Arthritis | causes, symptoms and treatment of arthritis

What is Reactive arthritis? reactive arthritis causes

Do you want to know about reactive arthritis causes?  Reactive arthritis is pain, stiffness, redness, or swelling in a joint resulting from a previous infection. This disease most often occurs in the joints of the lower limbs (knees, ankles, toes), but can also affect the upper limbs. The problems can occur only in the joints or affect other organs, such as the eyes, skin, muscles or tendons. (Learn more about reactive arthritis causes). 

What Causes Reactive Arthritis? reactive arthritis causes

Autoimmunity is understood to be the most important cause of reactive arthritis. When the causative bacteria reach the bloodstream, T cells are induced by splinters of bacterial cells, such as lipopolysaccharides.

The cytotoxic T lymphocytes attack the synovium (the tissue that lines the joint spaces). And this eventually leads to characteristic symptoms of the disease. Reactive arthritis usually occurs after infection of the intestines, urinary tract, or as a result of a sexually transmitted infection. (Learn more about reactive arthritis causes). 

For some reason, the infection seems to trigger the immune system to start attacking its own tissues. Creating an arthritis reaction.

Person experiences symptoms

Often, the initiating infection has been cured or is in remission (dormant) by the time a person experiences symptoms of reactive arthritis. Symptoms of arthritis usually appear 1 to 4 weeks after infection, probably around the 2 week mark (10-14 days). (Learn more about reactive arthritis causes). 

The most common triggers are intestinal infections that cause food poisoning. And / or diarrhea like Salmonella, Shigella, Campylobacter, Yersinia. Or Clostridium difficult, and sexually transmitted infections like chlamydia.

Scientists aren’t sure exactly why the immune system causes an arthritic reaction. But there appears to be a genetic component to the disease. About 75% of people with reactive arthritis have a gene called HLA-B27. This suggests that people with this gene have a genetic predisposition to develop the disease after infection.

Clinical Forms of reactive arthritis causes  

Reactive arthritis comes in two forms:

  • Reactive genitourinary arthritis: occurring between one to three weeks after a urogenital infection, most often due to Chlamydia trachomatis. The signs suggestive of a Chlamydia infection are primarily urinary disorders such as polyuria, dysuria or dyspareunia in women. The man may have prostatitis and the woman has symptoms of cervicitis, salpingitis and / or vulvovaginitis. (Learn more about reactive arthritis causes). 
  • Reactive digestive arthritis: it also appears between one and three weeks after food poisoning with Salmonella or Shigella most often. It is manifested by profuse diarrhea which may be mucus-bloody with fever.

Symptoms of reactive arthritis causes

Symptoms of reactive arthritis can be very typical of any inflammatory arthritis condition. At the onset of the disease, people may feel unwell, tired, and feverish. They may have headaches or lose weight. These early symptoms can also be caused by the recent infection triggering this form of arthritis. (Learn more about reactive arthritis causes). 

The disease usually occurs 1 to 4 weeks after an infection of the intestines. Urinary tract or as a result of a sexually transmitted infection (STI). Reactive arthritis tends to start very quickly and can be very severe. It most commonly affects the joints of the feet, ankles, knees and hips. They can become very stiff, swollen, sore, hot, and may be slightly red.

The disease can also cause inflammation of the lower back joints leading to back pain and stiffness. Inflammation in the tendons is also common. Reactive arthritis is often asymmetric, which means that it often affects only one side of the body. (Learn more about reactive arthritis causes). 

In reactive arthritis

some cases in our body, the toes may swell like sausages (this is called dactylitis). In reactive arthritis, often only one digit is affected. (Learn more about reactive arthritis causes). 

Other conditions that may be present with reactive arthritis include inflammation of the eye (conjunctivitis). And genital or urinary symptoms such as painful urination (urethritis) or pelvic pain in women. Men can sometimes have genital sores. In rare cases, a rash may occur and sores on the mouth or nose may develop.

After the first signs of reactive arthritis, the patient may also experience pain, swelling or tenderness in the large joints. It can affect the knee or large joints like the ankles or toes. Inflammation of the areas surrounding the joints, Achilles tendon, or lower back joints is also noteworthy. (Learn more about reactive arthritis causes). 

Reactive arthritis can also cause eye problems such as conjunctivitis, erythema, burning, tearing, or photophobia. Cases of irritates or uveitis are rarer. A person with this condition also has scaly rashes on the feet or hands, diarrhea, fever, mouth ulcers, or weight loss.

A large portion of people with this disease experience these symptoms for one to six months. Skin and eye conditions disappear on their own and do not require special treatment. (Learn more about reactive arthritis causes). 

 

Historical of reactive arthritis

Reactive arthritis remained before defined in 1916 World War. It was not until 1973 that Aho rationalized the concept of reactive arthritis. By defining them as reactive arthritis (without intra-articular germ) appearing in the weeks following a genitourinary or digestive infection. (Learn more about reactive arthritis causes). 

In fact, this concept of exclusively aseptic reactive arthritis has been successively shaken by various observations.

As early as the 1970s, the first studies revealed microscopic intracellular inclusions which could correspond to Chlamydia trachomatis. The main arthritogenic germ involved in reactive arthritis. (Learn more about reactive arthritis causes). 

For many years, the confirmation of this work has come up against the fact that. Most of these bacteria are very difficult to cultivate from synovial samples.

Biology techniques

Since the beginning of the 1990s, the explosion of new molecular biology techniques has enabled the detection by gene amplification or polymerase chain reaction (PCR) of tiny amounts of bacterial DNA in the joint.(Learn more about reactive arthritis causes). 

The discovery of messenger RNA from Chlamydia trachomatis by reverse. Transcriptase polymerase chain reaction (RT-PCR). Therefore suggests that germs could survive in small numbers in the joint cavity in certain reactive arthritis.

Since 1995, the phenomenon has been amplified with the discovery in synovial samples of reactive arthritis DNA of most of the other classical arthritogenic agents [3]. From year to year, the list of these arthritogenic agents grows.(Learn more about reactive arthritis causes). 

Pathophysiology Of Reactive Arthritis

Although the concept of reactive arthritis assumes remote infection of the joint, the persistence of arthritogenic bacteria in the body is a reality playing an important pathophysiological role in reactive arthritis. (Learn more about reactive arthritis causes). 

The persistence of bacteria can be at the site of the initial infection and / or within the joint. While all reactive arthritis is characterized by the persistence of bacterial antigens within the joint, chlamydial arthritis appears to be characterized by the persistence, at least in part, of Chlamydia in the synovial membrane. (Learn more about reactive arthritis causes). 

Specific nucleic acids

While in reactive post-digestive arthritis, searches for specific nucleic acids are usually negative. In the latter case the bacteria seem to persist alive in the intestinal wall and / or the mesenteric nodes. In the majority of cases, it appears that the monocytes play an important physio pathological role by transporting from the initial site of the infection to the joints, the living bacteria and / or bacterial components (nucleic acid and antigen). (Learn more about reactive arthritis causes). 

Localization of certain bacterial proteins could be at the origin of an arthrogenic peptide which presented by particular HLA class I molecules (HLA B27) to CD8 + T lymphocytes, could induce an immune reaction leading to arthritis.

In fact, it has been demonstrated that the adhesion molecules of certain batteries (Yersinia, Salmonella) use HLA B27 as ligand to attach themselves to cells in the synovial environment. In addition, certain genetically predisposed subjects, in particular HLA B27 +, would not have the capacity to normally eliminate infected macrophages, thus promoting the intra-articular persistence of the germ (Salmonella). (Learn more about reactive arthritis causes). 

 

Schematically, we can consider that there are two different situations:

Some reactive arthritis could be genuine chronic infectious arthritis linked to slow growing germs that are difficult or impossible to cultivate. These germs can survive in small numbers under conditions probably characterized by intermittent replication periods triggered by phenomena still unknown. (Learn more about reactive arthritis causes). 

These germs have an attenuated virulence, which differentiates them from the germs that trigger septic arthritis. Some reactive arthritis could be genuine aseptic arthritis. In this case, it is the persistence of bacterial antigens (lipopolysaccharides, heat shock proteins) which could explain the appearance of an inflammatory synovial reaction. (Learn more about reactive arthritis causes). 

What Are The Warning Signs Of Reactive Arthritis?

If you have reactive arthritis, you are likely to have the first signs of it within weeks of an infection, such as food poisoning or other bowel disease. It can also be chlamydia, a disease transmitted by an infected person during sex.

(It’s important to note that although the infection in question is transmissible, reactive arthritis itself cannot be passed from person to person). (Learn more about reactive arthritis causes). 

Signs of the disease include stiffness, pain, and swelling in a joint for no apparent reason. Additionally, the affected area may be red and warm to the touch. The pain and stiffness may be more severe in the morning. Usually, the disease attacks only one joint initially, but other joints can be affected over time. (Learn more about reactive arthritis causes). (Learn more about reactive arthritis causes). 

Most often, inflammation occurs in the lower limbs (knees, ankles, toes). You may also experience lower back pain if the condition affects your sacroiliac joints – the joints at the base of the spine, where it connects to the pelvis. If the joint problems persist, you may experience stiffness in the joints and muscle weakness, as well as difficulty in fully unfolding these joints.

Problems can also occur in other parts of the body, such as the tendons, skin and eyes. Some people experience pain in the heel, where the Achilles tendon attaches to the bone, or under the foot, where the tendons that support the arch of the foot attach to the heel. The eyes might also be sore or sensitive to sunlight. The mouth or genitals may be sore, painful or painless. (The inflammation associated with reactive arthritis that occurs in any of these places was formerly called Reiter syndrome). (Learn more about reactive arthritis causes). 

What Are The Treatment Options For Reactive Arthritis?

  • The main objectives of treatment include providing symptomatic relief and preventing disease progression. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the drugs of choice during the first stage. (Learn more about reactive arthritis causes). 

Glucocorticoids can be used, topically or as intra-articular injections, for inflammation. Oral glucocorticoids are in the main set aside for simple procedures of the disease. Antibiotic therapy is started in patients with active infection.

Disease-modifying antirheumatic drugs (DMARDs) are used in patients who do not respond to NSAID treatment. The role of biologics such as tumor necrosis factor (TNF) blocking agents in the treatment of reactive arthritis which is particularly severe is also being explored.

Reactive arthritis is a multi-organ disease. Its effective management involves a collaborative effort by a team of rheumatologists, gastroenterologists, ophthalmologists and allied health professionals.

Quality of life

Patient education also plays a major role in improving the quality of life of those affected. A healthy lifestyle and regular follow-up with specialists can help avoid further complications.

  • No steroidal anti-inflammatory drugs (NSAIDs) are usually essential for controlling pain and inflammation. Corticosteroids are sometimes needed intra-particularly. Antibiotics would make it possible to prevent relapses of reactive venereal arthritis quite effectively, so there was little argument in favor of the use of antibiotics, even in prolonged cures in reactive arthritis with a digestive entry point.

Treatment of genital infection

The treatment of genital infection and the search for other venereal diseases remain of course indicated in reactive chlamydial arthritis. Ciprofloxacin can be given in reactive yersine arthritis to eradicate  intestinal infection. The use of a single antibiotic is not sufficient to improve the course of reactive arthritis.

In the chronic forms of reactive arthritis resistant to NSAIDs, sulfasalazine and methotrexate are a therapeutic alternative, even if the intensity of their effect seems modest.

Reactive arthritis has recently been reported in a patient infected with HIV, under effective antiviral treatment resistant to methotrexate associated with corticosteroids, and in whom treatment with anti TNF has been effective. However, there is currently no official indication for TNF inhibitors in reactive arthritis despite their demonstrated efficacy in ankylosing spondylitis and psoriatic arthritis .

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