REACTIVE ARTHRITIS (ReA)

• Reactive arthritis, (formerly known as Reiter syndrome), is defined as a sterile joint inflammation within a month following a gastrointestinal or genitourinary infection
• It is categorized as a seronegative spondyloarthritis because of its association with HLA-B27. The usual age of onset is 20-40 years and both sexes are equally affected
• The characteristic triad consists of urethritis, arthritis, and conjunctivitis

• Genetic predisposition and association with HLA-B27
• Posturethritis: after infection with Chlamydia (commonly)
• Postenteritis: after infection with Shigella, Yersinia, Salmonella, or Campylobacter

• Classic triad of reactive arthritis - Urethritis, Conjunctivitis, and Arthritis, but it manifests in only about a third of affected individuals
• The clinical manifestations constitute a wide spectrum that ranges from an isolated, transient monoarthritis to severe multisystem disease.

Articular features

• Oligoarthritis (sometimes polyarthritis)

Acute onset

Often asymmetrical with a migratory character

Occurs predominantly in the lower extremities (knee, ankle, subtarsal, metatarsophalangeal, toe interphalangeal joints are most commonly involved) 

• Sacroilitis
• Enthesitis
• Dactylitis

 Extra‑articular symptoms

• Sterile Conjunctivitis – most common lesions
• Anterior uveitis, scleritis, keratitis or corneal ulcer may be seen
• Non specific enteritis – presents with abdominal pain and diarrhoea
• Sterile pyuria and urethritis
• Oral ulcers 

Skin

• Circinte balanitis: Vesicles on glans that rupture to form painless superficial erosions
• Keratoderma blenorrhagicum: hyperkeratinization of the palms and soles , resembles Psoriasis

Nail changes

• Onycholysis
• Distal yellowish discolouration
• Heaped up hyper keratosis

Symptoms from preceding infection 

• Diarrhoea
• Urogenital tract symptoms (dysuria, pelvic pain, urethritis, prostatitis)

• ↑ ESR and ↑CRP
• Positive HLA-B27
• Microscopy and culture of synovial fluid : Neutrophil leucocytosis
• Radiography : unilateral scaroilitis and large bulky asymmetrical syndesmophytes

Rest to the affected joints and immobilisation till acute inflammation subsides

Internal medicines

• Pachanaamrutha kashaya
• Balaguduchyadi kashaya
• Amrutothara kashaya
• Gokshuradi guggulu
• Sudarshana gutika
• Siva gutika
• Kaisora guggulu
• Amavatari rasa
• Silajith prayoga

Procedures

• Virechana – Nimbamruta eranda