What is it about ?
Reactive arthritis is a type of joint inflammation (arthritis) that develops as a reaction to other inflammation in the body.
A joint inflammation or arthritis is an inflammatory reaction of a joint. A joint is where two bones come together and can change position relative to each other. The ends of these bones are covered on the surface with a layer of cartilage. The entire joint is in a sort of sleeve, the joint capsule. The internal face of this envelope is covered with a mucous membrane which produces a lubricant, the synovial fluid.
Often, inflammation results in more fluid being present in the joint. The joint then has trouble functioning normally.
Possible causes are gastrointestinal infection, urinary tract infection, or sexually transmitted infection (STI). In cases of intestinal infection, the bacteria involved are most often Salmonella, Shigella, Campylobacter and (less often) Yersinia, and in cases of urinary or genital infection it is almost always Chlamydia trachomatis or from gonoccocci.
Where and how often?
Perhaps a hereditary predisposition plays a role. In the general population, the HLA-B27 gene is found in 8 to 10 out of 100 people. In the population with reactive arthritis after infection, the HLA-B27 gene is found in 60 to 80 out of 100 people. carrier of this gene, you are therefore more at risk of developing reactive arthritis after infection.
Reactive arthritis affects 3 in 10,000 people each year. The disease usually starts in people between the ages of 20 and 30. Symptoms are generally more severe in men.
How to recognize reactive arthritis?
A joint that is inflamed is red, hot, swollen, and painful.
In reactive arthritis, the large joints in the legs, such as the knees, are almost always inflamed. The joints of the arms, like the wrists, are affected 1 in 2 times.
Two to four weeks after infection, you develop inflammation in one or more joints (usually large joints). You suddenly have a fever and are tired.
Other symptoms are also possible:
- inflammation of the tendons (tendonitis);
- inflammation of the joints between the sacrum and the pelvis (sacroiliac joints);
- inflammation of the urethra (urethritis);
- inflammation of the glans (balanitis);
- inflammation of the conjunctiva of the eyes (conjunctivitis);
- inflammation of the uvea of the eyes (uveitis);
- inflammation in the form of balls under the skin (erythema nodosum).
Inflammation of the joints usually goes away within 6 months. Of every 100 people affected by reactive arthritis, 15 people will develop persistent arthritis. This is more often the case after a urinary or genital infection.
Oculourethro-synovial syndrome (Reiter’s syndrome) is a special form of reactive arthritis. There is inflammation of the eyes and genitals but also small red patches on the skin (rash) that peel (desquamation).
How does your doctor diagnose reactive arthritis?
Your doctor will think of reactive arthritis when you see the combination of symptoms.
Depending on this, the following examinations are possible:
- stool examination;
- urine examination;
- examination of secretions from the penis or vagina;
- blood test to measure inflammation, look for signs of infection (for example, antibodies to bacteria), and possibly test for HLA-B2;
- electrocardiogram (ECG) to check for inflammation in the heart;
- chest x-ray.
X-rays of the joints are usually normal at the onset of the disease.
A puncture of the inflamed joint may be done to remove synovial fluid. This liquid is sent to the laboratory for further examinations. Bacteria are usually not found in the synovial fluid.
How to prevent reactive arthritis?
Sexually transmitted infections (STIs), such as chlamydia and gonorrhea, can be prevented by using a condom during sex.
If you still have an infection, tell your partner so that they too can get tested.
Regarding gastrointestinal infections (Salmonella, Campylobacter), respect the rules of hygiene when cooking and cooking your meat well.
What can your doctor do?
If the responsible infection is a sexually transmitted infection (STI), it is treated with antibiotics. The other bacteria involved, such as intestinal bacteria, do not necessarily need to be treated with antibiotics.
Anti-inflammatory drugs (eg ibuprofen or naproxen) and rest help heal inflammation in the joints. If only one joint is inflamed, it can be inject cortisone (infiltration). For severe reactive arthritis, cortisone can also be taken orally (by mouth). Physical therapy can help maintain muscle strength and joint mobility.
If symptoms persist, treatment with anti-rheumatic drugs will be started. If necessary, your doctor may refer you to a musculoskeletal specialist (rheumatologist).
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