Neurologist

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Reactive Arthritis (cont.)

How is reactive arthritis diagnosed?

There is no single lab test used to diagnose reactive arthritis. Reactive arthritis is diagnosed based upon recognition of the combination of arthritis with inflammation of the eyes, and the genital, urinary, and/or gastrointestinal systems. The doctor obtains a medical history to note the time course of possible infection in the genital or urinary tracts, or the bowel. Stiffness and pain are monitored. Inflammatory types of joint problems typically cause more stiffness in the morning. Blood tests such as a “sedimentation rate” may be obtained to document the presence of inflammation in the body. The rheumatoid factor, which is typically present in rheumatoid arthritis, is usually negative in reactive arthritis. The HLA-B27 gene marker blood test can be helpful, especially in the diagnosis of patients with spine disease.

X-rays of the spine or other joints can reveal typical changes of inflammation in these areas but generally not until later in the disease. Occasionally, there are areas of unusual calcifications at the points where the tendons attach to the bones, indicating past inflammation in these areas. Those patients with eye inflammation may require ophthalmology evaluation to document the degree of inflammation in the iris. Stool cultures might be obtained to detect the presence of infections in the bowel. Similarly, urinalysis and culture of the urine may be necessary to detect bacterial infection in the urinary tract. The prostate gland, which can also be inflamed in a patient with reactive arthritis, may be examined for tenderness.

How is reactive arthritis treated?

Treatment of reactive arthritis is based on where it has become manifest in the body. For joint inflammation, patients are generally initially treated with nonsteroidal antiinflammatory drugs (NSAIDs). These medications include aspirin, indomethacin (Indocin), tolmetin (Tolectin), sulindac (Clinoril), piroxicam (Feldene), and others. Among their potential side effects are gastrointestinal irritation, including ulceration and bleeding. They should be taken with food to minimize this risk. Corticosteroids, such as prednisone, can be helpful to reduce inflammation and are used in the short-term treatment of inflammation in reactive arthritis. They can be given by mouth or by local injection into the joint. They are also used to decrease tendon inflammation in some forms of tendinitis.

Sulfasalazine (Azulfadine) has been shown to be effective in some patients with persistent reactive arthritis. Potential side effects of this sulfa-based medication include sulfa rash reaction and suppression of the bone marrow. Therefore, blood counts are monitored when Azulfidine is used long-term.

For the aggressive inflammation of chronic joint inflammation in reactive arthritis, medications that suppress the immune system, including methotrexate (Rheumatrex, Trexall), are used. Methotrexate can be given orally by injection. It is given on a weekly basis and requires regular monitoring of blood counts and blood liver tests because of potential toxicity to the bone marrow and liver.

Reactive arthritis has been reported in association with HIV infection (AIDS virus). In this context, immune suppression medicine is generally avoided because of the potential for worsening the HIV disease.

Eye inflammation can be alleviated with antiinflammatory drops. Some patients with severe iritis require local injections of cortisone to prevent damaging inflammation to the eye, which can lead to blindness.

The inflammation around the penis can be helped by cortisone creams (such as Topicort). When bacteria are discovered in the bowel or urine, antibiotics specific for those bacteria are given.

What does the future hold for reactive arthritis?

In the future, new medications will be developed that are more specific in the treatment of reactive arthritis. Trials with long-term antibiotic treatment are under way, and it is possible that these may be especially effective in reactive arthritis that is associated with Chlamydia infection.

The TNF-blockers, such as etanercept (Enbrel) and infliximab (Remicade) have potential for treating severe, resistant reactive arthritis. These drugs may improve both the joint and non-joint areas of inflammation. Further studies of these drugs are underway.

Reactive Arthritis At A Glance
  • Reactive arthritis involves inflammation of joints (arthritis), eyes (conjunctivitis), and the genital, urinary, or gastrointestinal systems.
  • Reactive arthritis can occur after genital (venereal) infection or bowel infection (dysentery).
  • Reactive arthritis shares many features with psoriatic arthritis, ankylosing spondylitis, and the arthritis of Crohn’s disease and ulcerative colitis.
  • Reactive arthritis can affect the joints, the spine, the eyes, urinary tract, mouth, colon, and heart.
  • There is no single laboratory test for diagnosing reactive arthritis. HLA-B27 genetic marker is commonly found in the blood.
  • Treatment of reactive arthritis is directed toward the specific body area(s) inflamed or affected.

Featured: Reactive Arthritis Main Article
Reactive arthritis is a chronic, systemic rheumatic disease characterized by three conditions, including conjunctivitis, joint inflammation, and genital, urinary or gastrointestinal system inflammation. Inflammation leads to pain, swelling, warmth, redness, and stiffness of the affected joints. Non-joint areas may experience irritation and pain. Treatment for reactive arthritis depends on which area of the body is affected. Joint inflammation is treated with antiinflammatory medications.

Medications

View All 11 Reactive Arthritis Medications »

Doctor’s & Expert’s Views

Procedures & Tests

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Related Diseases & Conditions

View All 10 Reactive Arthritis Related Diseases & Conditions »

Health Features

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Glossary



Terms related to Reactive Arthritis:

  • Arthritis, Reactive
  • Arthritis, Reiters
  • Reiter Disease
  • Seronegative Spondyloarthropathy
  • Spondyloarthropathy
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September 10, 2009 - Posted by | 1

2 Comments »

  1. Hey very nice blog!!….I’m an instant fan, I have bookmarked you and I’ll be checking back on a regular….See ya 🙂

    Comment by RobD | October 6, 2009 | Reply

  2. Hey, I found your blog in a new directory of blogs. I dont know how your blog came up, must have been a typo, anyway cool blog, I bookmarked you. 🙂

    Comment by Bill Bartmann | October 9, 2009 | Reply


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