Reactive Arthritis, formally known as Reiters syndrome, is an autoimmune condition that develops in response to an infection in another part of the body, generally the gastrointestinal tract but also the genitourinary tract. Reactive Arthritis shares some clinical characteristics with other spondyloarthropathies such as Ankylosing Spondylitis and Psoriatic Arthritis. Reactive Arthritis is characterised by predominantly lower limb arthritis and enthesitis (inflammation of tendon insertion sites) as well as inflammatory back pain, inflammation of the eye and in some cases genitourinary inflammation. A number of bacteria have been identified as the possible sources of infection leading to Reactive Arthritis. These include Campylobacter, Salmonella and Chlamydia species.
Reactive Arthritis affects both males and females equally and has an age on onset of between 20 and 50. The condition is usually self limiting within a few days though it has been known to go on for up to 4 months in some patients. Non steroidal anti-inflammatory drugs and physical therapy may be used for the pain. The bacterial infection may need to be treated with antibiotics.
Population studies have shown the condition to be one of the most strongly associated with HLA-B27 with over 80% of patients carrying the HLA-B*27 gene. The exact mechanism of action is unknown but may include the arthritogenic peptide theory in which a peptide either from B27 itself or from the site of attack such as the joint is presented to T cells by HLA-B27 leading to an immune response. Other theories include activation of auto reactive T cells which escaped thymic selection, molecular mimicry with bacterial peptide mimicking B27 derived self peptide and aberrant B27 heavy chain homodimers on the cell surface in the absence of beta 2 microglobulin acting as targets for inflammation.
HLA-B27 typing in Reactive Arthritis is a useful aid to diagnosis.
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