Reactive arthritis

Diagnosis

The diagnosis for reactive arthritis starts with an assessment of medical history, including any recent illnesses or infections, performing a physical examination and several tests.

During a physical examination for reactive arthritis, the doctor will check for signs of joint inflammation (swelling, warmth and tenderness) as well as assess the range of motion of the spine and affected joints. The doctor may also check for any signs of eye inflammation and skin rashes.

• Imaging tests: The doctor may request for an X-ray to confirm the diagnosis. Other kinds of arthritis can be ruled out with X-rays. X-rays of the low back, pelvis, and joints can reveal any of the significant signs of reactive arthritis. Other imaging tests such as CT scan and MRI may be required in some cases.
• Blood tests: To aid in the diagnosis, a laboratory analysis of the blood may be required to check for inflammation signs, presence of genetic marker associated with reactive arthritis, antibodies linked to various kinds of arthritis, or evidence of a previous or ongoing infection.
• Joint aspiration tests: Joint aspiration, also known as arthrocentesis, can help the doctor determine the cause of swollen and painful joints. A needle may be used to extract fluid from an afflicted joint. This fluid will be sent to the lab for analysis to test for:
  • White blood cell count: Elevated levels of white blood cells may signify presence of inflammation or infection in the body.
  • Infections: Other joint infections may cause similar symptoms and potentially result in serious joint damage. If bacteria are present in the joint fluid, this could indicate septic arthritis.
  • Crystals: This is to rule out other possible reasons of pain, such as gout. Gout is an extremely painful type of arthritis that commonly affects the big toe. Gout may be indicated by the presence of uric acid crystals in the joint fluid.

Treatment

The goal of treating reactive arthritis is to reduce symptoms and address the underlying bacterial infection. Typically, symptoms of reactive arthritis improve within three to six months of starting treatment. However, if new symptoms develop or the initial treatment is ineffective, the treatment plan may be modified over time.

• Medications: Several medications may be needed to treat the infection and manage the symptoms. Antibiotics may be prescribed for reactive arthritis caused by a bacterial infection.

Common medications used for reactive arthritis are:

• • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs can help alleviate the inflammation and pain associated with reactive arthritis. Indomethacin is a commonly prescribed NSAID.
  • Steroids. Steroid eye drops and creams may be used to treat eye problems and skin rashes, respectively. A steroid injection into the afflicted joints can lessen swelling and enables resumption of regular physical activity.
  • Rheumatoid arthritis drugs. Prescribed drugs on rheumatoid arthritis such as sulfasalazine, methotrexate, and etanercept may help with symptoms of reactive arthritis. It should be noted that there is still limited research to support the effectiveness of the treatment for reactive arthritis.
• Physical therapy: Strengthening exercises may improve joint function by strengthening the muscles surrounding the affected joints. To help the joints become more flexible and less stiff, range-of-motion exercises may be performed. For proper guidance, it is recommended to seek the advice of a physical therapist.