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Uncovering the mysterious root of reactive arthritis: How does it go from infection to arthritis?
Reactive arthritis, formerly known as Reiter syndrome, is a type of inflammatory arthritis caused by infection elsewhere in the body. Once the lymph node infection enters the body, it may trigger the disease. However, by the time patients finally develop symptoms, the initial "trigger" infection has often healed or gone into remission, making tracing the cause difficult. Reactive arthritis is often associated with other characteristic symptoms, and the condition was renamed after Hans Reiter's war crimes with the Nazi Party.
The classic presenting triad of reactive arthritis includes inflammation of large joints, inflammatory conjunctivitis or uveitis, and urethritis in men or cervicitis in women.
The pathological mechanism of reactive arthritis is related to the HLA-B27 gene and is usually caused by genitourinary system or intestinal infection. It is more common in people aged 20 to 40 years old, and the number of men is also higher than that of women. This disease may occur during epidemics, and HIV-infected individuals are at increased risk. Historically, cases spanning the First and Second World Wars have refocused awareness of this triad, also known as Fiessenger–Leroy–Reiter syndrome.
Symptoms and signs
Typical signs of reactive arthritis include blurred vision, pain when urinating, and swollen joints. The clinical mnemonics for this type of reactive arthritis are "can't see, can't pee, can't climb trees." Symptoms usually appear 1 to 3 weeks after infection, but may be delayed as long as 35 days.
The classic presentation of this condition begins with symptoms of urinary discomfort and later evolves into monoarthritis affecting large joints.
Patients may suffer from various problems caused by bacterial infections at the same time, such as vaginitis, cervicitis, etc. This symptom also accompanies Achilles tendinitis or plantar pain. Skin lesions are a common mixed condition, including annular balanitis in men.
Furthermore, reactive arthritis may also lead to heart problems, and about 10% of patients will develop related heart symptoms, including aortic reflux and pericarditis.
Causes and mechanisms
Reactive arthritis is often triggered by the HLA-B27 gene and a previous infection. The most common source of infection in the United States is reproductive tract infection caused by Chlamydia trachomatis. Globally, other bacteria that can cause the disease include Salmonella, Shigella, Proteus and other imported bacteria.
These bacterial infections often cause pathological reactions within 1 to 3 weeks, but the interaction mechanism between the infection and the host is still not fully understood.
Diagnosis and Treatment
The diagnosis of reactive arthritis mainly relies on clinical symptoms, especially joint swelling and pain. Urine and stool samples can be tested clinically to determine the cause.
In terms of treatment, it is important to find and eliminate the underlying source of infection, usually with antibiotics. If the infection is under control, nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to relieve symptoms. In severe cases, steroids or immunosuppressants may be needed.
Prognosis and Epidemiology
The prognosis of reactive arthritis varies among individuals and may be self-limiting, frequently relapsing, chronic, or progressive. Symptoms can last from a few weeks to six months in most patients. For 15% to 30% of patients, chronic arthritis or sacroarthritis may develop.
According to research, the incidence in female patients may be underestimated, making it difficult to estimate the actual incidence of the disease.
Obviously, reactive arthritis is a complex disease caused by infection. As medical research advances, our understanding of its causes, effects, and consequences is still being uncovered. Have you ever considered how joint problems caused by this infection can affect your daily life?
