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Stories for Reprint
Reactive Arthritis is a Rare but Serious Condition
By Petya Eckler, MARRTC Staff
When adults and children contract bacteria such as salmonella, hepatitis, strep or Chlamydia, a win over the infection usually means they are healthy again and free of worries. But in a small fraction, the infection may trigger a type of arthritis which appears between one and three weeks afterwards. This arthritis is usually temporary. For some, though, the arthritis lingers on and becomes a chronic condition.
This condition is called reactive arthritis and is a common type of inflammatory arthritis in young men. Women can also get it, though less often and with milder symptoms. Inflammatory arthritis causes pain, warmth, and swelling in joints, as opposed to degenerative arthritis that occurs in the joints of older adults as a result of wear and tear.
Symptoms of reactive arthritis are joint pain, the urgent need to urinate and burning with urination, conjunctivitis, also commonly known as pink eye, and a raised crusted rash on the soles of the feet that looks like psoriasis. In rare cases, there is even involvement of the aorta, the big blood vessel that carries blood away from the heart.
Because only a small number of people are affected with reactive arthritis, there's still little research on the disease, says Dr. Ross Petty, pediatric rheumatologist at British Columbia's Children's Hospital at University of British Columbia in Vancouver, Canada.
"It's one of those diseases which in most instances comes and goes... so people think it's not that important," he said. "Unfortunately, in a segment of people who get reactive arthritis it doesn't go and it is important."
Another reason for the low level of interest among scientists is the fact that by the time people develop the arthritis, the infection that has caused it has already gone and it's very hard to map out exactly what that infection was, Petty said.
"The microbiologic studies might not be very revealing and I think that has discouraged people as well," he said.
Still, reactive arthritis needs to be studied, according to Petty, especially in its chronic form.
"I think the big question is what makes the arthritis stay around and cause damage," he said.
Factors that can turn the arthritis from a one-time occurrence to a chronic condition are the bacteria that cause the initial infection, a person's genetic predisposition and the interaction between the two.
"If we can understand that we can predict who's going to have a long-term problem and do something about it to prevent the long term problem from happening," Petty said.
One factor that predisposes a person to develop reactive arthritis is an inherited trait known as human lymphocyte antigen (HLA) B27. HLA B27 is present in about 10 percent of healthy Caucasians. However, only a small fraction of those will develop reactive arthritis. Those who do have HLA B27 are not especially prone to develop infection, but they are more likely to develop reactive arthritis following infections with certain bacteria or viruses.
Most children with reactive arthritis have only a single episode and very few go on to have the chronic form. The chance of getting reactive arthritis is also influenced by nationality and geography. While the disease is quite rare in the United States, it's the most common kind of arthritis among children in the Scandinavian countries and that may be due to both genetic and environmental factors, Petty said.
The connection between arthritis and common infections in children should not panic parents though, Petty warns, and parent should never think that their children are going to get arthritis after every episode of infection.
"They [parents] should never think when they get an infection, that they're going to get arthritis. They should think that if their child has a painful joint for any period of time, they should seek the advice of a pediatric rheumatologist who knows and will recognize what this disease is," he said.
"When a diagnosis is made they shouldn't panic, because they should recognize that it can be treated and almost always damage to the joints prevented, so that the child's long term quality of life is fine. The important thing is to get early treatment from a competent physician who knows what they are doing."
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