Reactive Arthritis Treatment in Riverside, CA

Overview of Reactive Arthritis

Reactive arthritis happens as a reaction to something. In this case, it is a reaction to an infection. The infection is caused by bacteria. It may be in the gut, the urinary tract or the genitals. But the arthritis symptoms usually do not start until after you get over the infection. Swelling of the joints, eyes and urinary tract are the main signs of reactive arthritis. But not everyone gets all three, and they may not happen at the same time.

It often affects the knees and ankles. Many people also have sore sacroiliac joints, which are in the lower back. Reactive arthritis is a type of spondyloarthritis. This is a group of arthritis diseases that usually affect the sacroiliac joints and the entheses. Entheses are the places where tendons or ligaments attach to bones. Foot pain in people with reactive arthritis usually comes from swelling of the entheses.

The symptoms often go away on their own within a few weeks or months. But in some people, they last a long time. Doctors fit treatment to each person’s symptoms. Treatment usually mixes medicines and exercise.

Who Gets Reactive Arthritis?

Anyone can get reactive arthritis. It happens all over the world. It usually starts a few weeks after an infection caused by bacteria in the gut, urinary tract or genitals. Sometimes a sexually transmitted infection comes just before it starts. But many cases are linked to other kinds of infections that are not spread through sex. Some things raise the risk:

• Sex. Both men and women can get reactive arthritis. But men are more likely to get it after a sexually transmitted infection. Men and women get it equally after a gut infection.
• Age. It happens most often in people between 20 and 40.
• Genes. People who have a gene called HLA-B27 have a higher risk. They are also more likely to have worse symptoms that last longer. But people without HLA-B27 can still get it.
• HIV infection. Having AIDS or HIV raises the risk.

Symptoms of Reactive Arthritis

Some people with reactive arthritis have mild symptoms. Others have severe symptoms that make daily life hard. Symptoms usually start 1 to 6 weeks after an infection of the gut, urinary tract or genitals. By then, the infection is usually gone. The disease usually comes on fairly fast, over a few days.

Reactive arthritis causes swelling in the joints, eyes and urinary tract. But not everyone with it gets all three, and they may not happen at the same time. The main symptoms are below.

Joint pain and stiffness:

• Joints may hurt and become red and swollen. This is most common in the large joints of the legs, such as the knees and ankles.
• Stiffness in the morning or pain at night is common.
• The joints that hurt are usually on one side of the body.
• The lower back and buttocks may also hurt.
• Heel pain or foot pain is a sign of enthesitis. This is swelling where a tendon or ligament attaches to a bone.
• Fingers or toes may become swollen and painful. This is called dactylitis.

Swelling of the urinary tract:

• This is more common when reactive arthritis follows an infection of the genitals or urinary tract.
• In women, the swelling can spread to the cervix, fallopian tubes, vulva or vagina.
• Signs include needing to urinate more often and burning when you urinate.

Swelling of the eyes:

• Conjunctivitis, or “pink eye,” can happen. This is swelling of the clear layer that covers the white of the eye and lines the eyelids.
• Uveitis can also happen. This is swelling of the middle part of the eye.
• Both can cause redness, pain, burning, itching, crusty eyelids, blurry vision or pain from bright light.

Other symptoms of reactive arthritis include:

• Feeling tired or unwell.
• Fever.
• Weight loss.
• Diarrhea and belly pain.
• Small sores in the mouth.
• In men, small sores on the penis that do not hurt.
• A skin rash of red, raised bumps, usually on the palms or the soles of the feet. The bumps may join to form a larger, scaly rash. Doctors call it keratoderma blennorrhagica.
• Thick nails.

The symptoms often go away on their own within a few weeks or months. But in some people, they last a long time.

Causes of Reactive Arthritis

An infection sets off reactive arthritis. It is often a bacterial infection spread through sex or food. But reactive arthritis is separate from the infection. It usually starts after the infection is gone. The bacteria that often set it off are Salmonella, Yersinia, Campylobacter, Shigella and Chlamydia. But only a small number of people infected with them get reactive arthritis. Scientists do not fully understand why some people are more likely to get it.

Genes seem to explain part of it. Many people with reactive arthritis have a gene called HLA-B27. But many people who get it do not have this gene. So other genes and other outside factors that are not yet known must also play a part.

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Diagnosis of Reactive Arthritis

No single test can show that you have reactive arthritis. But your doctor may think you have it if you have joint pain and have had an infection of the gut, urinary tract or genitals in the past few weeks.

Other types of spondyloarthritis can cause the same symptoms. Your doctor may need to rule them out:

• Psoriatic arthritis.
• Ankylosing spondylitis.
• Arthritis linked to inflammatory bowel disease.
• Undifferentiated spondyloarthritis, which means a mix of symptoms that does not fit one type.

To diagnose reactive arthritis, doctors usually take the steps below.

Health history and physical exam. During the exam, your doctor usually:

• Asks about your symptoms and when they started. This includes signs of a recent infection.
• Checks your joints for soreness or swelling. They also check your skin, mouth and other moist linings of the body for rashes or sores.
• Checks your eyes for signs of swelling.

Lab tests. Your doctor may order these tests:

• HLA-B27. This blood test looks for HLA-B27, a gene that raises the risk of reactive arthritis. Having it fits with reactive arthritis, but it does not prove it. People who test negative can still have reactive arthritis. And not everyone who tests positive has it.
• Bacterial cultures. Stool and urine samples are tested for bacteria that often set off reactive arthritis. But a negative result does not rule it out. In most cases, the infection is gone by the time joint symptoms start.
• Joint fluid (synovial fluid) test. This test shows how much swelling is in the joint. It also helps rule out other causes of pain, such as a joint infection or gout. Your doctor uses a needle to take fluid from a joint and sends it to a lab.
• Sed rate (ESR) and C-reactive protein. These blood tests measure inflammation. But they do not point to reactive arthritis alone. A high result can mean any disease that causes inflammation. A normal result does not rule out reactive arthritis. These levels are usually not high in the long-lasting form of the disease.

Scans. Your doctor may order these scans:

• X-rays can show the state of the joints. They can show signs of reactive arthritis, such as swelling of the sacroiliac joints in the lower back. They can also help rule out other causes of joint pain. But X-rays often do not show changes until later in the disease.
• Ultrasounds, CT scans and MRIs. These scans help most for seeing joint changes early in the disease.

Other tests. To rule out diseases with the same symptoms, your doctor may order other blood tests, such as:

• Tests for rheumatoid factor (RF) and anti-CCP antibodies. These are linked to rheumatoid arthritis.
• An antinuclear antibody (ANA) test. This is linked to lupus.

Treatment of Reactive Arthritis

Reactive arthritis has no cure. So treatment aims to ease the symptoms. Doctors fit treatment to each person’s symptoms. Your doctor might use one or more of the following.

Medicines:

• Anti-inflammatory and pain medicines, from the store or by prescription. These can ease pain and swelling in the joints.
• Corticosteroids. These are usually given as shots into the joints that hurt. If many joints are affected, your doctor may give them by mouth or through a vein (IV). They are strong medicines, so doctors give the lowest dose that works. You may need corticosteroid creams for skin symptoms or eye drops for eye symptoms.
• Disease-modifying antirheumatic drugs (DMARDs). These medicines calm the whole immune system. This helps stop swelling in the joints and other tissues. Doctors usually use them only when anti-inflammatory medicines and corticosteroids have not worked.
• Antibiotics. Your doctor may prescribe them if you still have a bacterial infection.

Physical therapy. Physical therapy can ease pain and help your joints work better. A physical therapist can teach you ways to strengthen the muscles around a joint. This gives the joint support and helps it bend and move more easily.

Who Treats Reactive Arthritis?

Diagnosing and treating reactive arthritis usually takes a team of health care workers. The main doctors who treat it are:

• Rheumatologists. They are experts in arthritis and other diseases of the bones, joints and muscles.

Other specialists may also help with your care:

• Dermatologists, who treat problems with the skin, hair and nails.
• Gynecologists, who treat the female reproductive organs.
• Mental health professionals. They help people cope with problems at home and at work that may come from their health.
• Occupational therapists. They teach ways to protect your joints, ease pain, do daily tasks and save energy.
• Eye doctors (ophthalmologists), who treat eye problems.
• Orthopaedists, who treat bone and joint diseases and do surgery on them.
• Physical therapists. They help you live better through exercise, hands-on care and teaching.
• Primary care doctors, such as family doctors or internal medicine doctors. They help your providers work together and treat other problems as they come up.
• Urologists, who treat diseases of the urinary tract and the male reproductive organs.

Living With Reactive Arthritis

You can do some things to help you live with reactive arthritis:

• Balance rest and exercise. Exercise keeps your muscles healthy and strong. It also helps your joints move and stay flexible. Check with your doctor before you start to exercise.
• Use heat and cold to ease joint pain. Heat brings more blood to the area, helps you handle pain and helps you bend. Cold numbs the nerves around the joint to ease pain.
• Use a cane or walker to help you get around safely and with less pain.
• Use shoe inserts or braces to support your joint. They can ease pain and pressure on the area. This can help when you stand or walk.
• See a mental health professional if you have emotional problems. Living with a painful disease like reactive arthritis can be hard.

Be sure to see your health care providers regularly and follow their advice.

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