Reactive arthritis: symptoms, treatment

Tells Evgeny Zhilyaev,

Professor, MD, Doctor of the highest category.

Reactive arthritis is a disease that is currently poorly understood. Its peculiarity lies in the fact that it is not only launched, but also supported by infections. Hereditary predisposition also plays an important role in the development of the disease.

It is necessary to distinguish between reactive and infectious arthritis. The causative agents of reactive arthritis are practically unable to cause septic infection, the transformation of reactive arthritis into sepsis is practically excluded. While infectious arthritis develops into sepsis quite often and poses a serious threat to the patient's life.

Due to the fact that reactive arthritis is difficult to differentiate from other types of arthritis, in some cases, a trial course of antibiotic therapy is offered at the initial stage. If the arthritis is indeed sustained by infection, it is possible to achieve long-term remission for many months or even years. The list of infections that can cause reactive arthritis is quite long and is increasing every year.

Symptoms

The symptoms of the disease from the patient's point of view do not differ from other arthritic conditions.

The main manifestations of reactive arthritis are:

• joint and spine damage;

• joint pain and swelling;

• lesion of the entheses (places where the tendon connects to the bone);

• dactylitis (inflammatory processes in the fingers of the hand or foot).

Treatment of reactive arthritis

In theory, it is assumed that reactive arthritis develops under the influence of infections that cause conditions such as urethritis, prostatitis, inflammation of the female genital organs, enteritis and colitis. However, when a patient has been ill for quite a long time and has intestinal problems, chronic prostatitis or other concomitant diseases for a long period of time, it is difficult to determine whether there is a link between these diseases and arthritis.

A significant part of the microbes that can cause reactive arthritis are very common. In particular, genital chlamydia (the most well-known causative agent of reactive arthritis), this infection is present in 35-50% of the population, but not all carriers suffer from arthritis, so detecting signs of chlamydia infection does not prove that it is the cause of arthritis.

A positive response to antibacterial therapy is indicative. If the patient's condition improves after taking the drug, there is reason to believe that in this case the arthritis is supported by infection. Two classes of antibiotics are used to treat reactive arthritis: tetracyclines and fluoroquinolones. In some cases, macrolides may be used.

Sometimes a correct diagnosis can only be made based on the patient's response to treatment. The effect of taking antibiotics does not appear immediately, as a rule, at least a month passes between the start of taking antibiotics and the first results. To achieve a lasting effect of treatment, a repeated course of antibacterial therapy is recommended, therefore, during the first course, additional treatment is usually prescribed to reduce symptoms and alleviate the patient's condition (anti-inflammatory drugs, local injections).

The European Medical Center (Moscow) has created all conditions for the diagnosis and treatment of reactive arthritis. It is important to accurately determine the form of the disease – this is a key factor for successful treatment. Otherwise, the disease may develop into chronic arthritis, which requires continuous treatment in the clinic, even in remission. 

EMC rheumatologists successfully treat arthritis (including reactive arthritis in children) and achieve multi-month and even multi-year drug-free remissions. 

Author: Evgeny Zhilyaev, Professor, MD, Doctor of the highest category.