Reactive arthritis is a type of arthritis which affects a person's eyes, urethra, skin and joints.
Defining Reactive Arthritis
Reactive arthritis is a type of arthritis which affects a person's eyes, urethra, skin and joints. The disease presents as either acute or chronic, with periods of sudden remission or recurrences. Reactive arthritis affects different organs in a persons body, with differing symptoms that may appear at different times. The joint inflammation associated with the disease is referred to as, 'reactive arthritis,' because it is believed to involve an immune system response that is, 'reacting,' to the presence of bacterial infections in the person's gastrointestinal, urinary, or genital systems. Certain persons have immune systems that are, 'primed,' to react abnormally when these areas of their body are exposed to specific bacteria, leading their immune system to react with spontaneous inflammation of their joints and eyes. A doctor may be puzzled by these reactions because the infection itself is gone at the time the inflammation or arthritis occurs.
People between the ages of twenty and forty are most commonly affected by reactive arthritis, although it can affect people of any age. Men are more frequently affected by the venereal form of reactive arthritis, while the form that develops following a bowel infection affects both men and women equally. Reactive arthritis is a systemic rheumatic disease, meaning that it may affect other organs in a person's body than their joints, causing inflammation in a person's mouth, kidneys, lungs, eyes, heart, and skin. The disease is a form of arthritis that happens as a reaction to an infection somewhere in the person's body; infections that cause the disease start in the person's genitourinary tract and are spread through sexual intercourse. Additional forms of infections that may cause reactive arthritis include gastrointestinal infections from eating foods that have been contaminated, or from handling contaminated substances. Medical science is unsure why, but some people who develop the disease in response to specific infections have a genetic factor, the presence of the HLA-B27 gene, that seems to increase their risk.
Causes of Reactive Arthritis
The disease reactive arthritis itself is not contagious; however, the bacteria that causes it is. Reactive arthritis may be partially genetic in nature; there are specific genetic markers that are more frequent in persons with reactive arthritis than in others. In people who do have these genetic markers that predispose them to this disease, exposure to specific infections still seems to be required in order to trigger the onset of reactive arthritis.
Reactive arthritis may occur after venereal infections; one of the most common bacterium associated with post-venereal reactive arthritis is Chlamydia Trachomatis. Reactive arthritis can also occur after contracting Infectious Dysentery, bacterial organisms in the bowel such as shigella, salmonella, campylobacter, or yersinia. Reactive arthritis usually develops between one and three weeks after the onset of a bacterial infection. The exact causes of reactive arthritis remain unknown to medical science. Greater than eighty-percent of Caucasians with the disease, and fifty to sixty-percent of African-Americans with it, have positive blood tests for the genetic marker HLA-B27, suggesting that reactive arthritis does indeed have a genetic component.
Symptoms of Reactive Arthritis
Reactive arthritis can present a number of symptoms such as joint pain and inflammation, urinary tract symptoms and eye infection. Each person experiences symptoms differently. The symptoms of reactive arthritis can resemble other medical conditions or issues. What follows are the more common symptoms associated with the disease:
Discharge from penis
Increased urinary output
Inflammation of the spine
Painful and irritated eyes
Inflammation of the cervix
Inflammation of the inner eye
Inflammation of the prostate gland
Inflammation of the fallopian tubes
Burning sensation during urination
Inflammation of the lower back joints
Inflammation of the vulva and vagina
Inflammation of the urethra, causing a burning sensation during urination
Inflammation of the mucous membrane that covers the eyeball and eyelid
Heel spurs, which are bony growths in the heel that can cause chronic pain
Inflammation of the tendon that is attached to the bone causing heel pain or the shortening and thickening of the fingers
Joints, such as the ones in a person's feet, or a person's ankles, knees or wrists can become inflamed due to reactive arthritis. The joints involved may be on one side of the body, rather than both. The inflammation can lead to stiffness, swelling, redness and warmth in the joints involved. Persons affected may develop inflammation of entire fingers or toes. Reactive arthritis can be associated with spine inflammation that leads to pain and stiffness in the person's neck or back. Cartilage, particularly around the person's breastbone, may also become inflamed. The person's muscles may attach to their bones by their tendons. The person's tendon insertion points may also become inflamed, painful and tender when they exercise.
People affected by reactive arthritis can experience inflammation, pain and irritation involving their eyes, urinary tract, genitals, mouth lining, skin, large bowel and aorta. Inflammation of the white portion of their eyes, as well as the iris of their eyes, is a common occurrence in early reactive arthritis and can be intermittent as well. When the whites of a person's eyes become inflamed the person may not experience any pain. When the iris of a person's eye becomes inflamed, it may be painful; made worse by looking at bright lights. Urinary tract inflammation often involves the person's urethra and may be associated with a burning sensation when they urinate, or pus drainage. Skin around the penis may become inflamed or peel. The person's bladder and prostate gland may also become inflamed, which can then lead to an urge to urinate.
Skin on the palms of persons affected by reactive arthritis, or the soles of their feet, may develop tiny, fluid-filled blisters that can be filled with old blood. The skin may peel and mimic psoriasis. The person's mouth may develop ulcerations, either on their soft or hard palate, or perhaps on their tongue. The person may develop inflammation of their large bowel causing diarrhea, blood, or pus in their stool. A small number of people with reactive arthritis experience an inflammation of their aorta, with the potential to lead to failure of their aortic valve, or heart failure. There is potential for the electrical conducting pathway of a person's heart to become scarred due to reactive arthritis, potentially leading to irregular heartbeats that can necessitate placement of a pacemaker in order to regulate their heartbeat.
Diagnosing Reactive Arthritis
Reaching a diagnosis of reactive arthritis can be complicated because the symptoms of the disease many times occur several weeks apart. The person may present symptoms that appear either with, or shortly after, an inflammation of either their urinary tract or eye which last longer than a month, enabling a doctor to diagnose them with reactive arthritis. There is no one, single laboratory test that is used to diagnose the disease. A diagnosis is based upon recognition of arthritis in conjunction with inflammation of the person's genital, urinary, gastrointestinal system, or eyes. A doctor gathers the person's medical history, noting the time course of potential infection in the person's genital or urinary tracts, or in their bowel. The doctor monitors symptoms of pain and stiffness reported by the person. The doctor will likely order blood tests such as a, 'Sedimentation Rate,' test in order to document the presence of inflammation in the person's body. A test for the presence of the HLA-B27 gene marker in the person's blood may prove helpful, as well as a test to determine if rheumatoid factor is present.
X-rays of the person's spine and additional joints may be ordered to determine if there is inflammation in these areas; these X-rays may reveal calcifications that point to prior inflammation as well. Persons with eye inflammation may be examined by an ophthalmologist to determine the extent of the inflammation in their iris, as well as to document it. Stool cultures may be obtained from the person affected, as well as urine samples, to search for any bacterial infections. A prostate examination may be performed. If a doctor determines that it is necessary, an Arthrocentesis may also be ordered.
Treating Reactive Arthritis
Treatment for individuals with reactive arthritis is determined by a doctor based upon several things. The person's age, overall health, medical history, and the extent of their condition are determining factors. The person's ability to tolerate specific medications, procedures and therapies are others. A doctor also takes into consideration the expectations for the course of the condition, as well as the person's opinions and preferences. Treatment of reactive arthritis commonly involves the administration of antibiotics. Individualized treatment can also involve the use of non-steroidal anti-inflammatory medications, immunosuppressive medications, corticosteroids, exercise, and rest.
Persons with joint inflammation caused by reactive arthritis may be treated with non-steroidal anti-inflammatory drugs (NSAID's). NSAID's such as Indomethacin, Aspirin, Sulindac, Tometin, or Piroxicam may be administered. A doctor may also administer Corticosteroids such as Prednisone to reduce the inflammation the person is experiencing, which can be given either orally or through an injection. These medications may also be used to reduce inflammation of tendons in persons with reactive arthritis. There is a medication known as, 'Sulfasalazine,' that has shown effectiveness in treating persons with persistent reactive arthritis, although it has side effects such as a, 'sulfa-rash,' as well as suppression of the person's bone marrow. When people use this medication over lengthy periods of time, their blood counts are monitored.
Aggressive inflammation related to chronic joint inflammation due to reactive arthritis can be treated with medications that suppress the person's immune system. These medications include Methotrexate, which is administered either orally or through an injection. The medication is administered on a weekly basis. The medication also requires the person to pursue regular monitoring of their blood counts and blood liver due to the potential for toxicity to their bone marrow and liver. Methotrexate is not used in persons who have the HIV virus as well.
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