What is Reactive Arthritis

Reactive arthritis

What is Reactive Arthritis:

Reactive arthritis, formerly known as Reiter's syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can trigger the disease. By the time the patient presents with symptoms, often the "trigger" infection has been cured or is in remission in chronic cases, thus making determination of the initial cause difficult.

The arthritis often is coupled with other characteristic symptoms; this was previously referred to as Reiter's syndrome, Reiter's disease or Reiter's arthritis. The term "reactive arthritis" is preferred and increasingly used as a substitute for this designation because Hans Conrad Julius Reiter was not the first to describe the syndrome, his conclusions regarding its pathogenesis were incorrect, and because he committed war crimes as a Nazi at Buchenwald concentration camp during World War II.

The manifestations of reactive arthritis include the following triad of symptoms: an inflammatory arthritis of large joints, inflammation of the eyes in the form of conjunctivitis or uveitis, and urethritis in men or cervicitis in women. Arthritis occurring alone following sexual exposure or enteric infection is also known as reactive arthritis. Patients can also present with mucocutaneous lesions, as well as psoriasis-like skin lesions such as circinate balanitis, and keratoderma blennorrhagicum. Enthesitis can involve the Achilles tendon resulting in heel pain. Not all affected persons have all the manifestations.

The clinical pattern of reactive arthritis commonly consists of an inflammation of fewer than five joints which often includes the knee or sacroiliac joint. The arthritis may be "additive" (more joints become inflamed in addition to the primarily affected one) or "migratory" (new joints become inflamed after the initially inflamed site has already improved).

Causes:

Reactive arthritis is associated with the HLA-B27 gene on chromosome 6 and by the presence of enthesitis as the basic pathologic lesion  and is triggered by a preceding infection. The most common triggering infection in the US is a genital infection with Chlamydia trachomatis. Other bacteria known to cause reactive arthritis which are more common worldwide are Ureaplasma urealyticum, Salmonella spp., Shigella spp., Yersinia spp., and Campylobacter spp. 

A bout of food poisoning or a gastrointestinal infection may also precede the disease (the last four genera of bacteria mentioned above are enteric bacteria). Shigella is the most common organism causing reactive arthritis following diarrhea. Chlamydia trachomatis is the most common cause of reactive arthritis following urethritis. Ureaplasma and mycoplasma are rare causes. There is some circumstantial evidence for other organisms causing the disease, but the details are unclear. 

Reactive arthritis usually manifests about 1–3 weeks after a known infection. The mechanism of interaction between the infecting organism and the host is unknown. Synovial fluid cultures are negative, suggesting that reactive arthritis is caused either by an autoimmune response involving cross-reactivity of bacterial antigens with joint tissues or by bacterial antigens that have somehow become deposited in the joints.

Can reactive arthritis be permanently cured?

One type of treatment that has anti-inflammatory benefits which relieves pain in the joints and muscles is whole body cryotherapy. During this treatment, the user wears only underwear, gloves, and boots/socks in a cryo chamber. Once inside, they are enveloped with freezing liquid nitrogen, a dry cold that eventually reaches around -200 degrees Fahrenheit (-130 Celsius). This triggers a survival response in the body, in which anti-inflammatory molecules are released, reducing swelling and inflammation. Blood flow is restricted to the hands and feet, and goes to the core where there are the body’s nutrients.

When the patient steps out of the chamber, this nutrient- rich blood flows back into the rest of the body. The body will feel energized, and in less pain than before because of the effects of the cold. The cold will have soothed the joints and muscles in the body to relieve some of the pain. It’s similar to the effects of an ice bath, but is faster and colder than this more traditional treatment. Whole body cryotherapy is best used multiple times to relieve the pain over the long run. So, it is useful for chronic conditions.

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