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Reactive Arthritis

What is Reactive Arthritis?

Reactive Arthritis is an immune mediated inflammatory arthritis that occurs usually in response to an infection. The arthritis itself is not an infection in the joints, but is a result of the immune system being triggered by an infection. This is why it is called 'reactive'.

What are the symptoms of Reactive Arthritis?

Reactive Arthritis usually affects the large joints of the body such as the knees, ankles and the hips. It usually starts in the legs and can move its way to the arms. It can sometimes affect only one joint.

The joints are very painful, often very swollen and typically don't respond as well to Prednisolone as Rheumatoid Arthritis does.

Often the tendons can be involved, causing inflamed Achilles tendon and digits, such as the fingers and the toes.

It usually occurs 1-4 weeks after an original infection.

Sometimes parts of the body other than the joints can be affected in addition to the joints.

Other symptoms can be:

  • Mouth ulcers

  • Conjunctivitis

  • Rash

  • Nail changes such as ones usually seen in psoriatic arthritis

What causes Reactive Arthritis?

Reactive Arthritis is the response that a body has to an invading organism. We don't understand why some people have a reaction and other people do not.

HLA B27 is a common gene that is associated with Reactive Arthritis although it is not understood what it's exact relevance is.

Common associated organisms are:

  • Salmonella

  • Shigella

  • Campylobacter

  • Yersinia

  • Clostridium Difficile

How do we treat Reactive Arthritis?

50% of cases resolve within 6 months and most are resolved within 1 year.

Treatment is thus not indefinite, but aimed at controlling symptoms as best as possible until the process runs its natural course.

Initially anti inflammatories are trialled, cortisone injections into affected joints may be trialled.

If there is no response to the above and symptoms are very severe therapy with DMARDs may be trialled with a view to stopping them after 1 year to see if symptoms recur.

A common DMARD used to treat this condition is Sulfasalazine.

In addition to the above measures, if there is an ongoing active infection that needs to be appropriately treated.

What is the long term outcome with Reactive Arthritis?

50% of people resolve within 6 months and most are completely resolved after 12 months.

15-20%  of people develop ongoing arthritis symptoms needing long term treatment.

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