Reactive Arthritis/Reiter’s Arthritis

Trinity Angoni

Reactive arthritis

It has been postulated that Italian-born explorer Christopher Columbus suffered from Reiter's arthritis, dying from a heart attack caused by the condition

Definition

Reactive arthritis or Reiter’s syndrome is a painful form of inflammatory arthritis that develops in reaction to an infection by bacteria or virus

By the time the patient presents with symptoms, oftentimes the "trigger" infection has been cured or is in remission in chronic cases

Def…

Reactive arthritis is an RF-seronegative, HLA-B27-linked arthritis, often precipitated by genitourinary or gastrointestinal infections

Def ……

When the arthritis is followed by charecteristic of other symptoms it is then called reiter’s arthritis.

Def….

The arthritis may be "additive" (more joints become inflamed in addition to the primarily affected one) or

Migratory (new joints become inflamed after the initially inflamed site has already improved).

Def cont…….

Causes

Streptococcal throat infection glandular fever viral flu food poisoning sexually acquired

Pathology

It occurs in reaction to an infection by certain bacteria. Most often, these bacteria are in the genitals (Chlamydia trachomatis) or the bowel (Campylobacter, Salmonella, Shigella and Yersinia).

Signs and symptoms

burning pain on urination (dysuria) or an increased frequency of urination

prostatitis in men and cervicitis, salpingitis and/or vulvovaginitis in women.

penile lesions called balanitis circinata (circinate balanitis) can be found in males

inflammation of the eyes in the form of conjunctivitis or uveitis

cervicitis

salpingitis

Vulvo vaginitis

Balanitis circinata

Conjuctivitis

Uveitis

Signs and symptoms cont……..

Swelling and pain in large joints such as the knee.

Enthesitis can involve the Achilles tendon resulting in heel pain

A small percentage of men and women develop small hard nodules called keratoderma blennorrhagica on the soles of the feet

Enthesitis

Keratoderma blennorrhagica

keratoderma blennorrhagica

Because common systems involved include the eye, the urinary system, and the hands and feet, one clinical mnemonic for Reiter's syndrome is "Can't see, can't pee, can't climb a tree."

Epidemiology

A few studies have been completed, though. In Norway between 1988 and 1990, incidence was 4.6 cases per 100,000 for Chlamydia-induced Reiter's Syndrome and 5 cases per 100,000 for that induced by enteric bacteria.

Epidemiology cont…

It most commonly strikes individuals aged 20–40 years of age,

is more common in men than in women,

and more common in white than in black people.

This is owing to the high frequency of the HLA-B27 gene in the white population.

Patients with HIV have an increased risk of developing Reactive arthritis as well.

Treatment (medical)

The main goal of treatment is to identify and eradicate the underlying infectious source with the appropriate antibiotics if still present.

Otherwise, treatment is symptomatic for each problem.

Analgesics particularly NSAIDs, sulfasalazine, steroids .

immunosuppressants may be needed for patients with severe reactive symptoms that do not respond to any other treatment.

Physio mx

Electrotherapy ift Social support education Circulatory movements Deep tissue massage Your joints may need to be rested when the

pain and inflammation is most severe. Wrist splints and shoe insoles may be

helpful in the short-term. Ice packs and heat pads, used

alternatively, help to relieve joint pain and swelling.

Physio mx cont….

relaxation exercises to help to reduce pain and improve sleep.

Hydrotherapy for soothing joints