Related articles: Reactive arthritis
Definition
Reactive arthritis is an acute inflammation of the joints that is part of the spondyloarthropathy family.
This disease is often induced by an infection, generally urogenital (urethritis, cystitis and prostatitis) or gastro-intestinal (eg gastroenteritis); in practice, the inflammation of the joints represents a badly directed reaction towards an infection in the extra-articular site.
Two forms of reactive arthritis are more common: one sexually transmitted, the other dysenteric. In the first case, Chlamydia trachomatis genital tract infections are more frequently implicated. The dysenteric form can instead be contracted after intestinal infections caused mainly by Gram-negative bacteria, such as Shigella, Salmonella, Yersinia or Campylobacter . In both cases, reactive arthritis is probably the result of a joint infection or post-infectious inflammation.
A particular form of reactive arthritis is Reiter's syndrome, joint disease associated with enteritis / urethritis (or cervicitis), conjunctivitis and mucocutaneous lesions. The genetic predisposition contributes to the pathogenesis of the disease (many patients are HLA-B27 positive), although the mechanism by which it intervenes is not yet known.
Most common symptoms and signs *
- Asthenia
- Increase in the ESR
- Balanite
- Conjunctivitis
- dactylitis
- Diarrhea
- Dysuria
- Knee pain
- Pelvic pain
- Articolar pains
- Muscle pains
- Temperature
- Joint swelling
- Backache
- Weight loss
- Urethral leaks, sometimes visible only after squeezing the glans
- podagra
- Polyuria
- pollakiuria
- Rheumatism
- Joint stiffness
- Articular noises
- Scales on the skin
- Strangury
- Skin Ulcers
- Articular Pouring
- blisters
Further indications
Reactive arthritis usually occurs between the first and third week after a genitourinary or gastro-intestinal infection, manifesting itself with the characteristic triad consisting of arthritis, urethritis and conjunctivitis. These manifestations are of varying severity and can range from transient monoarticular inflammation to severe multi-system pathology.
Reactive arthritis causes pain, swelling, redness and heat in the joints. Joint involvement is generally asymmetrical and oligoarticular (ie affecting at most 4 joints) or polyarticular.
Inflammation most frequently involves the spine, sacroiliac joints and tendon insertions on the bone (note: enthesitis, tendinitis and plantar fasciitis are frequent and characteristic). However, the disease can affect many other parts of the body, including the joints of the lower limbs (knees and feet).
In the weeks following any sexual contact, urethritis may develop (with urethral secretions, pain and nuisance to urination and polyuria); prostatitis is also frequent in males and infections of the cervix, tubes and / or vulvovaginitis in females.
Conjunctivitis is the eye injury most commonly associated with reactive arthritis, but keratitis and anterior uveitis can also develop. Therefore, symptoms are possible, such as: eye redness and feeling of sand in the eyes, pain, photophobia and tearing.
Small superficial, transient and relatively painless mucocutaneous ulcers normally appear on the mucous membrane of the mouth, tongue and glans (circular balanitis). Particularly characteristic of reactive arthritis is the onset of blisters on the feet or hands, which become hyperkeratotic and form crusts (blennorrhagic keratoderma). In addition, systemic symptoms (modest fever, fatigue and weight loss), nail changes and lower back pain commonly occur.
Rarely, cardiovascular complications develop (eg aortitis, aortic insufficiency and cardiac conduction defects), pleurisy and CNS or peripheral symptoms.
The diagnosis is based on the recognition of the clinical triad typical of reactive arthritis (joint inflammation, urethritis and conjunctivitis).
The treatment aims to eradicate the triggering infection (by administering antibiotics) and relieve symptoms with analgesics, steroids and immunosuppressants associated with rest and specific exercises. The prognosis is variable.
Often, reactive arthritis resolves in 3-4 months, but about 50% of patients experience recurrent or long-lasting events. With a chronic or recurrent disease, continuous joint pain and vertebral or sacroiliac deformities may occur.
