Reactive Arthritis-WHAT? “React THIS-Arthritis”!

Aka Spondyloarthropathy, enteropathic arthritis, possible ankylosing spondylitis

For me it took 3 bouts of sacroillitis (one was VERY bad-oy vay- couldn’t walk, sleep, lay) that comes accompanied with it’s pal uveitis and pinkeye.

My rheumatologist calls with the results of my genetic testing-the gene HLA-B27 locked up the dx after the MRI of lower lumbar and si joint showed inflammation only and no bone fusing-had there been bone fusing a diagnosis of anklylosing spondylitis would have been appropriate.  Thank goodness it wasn’t that-well isn’t so far-  My grandmother had AS and she was in great pain and hunched over.  She also had undiagnosed lupus, which attacked her nerves, blood and skin the most-just like ME.

The pain radiating on one side above my butt and under lower back-now known as the si joint is warm to the touch, swollen looking and varies in intensity when it acts up and is painful.  At it’s worst I would not hesitate to clobber ya for getting in touching distance, lol.  Sometimes it’s one side, sometimes its both and last December, the worst flare I ever had with it, it was both, it also included the pelvic area and I could not MOVE without pain.  Its horrendous.  It comes with uveitis and/or pinkeye.  And what the two have to do with each other, BEATS ME!  But here’s the idea the doctors have:

Fast facts

  • Reactive arthritis can affect the heels, toes, fingers, low back, and joints, especially of the knees or ankles.
  • The infection that causes reactive arthritis usually presents (shows up) as diarrhea or as a sexually transmitted disease. But, it can have no symptoms (called asymptomatic).
  • Though it often goes away on its own, reactive arthritis can be prolonged and severe enough to require seeing a specialist.
ReactiveArthritis2This figure shows the areas of the body that reactive arthritis might affect.

What is reactive arthritis?

Reactive arthritis is a painful form of inflammatory arthritis (joint disease due to inflammation). It occurs in reaction to an infection by certain bacteria. Most often, these bacteria are in the genitals (Chlamydia trachomatis) or the bowel (Campylobacter, Salmonella, Shigella and Yersinia). Chlamydia most often transmits by sex. It often has no symptoms, but can cause a pus-like or watery discharge from the genitals. The bowel bacteria can cause diarrhea.

Reactive arthritis can have any or all of these features:

  • Pain and swelling of certain joints, often the knees and/or ankles
  • Swelling and pain at the heels
  • Extensive swelling of the toes or fingers
  • Persistent low back pain, which tends to be worse at night or in the morning

Some patients with this type of arthritis also have eye redness and irritation. Still other signs and symptoms include burning with urination and a rash on the palms or the soles of the feet.

What causes reactive arthritis?

The bacteria induce (cause) arthritis by distorting your body’s defense against infections, as well as your genetic environment.

How exactly each of these factors plays a role in the disease likely varies from patient to patient. This is a focus of research.

Who gets reactive arthritis?

The bacteria that cause reactive arthritis are very common. In theory, anyone who becomes infected with these germs might develop reactive arthritis. Yet very few people with bacterial diarrhea actually go on to have serious reactive arthritis.

Signs and symptoms that affect your bones and muscles may include:

  • Joint pain, usually in your knees, ankles and feet
  • Heel pain
  • Pain and swelling at the back of your ankle
  • Swollen toes or fingers, which may look like sausages
  • Pain in your low back or buttocks

Reproductive and urinary
Possible signs and symptoms of your reproductive and urinary systems include:

  • Pain or burning during urination
  • Increased frequency of urination
  • Inflammation of the prostate gland (prostatitis)
  • Inflammation of the cervix (cervicitis)

Eyes, mouth and skin
Signs and symptoms that affect your eyes, mouth and skin may include:

  • Eye inflammation (conjunctivitis)
  • Inflammation of your inner eye (uveitis)
  • Mouth ulcers
  • Skin rashes

Reactive arthritis develops in reaction to an infection in another part of your body, often in your intestines, genitals or urinary tract. You may not be aware of the triggering infection because it may cause only mild symptoms or none at all.

Numerous bacteria can cause reactive arthritis. The most common ones include:

  • Chlamydia
  • Salmonella
  • Shigella
  • Yersinia
  • Campylobacter

Reactive arthritis isn’t contagious. However, the bacteria that cause it can be transmitted sexually or in contaminated food. But only a few of the people who are exposed to these bacteria develop reactive arthritis.

How is enteropathic arthritis treated?

Like the other spondyloarthropathies, the patient needs physical therapy and exercise. Treatment of the bowel disease may help the peripheral joints but not the spine. Removing the colon (colectomy) in ulcerative colitis may “cure” the arthritis. One can use non-steroidal anti-inflammatory drugs (NSAIDs), but there is a need to be aware of the bowel effects. Local injection of steroids into joint(s) can be very helpful. Oral steroids can be used in more severe cases. In resistant cases, medications normally used to treat rheumatoid arthritis, such as methotrexate, azathioprine (Imuran®) or sulfasalazine can be tried for the joints. Anti-TNF-a drugs, like adalimumab (Humira®) and infliximab (Remicade®) have shown benefit with joint and bowel disease.

Also called Reiter’s Syndrome-here is more info: