Causes, Symptoms and Treatment of Reactive Arthritis

Reactive arthritis develops in 3% of patients who have undergone chlamydial urogenital infection. It is diagnosed in 4% of patients with intestinal infectious diseases. In children, pathology is extremely rare. Most often, reactive arthritis affects men 20-40 years old, in women it is detected 20 times less often. In his treatment conservative methods are used – taking antibiotics and analgesics, conducting physiotherapy and massage procedures, exercise therapy.

Reactive Arthritis Overview

Reactive arthritis is an inflammatory disease of large and small joints. It develops against a background of urogenital, intestinal infection, or some time after its cure. Pathology is characterized by consistent involvement in the inflammatory process of the organs of the genitourinary system, eyes, and joints. Not all people in whose bodies infectious pathogens penetrate reactive arthritis. The relationship between inflammatory joint damage and carriage of HLA-B27 antigen has been established. In this case, the likelihood of developing an autoimmune disease is 50 times higher.

Causes of pathology

The selectivity of reactive arthritis is due to a genetic predisposition. After the introduction of the pathogens of urogenital and intestinal infections into the body, they penetrate through the hematogenous pathway into the synovial fluid. As a result of their contact with HLA-B27 antigens, complex protein complexes are formed that are similar in structure to articular tissue cells. The immune system produces antibodies to destroy foreign proteins, but they attack the body’s own cells, which leads to the development of an aseptic inflammatory process.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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chlamydia

Chlamydia – spherical pathogenic bacteria that parasitize in the human body in the form of cytoplasmic inclusions. The causative agent of urogenital reactive arthritis is C. trachomatis. In most cases, infection occurs through unprotected sexual contact. Less commonly, chlamydia is transmitted from person to person through the household, for example, through bedding and toiletries. It is also possible infection of the child during its passage through the birth canal.

Other genitourinary infections

Less commonly, causative agents of ureaplasmosis and mycoplasmosis act as etiofactors of reactive arthritis. These are the smallest microorganisms of the mycoplasma family – an intermediate link between viruses and bacteria (they do not have DNA and cell membranes). In 70-80% of cases, the disease proceeds in the form of asymptomatic carriage. But with the incorrect functioning of the immune system after the penetration of bacteria into the body, the inflammatory process in the joints starts.

Intestinal infections

The causative agents of intestinal infections are capable of provoking the development of reactive arthritis – yersinia, salmonella, dysentery bacillus, campylobacter, clostridia. These pathogenic bacteria are transmitted from person to person by the usual household route and enter the body along with food. The risk of contracting intestinal infections increases with the use of food that has not undergone heat treatment.

Respiratory infections

The causative agents of infections affecting the upper and lower respiratory tract, rarely cause reactive arthritis. However, similar cases are described in the medical literature. The most common etiofactors are viruses. They contain special proteins, similar in structure to the cells of the synovial membranes. Therefore, the immune system attacks not only viruses, but also articular structures.

Other infectious diseases

A prerequisite for reactive arthritis can be viral hepatitis, HIV and other bacterial and viral infections. The main difference between pathogenesis is the absence of pathogens directly in the joints. The impetus for the development of inflammation is exclusively produced by the immune system antibodies. Therefore, there is the possibility of making the wrong diagnosis. Complex treatment of infectious arthritis is carried out, while the use of immunomodulators is necessary.

Typical signs and symptoms of pathology

Reactive arthritis is characterized by the classical triad of clinical manifestations – sequential damage to the eyes, urogenital tract and joints. The first signs occur approximately 2-4 weeks after the symptoms of infection. The clinic lasts for 3-12 months. Then the severity of symptoms begins to gradually weaken, until their complete disappearance. This does not mean that the person has fully recovered. Under the influence of provoking external or internal factors, a relapse of reactive arthritis may occur with the involvement of healthy joints in the chronic inflammatory process.

Articular

Reactive arthritis always manifests acutely, with the defeat of several joints of the legs. Most often, interphalangeal, metatarsophalangeal, calcaneal, knee, ankle joints are involved in the inflammatory process. There are aching, pressing pains, worse when walking. The joints increase in size, the skin above them swells, reddens, becomes hot to the touch. Body temperature rises to 37-38 degrees, weakness, malaise, rapid fatigue appear.

Extraarticular

Extraarticular signs of reactive arthritis occur before articular. At first, urethritis flutters – inflammation of the walls of the urethra. Pathology is characterized by pain, burning, itching when the bladder is empty. Urges to urinate more often, while a small amount of urine is separated.

Soon conjunctivitis joins the urethritis. The eyelids turn red, swell, the mucous membrane becomes inflamed, photophobia, visual disturbances appear, black dots, colored spots flicker in front of the eyes.

Which doctor to contact

Rheumatologist is involved in the treatment of reactive arthritis. But since it is unlikely to independently determine the cause of joint pain, it is advisable to consult a general practitioner – a therapist. He will prescribe the necessary diagnostic measures, and after studying their results, he will refer the patient to a rheumatologist. In the examination, as well as further treatment, infectionists, venereologists, urologists, gynecologists, otolaryngologists, gastroenterologists can take part.

Methods of diagnosis of the disease

Other pathologies affecting the joints of the legs may mask under the symptoms of reactive arthritis. This is deforming osteoarthrosis, including gonarthrosis, infectious, rheumatoid, gouty arthritis, bursitis, tendovaginitis, synovitis. Therefore, a thorough differential diagnosis is carried out to exclude these diseases, as well as to identify the causes of the patient’s well-being.

Medical history

The primary diagnosis can be made on the basis of a combined lesion of the eyes, small and large joints of the legs, urethra. Anamnesis data is also important. The development of reactive arthritis is indicated by recently transferred or still proceeding urogenital, intestinal, and respiratory infections. The doctor asks the patient about the presence of autoimmune pathologies in relatives, for example, psoriasis or ankylosing spondylitis.

Laboratory research

The inflammatory process taking place in the body is detected at the stage of conducting general clinical tests to increase the level of leukocytes and the increased erythrocyte sedimentation rate. In the biochemical and serological diagnostics of reactive arthritis, the polymerase chain reaction method, which makes it possible to establish the specificity of infectious agents, is most in demand.

In addition, synovial fluid is examined. Signs of the pathology are its low viscosity, elevated white blood cell count, poor mucin clot formation.

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Instrumental studies

Using radiography, you can identify signs of joint damage – narrowing of the joint space, erosion of bone surfaces. Heel spurs, paravertebral ossification, periostitis of the foot bones are visualized on two-projected images. In most cases, arthroscopy is not required.

For a more detailed study of the joint structures, an MRI is sometimes prescribed, which allows you to assess the condition of the cartilage, muscles, ligament-tendon apparatus, nerve trunks, and blood vessels.

How is reactive arthritis treated?

Patients are shown complex therapy of pathology. At the same time, treatment is carried out for the infection that provoked the development of arthritis, the elimination of symptoms of damage to the urethra, mucous membranes of the eyes and joints. The main goal of therapy is to achieve sustainable remission.

Medicines

Antibiotics are included in treatment regimens, to which pathogens are most sensitive. The most commonly used tetracyclines, macrolides, fluoroquinolones, cephalosporins, semisynthetic penicillins. Antifungal agents, hepatoprotectors, eubiotics, balanced complexes of vitamins and minerals are used to prevent complications of antibiotic therapy.

A group of drugs for the treatment of reactive arthritisNames of medicines
ImmunosuppressantsAzathioprine, Sulfasalazine, Methotrexate
TNF inhibitorsEtanercept, Infliximab
GlucocorticosteroidsMethylprednisolone, Diprospan, Phlosterone, Dexamethasone
Nonsteroidal anti-inflammatory drugsDiclofenac, Indomethacin, Meloxicam, Ketorolac, Nimesulide, Lornoxicam, Ibuprofen, Etoricoxib, Celecoxib, Rofecoxib
Preparations for local applicationDimexide, Voltaren, Ortofen, Nise, Ketorol, Nurofen, Dolgit, Bystrumgel

Physiotherapy

In physiotherapy of reactive arthritis, magnetotherapy, sinusoidal modulating currents, cryotherapy, laser therapy, ozokeritotherapy, applications with paraffin, UHF therapy are used.

For relief of severe pain, phonophoresis or electrophoresis with glucocorticosteroids, anesthetics, B vitamins, chondroprotectors is performed.

Operative therapy

There is no need for surgical treatment of patients. In some cases, exudate is extracted from the joint using a puncture, and its cavity is treated with solutions with antimicrobial and antiseptic activity.

Therapeutic gymnastics and massage

Physical therapy classes are conducted under the guidance of a physical therapy doctor immediately after the relief of severe pain and acute inflammation. The goals of daily exercise are to strengthen muscles, improve blood circulation, increase range of motion in the joints. Shallow lunges and squats are shown to patients, imitation of riding a bicycle in a prone position.

Therapeutic gymnastics is always combined with sessions of classical, vacuum, acupuncture massage. During the procedures, the masseur acts on tense muscles, performing kneading, stroking, vibration. After 10-20 sessions, pain, sensory impairment, stiffness, muscle cramps are eliminated.

Folk methods

At the stage of remission, doctors allow patients to get rid of residual discomfort with the help of folk remedies. Home-made ointments, infusions and decoctions of medicinal herbs, vodka and oil tinctures, compresses are used. Their weak therapeutic effect is due to locally irritating, warming, distracting effect.

A therapeutic diet is not an independent therapy for reactive arthritis. Its observance does not allow to reduce the severity of symptoms, to weaken the inflammatory processes. Rheumatologists recommend only to exclude from the diet foods high in fat and alcohol, which provoke an exacerbation of the disease.

Possible consequences

Every tenth patient after suffering reactive arthritis has a deformation of the feet, flat feet develops. In the absence of medical intervention, a chronic inflammatory process leads to the gradual destruction of cartilage and bone structures, provokes the appearance of deforming arthrosis. Partial or complete fusion of the joint gap results in ankylosis, or immobilization of the joint.

Prognosis of the disease

Only in 35% of diagnosed cases can we talk about a complete cure. Symptoms of the pathology disappear within 5-6 months and no longer appear. Approximately the same number of patients had relapses of arthritis after several years. In 25% of patients, the pathology slowly but stubbornly progresses. Reactive arthritis leads to severe damage to joints and spinal column in 5% of cases.

Preventive measures

The main prevention of the disease is excluded in preventing the development of urogenital or intestinal infections. If it was not possible to avoid infection, then you need to seek medical help at the first sign of pathology. Doctors also recommend a full examination 1-2 times a year, especially if relatives have any autoimmune diseases.

Anatoly Kudravets

Anatoly Kudravets, Orthopedic Traumatologist. He works with severe cases, practices operative methods of treating connective tissues

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