Reactive arthritis (ReA) is an autoimmune condition that develops in response to an infection in another part of the body. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings M00-M99 - Diseases of the Musculoskeletal system and Connective tissue (M00-M25 Arthropathies (M00-M03 Infectious arthropathies The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Autoimmunity is the failure of an organism to recognize its own constituent parts as self, which results in an immune response against its own cells and tissues Coming into contact with bacteria and developing an infection can trigger reactive arthritis. ^[1] It has symptoms similar to various other conditions collectively known as "arthritis," such as rheumatism. Arthritis (from Greek arthro-, joint + -itis, inflammation plural arthritides is a group of conditions involving damage to the Joints of the body Rheumatism or Rheumatic disorder is a non-specific term for medical problems affecting the Heart, Bones Joints Kidney, Skin It is caused by another infection and is thus "reactive", i. e. , dependent on the other condition. The "trigger" infection has often been cured or is in remission in chronic cases, thus making determination of the initial cause difficult.

The symptoms of reactive arthritis very often include a combination of three seemingly unlinked symptoms—an inflammatory arthritis of large joints, inflammation of the eyes (conjunctivitis and uveitis), and urethritis. A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from Rheumatoid arthritis ( RA) is a chronic systemic autoimmune disorder that causes the Immune system to attack the Joints, where Conjunctivitis (commonly called " Pink Eye " or " Red Eye " in North America and " Madras eye " in India) is an inflammation Uveitis specifically refers to Inflammation of the middle layer of the Eye, termed the " Uvea " but in common usage may refer to any inflammatory Urethritis is inflammation of the Urethra. The main symptom is Dysuria, which is painful or difficult urination A useful mnemonic is "the patient can't see, can't pee and can't climb a tree". A mnemonic device (nəˈmɒnɪk is a Memory aid Commonly met mnemonics are often verbal something such as a very short poem or a special word used to help a person remember Formerly known as Reiter’s syndrome, after German physician Hans Reiter, it is also known as arthritis urethritica, venereal arthritis and polyarteritis enterica. Dr Hans Conrad Julius Reiter ( February 26, 1881 –1969 was a German physician convicted of War crimes for his medical experiments at the concentration It is a type of seronegative spondyloarthropathy.

Reactive arthritis is an RF-seronegative, HLA-B27-linked spondyloarthropathy (autoimmune damage to the cartilages of joints) often precipitated by genitourinary or gastrointestinal infections, some of which can be transmitted through sexual activities. Rheumatoid factor (RF or RhF is an Autoantibody ( Antibody direct against an organism's own tissues most relevant in Rheumatoid arthritis. Serotype Disease associations Spondylarthropathies The relationship between HLA-B27 and many diseases has not yet been fully elucidated Cartilage is a type of dense Connective tissue. It is composed of specialized cells called chondrocytes that produce a large amount of extracellular matrix A joint is the location at which two or more Bones make contact An infection is the detrimental Colonization of a host Organism by a foreign Species.

It most commonly strikes individuals aged 20-40, is more common in men than in women, and is more common in white men than in black men. This is owing to white individuals' being more likely to have tissue type HLA-B27 than black individuals. People with HIV have an increased risk of developing reactive arthritis as well. Human immunodeficiency virus ( HIV) is a Lentivirus (a member of the Retrovirus family that can lead to acquired immunodeficiency syndrome Food poisoning is a common cause. Foodborne illness (also foodborne disease) is any Illness resulting from the consumption of food

History

Reactive arthritis was first described by Hans Reiter, a German military physician, who in 1916 described the disease in a World War I soldier who had recovered from a bout of diarrhea, although the term has been found on Death Certificates dating back to 1877. Dr Hans Conrad Julius Reiter ( February 26, 1881 –1969 was a German physician convicted of War crimes for his medical experiments at the concentration Germany, officially the Federal Republic of Germany ( ˈbʊndəsʁepuˌbliːk ˈdɔʏtʃlant is a Country in Central Europe. World War I (abbreviated WWI; also known as the First World War, the Great War, and the War to End All In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea (George Sherman, 4/10/1877, died of "Reiters Disease" at Randalls Island, NYC) . The term Reiter's syndrome is being phased out, partly due to a move in the field of medicine to give descriptive names, rather than personal names, to conditions, and partly due to Dr. Reiter's experiments in Nazi concentration camps. See also List of Nazi-German concentration camps, Extermination camp Prior to and during World War II, Nazi Germany under Hitler maintained At least one reference states Reiter's syndrome is to be used when areas other than joints are affected.

Causes

It is set off by a preceding infection, the most common of which would be a genital infection with Chlamydia trachomatis in the US. An infection is the detrimental Colonization of a host Organism by a foreign Species. Chlamydia trachomatis, an obligate intracellular human pathogen is one of three bacterial species in the genus Chlamydia, family Chlamydiaceae Other bacteria known to cause reactive arthritis which are more common worldwide are Neisseria gonorrhoeae, Ureaplasma urealyticum, Salmonella spp. Neisseria gonorrhoeae, also known as Gonococci (plural or Gonococcus (singular is a species of Gram-negative kidney bean-shaped Diplococci Ureaplasma urealyticum is a Bacterium belonging to the family Mycoplasmataceae. Salmonella is a Genus of rod-shaped Gram-negative enterobacteria that causes Typhoid fever, Paratyphoid fever , Shigella spp. This article is about the bacteria For the disease see Shigellosis Shigella is a Genus of Gram-negative , Yersinia spp. Yersinia is a Genus of bacteria in the family Enterobacteriaceae. , and Campylobacter spp. The Genus Campylobacter, (meaning 'twisted bacteria' first discovered in 1963 describes Gram-negative, spiral Microaerophilic bacteria ^[2] A bout of food poisoning or a gastrointestinal infection may also trigger the disease (those last four genera of bacteria mentioned are enteric bacteria). Foodborne illness (also foodborne disease) is any Illness resulting from the consumption of food A genus (plural genera from Γένος Latin genus "descent family type gender" is a low-level Taxonomic Reactive arthritis usually manifests about 1-3 weeks after a known infection. The mechanism of interaction between the infecting organism and the host is unknown. Synovial fluid cultures are negative, suggesting that ReA is caused either by an over-stimulated autoimmune response or by bacterial antigens which have somehow become deposited in the joints.

Signs and symptoms

Symptoms generally appear within 1-3 weeks but can range from 4-35 days from the onset of the inciting episode of the disease.

The classical presentation is that the first symptom experienced is a urinary symptom such as burning pain on urination (dysuria) or an increased need for or frequency) of urination (polyuria. In Medicine, specifically Urology, dysuria refers to painful Urination. Frequency is a measure of the number of occurrences of a repeating event per unit Time. In Medicine, polyuria is a condition characterized by the passage of large volumes of urine (at least 2 Other urogenital problems may arise such as prostatitis in men, and cervicitis, salpingitis and/or vulvovaginitis in women. Prostatitis is an Inflammation of the Prostate gland in men A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits Inflammation of the tissues of the Cervix is known as cervicitis. Salpingitis is an Infection and Inflammation in the Fallopian tubes. Vaginitis is an Inflammation of the Vaginal Mucosa and often associated with an irritation or infection of the Vulva leading to vulvovaginitis

Diagnosis revealed that the rash on the bottom of this individual’s feet, known as keratoderma blennorrhagica, was due to Reiter's syndrome'-CDC/ Dr. M. F. Rein.

The arthritis that follows usually affects the large joints such as the knees causing pain and swelling with relative sparing of small joints such as the wrist and hand. Arthritis (from Greek arthro-, joint + -itis, inflammation plural arthritides is a group of conditions involving damage to the Joints of the body The knee is the lower extremity Joint connecting the Femur, Patella, and the Tibia. Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm

Eye involvement occurs in about 50% of men with urogenital reactive arthritis and about 75% of men with enteric reactive arthritis. Conjunctivitis and uveitis can include redness of the eyes, eye pain and irritation, or blurred vision. Conjunctivitis (commonly called " Pink Eye " or " Red Eye " in North America and " Madras eye " in India) is an inflammation Uveitis specifically refers to Inflammation of the middle layer of the Eye, termed the " Uvea " but in common usage may refer to any inflammatory Eye involvement typically occurs early in the course of reactive arthritis, and symptoms may come and go.

Roughly 20 to 40 percent of men with reactive arthritis develop penile lesions called balanitis circinata (circinate balanitis) on the end of the penis. Balanitis circinata (also known as circinate balantitis is a serpiginous annular Dermatitis associated with Reactive arthritis. A small percentage of men and women develop small hard nodules called keratoderma blennorrhagica on the soles of the feet, and less often on the palms of the hands or elsewhere. Keratoderma blennorrhagica (or keratosis blennorrhagica) are skin lesions commonly found on the palms and Soles but which may spread to the In addition, some people with Reactive Arthritis develop mouth ulcers that come and go. In some cases, these ulcers are painless and go unnoticed. Some people suffer serious gastrointestinal problems similar to those of Crohn's Disease.

About 10 percent of people with Reactive Arthritis, especially those with prolonged disease, will develop cardiac manifestations including aortic regurgitation and pericarditis. Pericarditis is an Inflammation ( -itis) of the Pericardium (the fibrous sac surrounding the heart

Commonly remembered with the mnemonic "Can't See, Can't Pee, Can't Climb a Tree". Alternatively, the final letters of Jack KeroUAC's name (a "Reiter") are an acronym for urethritis, arthritis and conjunctivitis.

Diagnosis

There are countless clinical symptoms, but the clinical picture is dominated by polyarthritis. Polyarthritis is any type of Arthritis which involves five or more joints &mdash an inflammation of two three or four joints is an Oligoarthritis. There is pain, swelling, redness, and heat in the joints. Pain, in the sense of physical pain, is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus or bodily harm A joint is the location at which two or more Bones make contact MRI's are effective for diagnosis.

The urethra, cervix and throat may be swabbed in an attempt to culture the causative organisms. In Anatomy, the urethra (from Greek ουρήθρα - ourethra) is a tube which connects the Urinary bladder to the outside of The cervix (from Latin "neck" is the lower narrow portion of the Uterus where it joins with the top end of the Vagina. In Anatomy, the throat is the anterior part of the Neck, in front of the vertebral column. A microbiological culture, AKA microbial culture, is a method of multiplying microbial organisms by letting them reproduce in predetermined culture media under controlled laboratory Cultures may be carried out on urine and stool samples. Urine is a liquid waste product of the body secreted by the Kidneys by a process of filtration from Blood and Excreted through the Urethra. Synovial fluid from an affected knee may be aspirated to look at the fluid under the microscope and for culture. Synovial fluid is a thick stringy fluid found in the cavities of Synovial joints With its egg-like consistency ("synovial" partially derives from ovum,

Also, a blood test for the gene HLA-B27 may be given to determine if the patient has the gene. Serotype Disease associations Spondylarthropathies The relationship between HLA-B27 and many diseases has not yet been fully elucidated About 75 percent of all patients with Reiter's Syndrome have the gene.

Treatment

The main goal of treatment is to identify and eradicate the underlying infectious source with the appropriate antibiotics if still present. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa Otherwise, treatment is symptomatic for each problem. Analgesics, steroids and immunosuppressants may be needed for patients with severe reactive symptoms that do not respond to any other treatment. A steroid is a Terpenoid Lipid characterized by a Carbon skeleton with four fused rings generally arranged in a 6-6-6-5 fashion An immunosuppressant is a substance that performs Immunosuppression of the Immune system.

Prognosis

Reactive arthritis may be self limiting, frequently recurring, chronic or progressive. Most patients have severe symptoms lasting a few weeks to six months. Approximately 15 to 50 percent of cases have recurrent bouts of arthritis. Chronic arthritis or sacroiliitis occurs in 15-30 percent of cases. Repeated attacks over many years is common, and more than 40 percent of the patients end up with chronic and disabling arthritis, heart disease, diabetes or impaired vision. Arthritis (from Greek arthro-, joint + -itis, inflammation plural arthritides is a group of conditions involving damage to the Joints of the body Heart disease is an Umbrella term for a variety for different diseases affecting the Heart. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc However, most people with reactive arthritis can expect to live normal life spans and maintain a near-normal lifestyle with modest adaptations to protect the involved organs. Life expectancy is the average number of years of life remaining at a given age

References

External links

• Reactive arthritis topic list - Merck Manual
• Reiter's Syndrome - WrongDiagnosis. com