Reactive Arthritis (cont.)
How is reactive arthritis diagnosed?
There is no single lab test used to diagnose reactive arthritis.
Reactive arthritis is diagnosed based upon recognition of the combination
of arthritis with inflammation of the eyes, and the genital, urinary,
and/or gastrointestinal systems. The doctor obtains a medical history to
note the time course of possible infection in the genital or urinary
tracts, or the bowel. Stiffness and pain are monitored. Inflammatory
types of joint problems typically cause more stiffness in the morning.
Blood tests such as a "sedimentation rate" may be obtained to
document the presence of inflammation in the body. The rheumatoid factor,
which is typically present in rheumatoid arthritis, is usually negative in
reactive arthritis. The HLA-B27 gene marker blood test can be helpful,
especially in the diagnosis of patients with spine disease.
X-rays of the spine or other joints can reveal typical changes of
inflammation in these areas but generally not until later in the disease. Occasionally, there are areas of unusual
calcifications at the points where the tendons attach to the bones,
indicating past inflammation in these areas. Those patients with eye
inflammation may require ophthalmology evaluation to document the degree
of inflammation in the iris. Stool cultures might be obtained to detect
the presence of infections in the bowel. Similarly, urinalysis and culture
of the urine may be necessary to detect bacterial infection in the urinary
tract. The prostate gland, which can also be inflamed in a patient with
reactive arthritis, may be examined for tenderness.
How is reactive arthritis treated?
Treatment of reactive arthritis is based on where it has become manifest
in the body. For joint inflammation, patients are generally initially
treated with nonsteroidal antiinflammatory drugs (NSAIDs). These
medications include aspirin, indomethacin (Indocin), tolmetin (Tolectin),
sulindac (Clinoril), piroxicam (Feldene), and others. Among their
potential side effects are gastrointestinal irritation, including
ulceration and bleeding. They should be taken with food to minimize this
risk. Corticosteroids, such as prednisone, can be helpful to reduce inflammation and are used
in the short-term treatment of inflammation in reactive arthritis. They can
be given by mouth or by local injection into the joint. They are also used
to decrease tendon inflammation in some forms of tendinitis.
Sulfasalazine (Azulfadine) has been shown to be effective in some
patients with persistent reactive arthritis. Potential side effects of this
sulfa-based medication include sulfa rash
reaction and suppression of the bone marrow. Therefore, blood counts are
monitored when Azulfidine is used long-term.
For the aggressive inflammation of chronic joint inflammation in reactive arthritis, medications that suppress the immune system, including
methotrexate
(Rheumatrex, Trexall), are used. Methotrexate can be given orally by
injection. It is given on a weekly basis and requires regular monitoring
of blood counts and blood liver tests because of potential toxicity to the
bone marrow and liver.
Reactive arthritis has been reported in association with HIV infection
(AIDS virus). In this context, immune suppression medicine is generally
avoided because of the potential for worsening the HIV disease.
Eye inflammation can be alleviated with antiinflammatory drops. Some
patients with severe iritis require local injections of cortisone to
prevent damaging inflammation to the eye, which can lead to blindness.
The inflammation around the penis can be helped by cortisone creams
(such as Topicort). When bacteria are discovered in the bowel or urine,
antibiotics specific for those bacteria are given.
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