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Arthritis: Reactive Arthritis
Reactive arthritis, sometimes previously referred to as Reiter's syndrome, is a form of arthritis that, in addition to joints, also affects many other areas of the body including the eyes, urethra (the tube that carries urine from the bladder to the outside of the body), and skin.
The disease is recognized by a number of symptoms in different organs of the body that may or may not appear at the same time. It may come on quickly and severely or more slowly, with sudden remissions or recurrences.
Reactive arthritis primarily affects sexually active males between the ages of 20 and 40. Those with HIV (human immunodeficiency virus) are at a particularly high risk.
What Causes Reactive Arthritis?
The cause of reactive arthritis is still unknown, but research suggests the disease is caused by a combination of genetic predisposition and various other factors.
Approximately 75% of those with the condition have a positive blood test for the genetic marker HLA-B27, which suggests that the disease has a genetic component. In sexually active males, most cases of reactive arthritis follow infection with Chlamydia trachomatis or Ureaplasma urealyticum (both are common sexually transmitted diseases). In other cases, people develop the symptoms following an intestinal infection with shigella, salmonella, yersinia or campylobacter bacteria that cause food poisoning.
With the exception of using condoms during sexual activity, there is no known preventative measure for reactive arthritis.
What Are the Symptoms of Reactive Arthritis?
The first symptoms of reactive arthritis are painful urination and a discharge from the penis if there is inflammation of the urethra. More rarely diarrhea occurs if the intestines are affected. This is then followed by arthritis 4 to 28 days later. The arthritis usually affects the fingers, toes, ankles, hips and knee joints. Typically, only one or a few of these joints may be affected at one time. Other symptoms include:
- Mouth ulcers
- Inflammation of the eye
- Keratoderma blennorrhagica (patches of scaly skin on the palms, soles, trunk, or scalp)
- Back pain from sacroiliac (SI) joint involvement
- Pain from inflammation of the ligaments and tendons at the sites of their insertion into the bone (enthesitis)
How Is Reactive Arthritis Diagnosed?
Diagnosis of reactive arthritis can be complicated by the fact that symptoms often occur several weeks apart. A doctor may diagnose reactive arthritis when the patient's arthritis occurs together with or shortly following inflammation of the eye and the urinary tract and lasts a month or longer.
There is no specific test for diagnosing reactive arthritis, but the doctor may have the urethral discharge tested to check for sexually transmitted diseases. Stool samples may also be tested for signs of infection. Blood tests of reactive arthritis patients are typically positive for the HLA-B27 genetic marker, with an elevated white blood cell count and an increased erythrocyte sedimentation rate (ESR) -- both signs of inflammation. The patient may also be mildly anemic (having too few red blood cells in the bloodstream).
X-rays of the joints outside the back do not usually reveal any abnormalities unless the patient has had recurrent episodes of the disease. On an X-ray, joints that have been repeatedly inflamed may show areas of bone loss, signs of osteoporosis, or bony spurs. Joints in the back and pelvis (sacroiliac joints) may show abnormalities and damage from reactive arthritis.
WebMD Medical Reference provided in collaboration with the Cleveland Clinic
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Important Safety Information you should know about HUMIRA® (adalimumab).
Serious infections have happened in patients receiving HUMIRA. These infections include TB (tuberculosis) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections.
Before starting HUMIRA:
Tell your doctor if you think you have an infection, are being treated for an infection, have signs of an infection (such as a fever, cough, or flu-like symptoms), have any open sores on your body, have warm, red, or painful skin, get a lot of infections or have infections that keep coming back, have or had hepatitis B infection, take the medicine Kineret (anakinra), have TB or have been in close contact with someone who has TB, have lived in an area where TB or histoplasmosis is common, or were born in, lived in or traveled where there is more risk for getting TB. Your doctor should test you for TB before starting HUMIRA. If your doctor prescribes any medicine for the treatment of TB, you should start taking it before starting HUMIRA and take the full course of TB medicine prescribed.
Tell your doctor if you have any numbness or tingling, or have a disease that affects your nervous system such as multiple sclerosis or Guillain-Barré syndrome, have heart failure or other heart conditions, are scheduled for major surgery, are pregnant, become pregnant, plan to become pregnant or are breastfeeding. Tell your doctor if you are allergic to HUMIRA or any of its ingredients or are allergic to rubber or latex. The needle cover of the prefilled syringe and the pen contain dry natural rubber.
Also, tell your doctor if you have recently received or are scheduled for any vaccines. Except for live vaccines, patients may still receive vaccines while on HUMIRA. It is recommended that children with juvenile idiopathic arthritis be brought up to date with all immunizations prior to starting HUMIRA.
After starting HUMIRA:
Call your doctor right away if you get an infection, or any sign of an infection including a fever, feeling very tired, cough, flu-like symptoms, warm, red or painful skin or if you have any open sores on your body. HUMIRA can make you more likely to get infections or make any infection that you may have worse.
Possible side effects of HUMIRA:
Serious side effects, which sometimes lead to death, have happened in patients taking HUMIRA.
- Serious infections. These infections include TB (tuberculosis) and infections caused by viruses, fungi, or bacteria. Your doctor will examine you for TB and perform a test to see if you have TB. If your doctor feels that you are at risk for TB, you may be treated with medicine for TB before you begin treatment with HUMIRA and during treatment with HUMIRA. Even if your TB test is negative your doctor should carefully monitor you for TB infections while you are taking HUMIRA. Patients who had a negative TB skin test before receiving HUMIRA have developed active TB. Tell your doctor if you have any of the following symptoms while taking or after taking HUMIRA: cough, low-grade fever, weight loss, or loss of body fat and muscle.
- Certain types of cancer. There have been cases of certain kinds of cancer in patients taking HUMIRA or other TNF blockers. Patients with RA, especially more serious RA, may have a higher chance for getting a kind of cancer called lymphoma. Some patients receiving HUMIRA have developed types of cancer called non-melanoma skin cancer (basal cell cancer and squamous cell cancer of the skin), which are generally not life threatening if treated. Tell your doctor if you have a bump or open sore that doesn't heal.
- Allergic reactions. Signs of a serious allergic reaction include skin rash, a swollen face, or trouble breathing.
- Hepatitis B virus reactivation in patients that carry the virus in their blood. Tell your doctor if you have any of the following symptoms: feel unwell, poor appetite, fatigue, fever, rash or joint pain.
- Nervous system problems. Signs and symptoms include: numbness or tingling, problems with your vision, weakness in your arms or legs, and dizziness.
- Blood problems. Symptoms include a fever that does not go away, bruising or bleeding very easily, or looking very pale.
- New heart failure or worsening heart failure you already have. Symptoms include shortness of breath or swelling of your ankles or feet, or sudden weight gain.
- Immune reactions including a lupus-like syndrome. Symptoms include chest discomfort or pain that does not go away, shortness of breath, joint pain, or rash on your cheeks or arms that gets worse in the sun.
Call your doctor or get medical care right away if you develop any of the above symptoms. Your treatment with HUMIRA may be stopped.
Common side effects of HUMIRA are: injection site reactions (redness, rash, swelling, itching or bruising), upper respiratory infections (sinus infections), headaches, rash and nausea.
These are not all the side effects with HUMIRA. Ask your doctor or pharmacist for more information.
Information You Should Know About HUMIRA® (adalimumab).
HUMIRA is used to reduce the signs and symptoms of moderate to severe rheumatoidarthritis in adults, may prevent further damage to your bones and joints, and may help your ability to perform daily activities. HUMIRA can be used alone or with methotrexate or with certain other medicines. HUMIRA is used to reduce the signs and symptoms of moderate to severe polyarticular juvenile idiopathic arthritis in children 4 years of age and older. HUMIRA can be used alone or with methotrexate or with certain other medicines. HUMIRA is used to reduce the signs and symptoms of psoriatic arthritis in adults, may prevent further damage to your bones and joints, and may help your ability to perform daily activities. HUMIRA can be used alone or with certain other medicines. HUMIRA is used to reduce the signs and symptoms of ankylosing spondylitis in adults. HUMIRA is used to reduce the signs and symptoms of moderate to severe Crohn's disease in adults who have not responded well to conventional treatments. HUMIRA is also for these adults with moderate to severe Crohn's disease who have lost response or are unable to tolerate infliximab. HUMIRA is used to treat moderate to severe chronic (lasting a long time) plaque psoriasis in adults who are under the ongoing care of a physician, have the condition in many areas of their body and who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills).
HUMIRA is taken by injection.
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