What is reactive arthritis? Does the condition go away in all patients permanently or can it recur?
Reactive arthritis is an arthritis associated with pain and swelling that occurs 1 - 4 weeks after an infection. Reactive arthritis is characterized by asymmetric swelling in 4 or fewer joints. While most cases resolve on their own, some patients do get persistent disease or symptoms that remit and relapse. Many patients carry the genetic marker HLA-B27 which predisposes them to this condition. HLA-B27 is found in up to 80% of Caucasian patients with this condition but only 50% of African Americans.
What causes reactive arthritis? What are the symptoms of reactive arthritis?
This type of arthritis is the most common cause of inflammatory arthritis (pain plus swelling of the joints) in young men. Infections that may commonly cause reactive arthritis include sexually transmitted diseases such as chlamydia or HIV, as well as GI (gastrointestinal) pathogens causing diarrhea, such as shigella or salmonella. In addition to arthritis, patients may also develop rash, eye inflammation and urological symptoms.
How is reactive arthritis treated?
Treatment is directed toward the underlying infection as well as NSAIDs (nonsteroidal anti-inflammatory drugs) to help with the arthritis symptoms. Patients with persistent disease may require DMARDs (disease-modifying anti-rheumatic drugs) and biological DMARDs.
Is there any research which shows why not every infection causes reactive arthritis?
The answer to this can be quite technical. In essence, the occurence of arthritis to infections is based on the organisms involved and the individuals immune response to the foreign organism or bacteria. It is the immune response that contributes to the inflammatory reaction (i.e. arthritis). The expression of HLA-B27 on cell lines may modify the response of the immune cells to enable invasion by the disease causing bacteria.
Answers provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle of TNF Blockers. The book is useful for anyone on one of the biologic drugs (Enbrel, Remicade, Humira) or considering the biologic drugs. Read our review of the book.