Reactive Arthritis (RA) is a chronic form of inflammatory arthritis wherein the following three conditions are combined:
- inflammation of the eyes (conjunctivitis)
- inflammation of the genital, urinary or gastrointestinal systems
It is felt that it involves an immune system which is reacting to the presence of bacterial infections in the genital, urinary, or gastrointestinal systems. RA is considered a systemic rheumatic disease. This means it can affect other organs than the joints, such as the eyes, mouth, skin, kidneys, heart, and lungs. RA shares many features with several other arthritic conditions, such as psoriatic arthritis, ankylosing spondylitis, and arthritis associated with Crohn’s disease and ulcerative colitis. Each of these arthritic conditions can cause similar disease and inflammation in the spine and other joints, eyes, skin, mouth, and various organs. In view of their similarities and tendency to inflame the spine, these conditions are collectively referred to as “spondyloarthropathies.” RA is felt in part to be genetic . There are certain genetic markers that are far more frequent in patients with RA than in the normal population. For example, the HLA-B27 gene is commonly seen in patients with RA. Even in patients who have the genetic background that predisposes them to developing RA, exposure to certain infections seem to be required to trigger the onset of the disease.
RA can occur after genital infections. The most common bacteria that has been associated with this form of RA is an organism called Chlamydia. RA also occurs after infectious dysentery, with bacterial organisms in the bowel, such as Salmonella, Shigella, Yersinia, and Campylobacter. Typically, the arthritis develops one to three weeks after the onset of the bacterial infection.
The symptoms of RA can be divided into those which affect the joints and those which affect the non-joint areas. The classic joints that become inflamed in RA are the knees, ankles, feet, and wrists. The particular joints involved are usually asymmetric, that is, one side of the body or the other is affected, rather than both sides simultaneously. The inflammation leads to stiffness, pain, swelling, warmth, and redness of the joints involved. Patients may develop inflammation of entire fingers or toes which can give the appearance of a “sausage digit.” The arthritis of RA can be associated with inflammation of the spine, leading to stiffness and pain in the back or neck. Cartilage can also become inflamed, especially around the breastbone where the ribs meet in the front of the chest, this condition is called costochondritis. Muscles attach to the bones by tendons. In RA, the tendon insertion points can become inflamed (tendonitis), tender, and painful when exercised.
Non-joint areas that become inflamed and cause symptoms in RA include the eyes, genitals, urinary tract (urethra, bladder and prostate gland), mouth lining, large bowel, and the aorta. Inflammation of the whites of the eye (conjunctivitis) and the iris of the eye (iritis) is frequently seen early in RA and may be intermittent. When the whites of the eye are inflamed causing conjunctivitis, there may be no pain. When the colored part of the eye (iris) is inflamed, causing iritis, it can be very painful and especially worse when looking into bright lights. Urinary tract inflammation commonly involves the urethra, the tube that drains urine from the bladder. This inflammation (urethritis) can be associated with burning on urination and/or pus drainage from the end of the penis. The skin around the penis can become inflamed and scale. The bladder and prostate gland can also become inflamed, leading to an urge to urinate. The mouth can develop open sores (ulcerations) on the hard and soft palate, and even on the tongue. These may go unnoticed by the patient, as they are often painless. Inflammation of the large bowel (colitis) can cause diarrhea, or pus or blood in the stool. Inflammation of the aorta (aortitis) can be seen in a small percentage of patients who have RA. It can lead to failure of the aortic valve of the heart, which can cause heart failure. The electrical conducting pathway of the heart can also become scarred in RA, leading to irregular heartbeats (arrhythmias) that may require placement of a pacemaker to regulate the heartbeat.
Is RA the cause of CP/CPPS?
Research has shown that RA occurs predominantly in individuals with the histocompatibility antigen HLA-B27. In most series, 60 to 85 percent of RA patients are B27-positive. The percentage of people carrying HLA-B27 in the general population is about 8%. In a small unpublished survey of CP/CPPS patients, researcher Dr Daniel Shoskes found a low incidence of HLA-B27+. Moreover the other symptoms of RA, like swollen, painful knee on one side, or sausage digits, are difficult to miss. It is therefore unlikely to be associated with CP/CPPS.