by exfoliation of dry skin. Ulcers of mouth and over and around the Gentitalia (Tip of the penis and Vulva) are not uncommon.
Hand joints may be involved but, many present with pain and stiffness around low back region which is suggestive of sacroilitis. Sacrolilitis is actually a hallmark of Ankylosing Spondylosis but can also be seen in diseases like reactive arthritis and psoriatic arthritis.
Thus, red eyes, painful eyes, stinging sensation of eyes, oral ulcers, genital ulcers, skin rash, low back pain and stiffness are important symptoms to look for.
How is reactive arthritis diagnosed? Do I need to do a lot of tests to confirm the diagnosis?
Actually reactive arthritis is so obvious clinically that one hardly needs any tests to diagnose. However, there are few tests which are done to assess the disease activity; some are done to confirm the disease in case of a dilemma.
Blood for ESR and C Reactive Protein (CRP) are done to assess the severity of disease. Values of both the parameters are raised significantly in reactive arthritis and any form of autoimmune inflammatory arthritis. Testing for HLA B27 is not mandatory for fetching a diagnosis but in some cases it is done if the doctor is in confusion with the diagnosis.
The HLA B27 test is positive is around 65% of patients in Reactive arthritis and more than 90% of patients with ankylosing spondylosis. X rays of affected joints are done to look for any evidence of joint erosion. Although, erosion of joints is a late feature but presence of such evidence suggests an aggressive disease. Eye check up is necessary when there is eye involvement. But eye check up is mandatory in children aged less than 15 years even if there are no eye symptoms as there is often asymptomatic uveitis or conjunctivitis.
What medicines are used for treating Reactive Arthritis? I am being prescribed pain killers. How long should I take them?
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