Reactive arthritis is joint pain and swelling triggered by an infection in another part of the body, most often intestines, genitals or urinary tract. Reactive arthritis usually targets knees, ankles and the joints of the feet. Inflammation also can affect eyes, skin and urethra.
The infection usually occurs days to weeks before the onset of joint pain. In some cases, a preceding infection may only be identified with laboratory testing. Previously, reactive arthritis was sometimes called Reiter’s syndrome, which was characterized by eye, urethra and joint inflammation.
Signs and symptoms
- Pain and stiffness in joints, especially knees, ankles and feet
- Eye inflammation like conjunctivitis
- Urinary problems like increased frequency and discomfort during urination
- Inflammation of soft tissues like muscles, tendons and ligaments
- Swollen toes or fingers
- Skin problems including a rash on the soles and palms and mouth sores
- Low back pain
Causes
Infection by certain bacteria. Most often, these bacteria are in the genitals (Chlamydia trachomatis) or the bowel (Campylobacter, Salmonella, Shigella and Yersinia).
Pathophysiology
The bacteria induce (cause) arthritis by distorting body’s defence against infections, as well as the individual’s genetic environment
Reactive arthritis is an immune-mediated syndrome triggered by a recent infection. It is hypothesized that T lymphocytes are induced by bacterial fragments such as lipopolysaccharide and nucleic acids when invasive bacteria reach the systemic circulation. These activated cytotoxic-T cells then attack the synovium and other self-antigens through molecular mimicry. This is supported by the evidence of Chlamydia trachomatis and C pneumoniae ribosomal RNA transcripts, enteric bacterial DNA, and bacterial degradation products in the synovial tissue and fluid. It is believed that anti-bacterial cytokine response is also impaired in reactive arthritis, resulting in the decreased elimination of the bacteria. It is, however, unclear why such localization of inflammation occurs.
The prevalence of HLA-B27 in reactive arthritis is estimated at 30% to 50% in patients with reactive arthritis, although values range widely. In hospital-based studies with more severely affected patients, frequencies as high as 60% to 80% have been reported. HLA-B27 should not be used as a diagnostic tool for a diagnosis of acute reactive arthritis. The presence of HLA-B27 is believed to potentiate reactive arthritis by presenting bacterial antigens to T cells, altering self-tolerance of the host immune system, increased TNF-alpha production, promoting the invasion of microbes in the gut, and delayed clearance of causative organisms.
Initially, the dermal histopathological features of reactive arthritis are similar to psoriasis. Examination of the synovial fluid reveals large macrophages, Reiter cells with phagocytosed neutrophils, lymphocytes, and plasma cells. Extensive pannus formation is very rare.
Diagnosis
Diagnosis is largely based on symptoms of the inducing infections and appearance of typical musculoskeletal (joint and muscle) involvement.
Blood tests are done for any infection and all types of arthritic conditions.
If indicated, doctors might order a test for Chlamydia infection or test for the HLA-B27 gene
Treatments
Treatment for the infection consists mainly of antibiotics. Other medications used to treat reactive arthritis include:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Corticosteroids
- Topical steroids
- Rheumatoid arthritis medications such as sulfasalazine (Azulfidine), methotrexate (Trexall) or etanercept (Enbrel)
Physical therapy is found beneficial in the management of reactive arthritis to improve the flexibility of joints & to reduce stiffness.
Prognosis
Follows a typically self-limited course, with resolution of symptoms by 3-12 months.
Complications
- Recurrent arthritis (15-50%)
- Chronic arthritis or sacroiliitis (15-30%)
- Ankylosing spondylitis (30-50% of HLA-B27–positive patients)
- Urethral stricture
- Aortic root necrosis
- Secondary glaucoma
- Cataracts
- Cystoid macular edema
- Posterior and anterior synechiae
- Cyclitic membrane
- Vitreous opacification
- Ankylosing spondylitis
- Psoriatic arthritis
- Sacroiliitis
- Erythroderma (rare)
Disease & Ayurveda
Considering the clinical features & presentation, the disease reactive arthritis can be compared with aamavata described in Ayurveda classic texts.
Nidana
Incompetent and unwholesome diet with opposite potency
Improper body postures & movements
Loss of appetite & digestive power
Exercise immediately after highly unctuous & oily food
Sedentary lifestyle
Purvaaroopa
Dourballya – Tiredness/Fatigue
Hrudayasya gauravam – Heaviness of chest
Samprapti
The ama produced due to defective digestion & sedentary lifestyle, gets lodged in the site of sleshma (Kapha) like joints with the help of Vaata and produce symptoms of Aamavaata.
Lakshana
Angamarda – bodyache
Aruchi – Loss of taste sensation
Thrishna – Excessive thirst
Alasyam – Lethargy/laziness
Gauravam – Heaviness of the body
Jwara – Fever
Apaaka – Indigestion
Soonata – Oedema
Divisions
It can develop by the vitiation of Vaata, Pitta, Kapha individually (ekadoshaja), or any two of them together(dwidoshaja) or all the three doshas vitiated together(tridoshaja).
Prognosis
Saadhya – only one dosha vitiated
Yaapya – two doshas involved
Asadhya – All doshas involved & the disease affected all over the body.
Chikithsa
Ayurveda treatment for Aamavaata is completely different from other joint diseases. Use of any snehadravya like oils/ghee will aggravate all the symptoms in this disease. So, only langhana(weight reducing therapy like fasting)and Rookshana(drying up therapies with medicines & treatment procedures) are recommended.
Samana
Lepana with rookshadravyas like kolakulathadi choorna
Parisheka with soolaharakwatha like dasmoolakwatha
Aamapachanam with shaddharanam choornam etc
Agnideepanam with gandharvahastadi kwatham etc
Vyadhivipareeta chikithsa
Sodhana
Langhana
Swedana
Virechana
Snehapanam
Vasti especially kshaaravasti
Commonly used medicines
Amruthotharam kashayam
Rasnasunthyadi kashayam
Yogarajaguggulu
Shaddharanam choornam
Guggulutiktakam ghrutam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Home remedies
No home remedies are proven to cure reactive arthritis. But a healthy diet and lifestyle will be helpful to improve the quality of life.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha and cause respiratory problems
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, honey
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Protect yourself from cold climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle.
Yoga
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/books/NBK499831/#_article-28255_s5_
The objectives of this study were to investigate and validate individual variables and to develop a composite score for disease activity measurement in patients with reactive arthritis (REA). In the first cross‐sectional part, the clinical and laboratory evaluation of 45 patients was used to elaborate the most important individual disease activity measures. In the second prospective part, these variables as well as a composite score for disease activity measurement of REA were prospectively validated in 23 patients at two points in time.The following variables emerged as the most useful for the composite measure: number of swollen and tender joints, patient’s pain and global assessment, and C‐reactive protein. The score was calculated by simple addition of the individual figures.
It was concluded that DAREA constitutes a reliable score which can easily be assessed on a day‐to‐day office work basis.
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
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