A B C D E F G H I J K L M N O P R S T U V W

REACTIVE ARTHRITIS

What is Reactive Arthritis ?

The joint is made up of two bone-ends, each covered with a layer of cartilage. They are encircled like a balloon by the joint capsule. This capsule has a lining called synovium. The synovium produces a small amount of fluid that lubricates the joint. Arthritis means inflammation of one or more joints. When inflamed, the synovium becomes thickened and swollen. It produces a lot of fluid that distends the joint. To you, the patient, this inflamed joint is red, hot, swollen and painful. The fluid in the joint restricts its movement. The increased pressure of fluid gives a lot of pain and stiffness. The arthritis of reactive arthritis is very variable. It may stay in one joint or it may affect many joints together with a lot of aching and stiffness particularly in the back. The painful joints settle as the process of inflammation subsides. In most people the joints are normal again after a few months. Later, the arthritis can flare up again. If the inflammation carries on for many months scar tissue forms in the joint. This will restrict the movement of the joint and damage the cartilage permanently. However, chronic arthritis is rare.

How does Reactive Arthritis occur ?

Reactive arthritis is started by an infection somewhere quite distant from the joint. This infection triggers the body's (immune) defence system so that it acts against its own tissues; in this case, the joint. This results in inflammation. The infection may be a sore throat, gastroenteritis or perhaps a chest infection. A sexually acquired urinary infection can result in other features as well (Reiter's syndrome). All infections may be quite mild and therefore be unrecognized.

Why does Reactive Arthritis occur ?

It is commonest in young men. It is found more frequently in people who have inherited the gene called HLA B27. This gene is present in 1 in 10 of the European population. The part played by infection or by this gene in triggering the immune system is still quite unknown.

Treatment Involved for Reactive Arthritis

There are many kind of arthritis. Your doctor will try and work out which type is affecting you so that he can give the correct treatment. All inflamed joints benefit from anti-inflammation treatment. These are called non-steroidal anti-inflammatory drugs (NSAIDs). There are more than 40 different types. Different drugs suit different people. They all reduce the pain, redness, heat, swelling and stiffness of joints. Most are tablets: some are also suppositories or gels to rub into a joint. They can be taken for long periods. As the arthritis is caused by a disorder of the body's immune system there are drugs which directly influence this. These are called slow-acting disease-modifying drugs. They are rarely needed as the arthritis usually gets better within 3 months and the NSAIDs provide enough pain relief. However, when the disease becomes long-standing, these drugs will reduce the disease in joints in about two-thirds of patients. They take about 2 months to start to work and have to be taken under hospital supervision. Physiotherapy is very important when joints are inflamed. It involves exercise to keep muscles strong, electrical therapy to reduce inflammation and advice on rest and posture. When a joint settles, the physiotherapist can advise you on exercises which you can do. These are designed to get your muscles fit without causing overstrain on the joint that was inflamed.

During Treatment for Reactive Arthritis

Reactive arthritis is usually very mild and doesn't last long (less than 3 months). Most people do not need to attend a hospital specialist. They simply need rest, physiotherapy and NSAIDs. NSAIDs are very safe drugs. However, they may cause indigestion, fluid accumulation (swollen ankles) or a rash. If you get any of these symptoms, please tell your doctor. If you suffer from peptic ulcers, you will not be prescribed NSAIDs as they may delay healing. Disease modifying drugs need supervision by the hospital with regular blood tests. They may affect the blood and bone marrow or cause ulcers or skin rash.

After Treatment for Reactive Arthritis

The arthritis may return after another infection. This new infection may go quite unnoticed by you. The attacks of arthritis are usually mild and settle within a few weeks. It is very rare for deformity of joints to occur.

If Reactive Arthritis is Left Untreated

Untreated, the arthritis would be very painful for a few weeks. You would have to stay in bed resting for most of the time. The natural outcome, however, would be good, and you would be probably regain normal function of your joints when the disease finally resolved.

Effects on Family of Reactive Arthritis

Family and friends should provide support for you, both physically and mentally. It is actually frustrating for someone to get arthritis from a simple infection which is normally of no consequence. They need reassurance of its benign outcome together with help with exercises and pain relief.