Bay Biosciences provides high quality, clinical grade bio-specimens, cryogenically preserved sera (serum), plasma and peripheral blood mononuclear cells (PBMC) biofluid samples from patients diagnosed with reactive arthritis.
The sera (serum), plasma and PBMC biofluid specimens are processed from patient’s peripheral whole-blood using customized collection and processing protocols. The reactive arthritis bio-specimens are collected from unique patients diagnosed with reactive arthritis and are provided to a valued pharmaceutical customer for research, diagnostics, discovery and drug development.
Detailed clinical data, reactive arthritis patients history, symptoms, complete blood count (CBC), elevated biomarker levels, genetic and metabolic information, histopathological findings, annotations associated with reactive arthritis specimens is provided to a valued customer for research, development and drug discovery. The reactive arthritis sera (serum), plasma and peripheral blood mononuclear cells (PBMC) biofluid are processed from patients peripheral whole-blood using customized collection and processing protocols.
Reactive Arthritis Overview
Reactive arthritis, formerly known as Reiter’s syndrome, is a form of inflammatory arthritis that develops in response to an infection in another part of the body (cross-reactivity). Reactive arthritis is a painful form of inflammatory arthritis (joint disease due to inflammation). It occurs in reaction to an infection by certain bacteria. Most often, these bacteria are in the genitals (Chlamydia trachomatis) or the bowel (Campylobacter, Salmonella, Shigella and Yersinia). Chlamydia most often transmits by sex. It often has no symptoms, but can cause a pus-like or watery discharge from the genitals. The bowel bacteria can cause diarrhea. If you develop arthritis within one month of diarrhea or a genital infection especially with a discharge you may have reactive arthritis. Reactive arthritis tends to occur most often in men between ages 20 and 50.
Previously reactive arthritis was called by the name “Reiter’s syndrome” which was characterized by eye, urethra and joint inflammation. Now it belongs to the family of arthritis called “spondyloarthritis“. Reactive arthritis isn’t common. For most patients, signs and symptoms come and go, eventually disappearing within 12 months.
Causes of Reactive Arthritis
Reactive arthritis develops in reaction to an infection in the body, often in the intestines, genitals or urinary tract. You might not be aware of the triggering infection if it causes mild symptoms or no symptoms at all. Numerous bacteria can cause reactive arthritis. Some are transmitted sexually, and others are foodborne.
Following are the most common type of bacterial infections that can cause reactive arthritis:
- Chlamydia
- Salmonella
- Shigella
- Yersinia
- Campylobacter
- Clostridium difficile
Reactive arthritis is not a contagious disease. However, the bacteria that cause it can be transmitted sexually or in contaminated food. Only a few of the people who are exposed to these bacteria develop reactive arthritis.
The bacteria induce (cause) arthritis by distorting the body’s defense against infections, as well as the genetic environment. How exactly each of these factors plays a role in the disease likely varies from patient to patient.
Reactive arthritis can have any or all of the following features features:
- Pain and swelling of certain joints, often the knees and/or ankles
- Swelling and pain at the heels
- Extensive swelling of the toes or fingers
- Persistent low back pain, which tends to be worse at night or in the morning
Some patients with this type of arthritis also have eye redness and irritation. Still other signs and symptoms include burning with urination and a rash on the palms or the soles of the feet.
Signs and Symptoms of Reactive Arthritis
Signs and symptoms of reactive arthritis generally start one to four weeks after exposure to a triggering infection. Following are the common signs and symptoms of reactive arthritis:
- Pain and stiffness: The joint pain associated with reactive arthritis most commonly occurs in the knees, ankles and feet. Reactive arthritis patients may also have pain in the heels, lower back or buttocks.
- Eye inflammation: Many patients who have reactive arthritis also develop eye inflammation (conjunctivitis).
- Urinary problems: Reactive arthritis patients have increased frequency and discomfort during urination, as can inflammation of the prostate gland or cervix also may occur.
- Inflammation of soft tissue where it enters bone (enthesitis): This might include muscles, tendons and ligaments.
- Swollen toes or fingers: In some reactive arthritis cases, the toes or fingers might become so swollen that they look like sausages.
- Skin problems: Reactive arthritis can affect the skin a variety of ways, including a rash on the soles and palms and mouth sores.
- Lower back pain: The pain tends to be worse at night or in the morning.
Reactive Arthritis Genetics
The bacteria that cause reactive arthritis are very common. In theory, anyone who becomes infected with these germs might develop reactive arthritis. Yet very few patients with bacterial diarrhea actually go on to have serious reactive arthritis. What remains unclear is the role of Chlamydia infection that has no symptoms. It is possible that some cases of arthritis of unknown cause are due to Chlamydia.
Reactive arthritis tends to occur most often in men between ages 20 and 50. Some patients with reactive arthritis carry a gene called HLA-B27. Patients who test positive for HLA-B27 gene often have a more sudden and severe onset of symptoms. They also are more likely to have chronic (long-lasting) symptoms. Yet, patients who are HLA-B27 negative (do not have the gene) can still get reactive arthritis after exposure to an organism that causes it. Patients with weakened immune systems due to AIDS and HIV can also develop reactive arthritis.
Reactive Arthritis Diagnosis
Rheumatologists are experts in diagnosing arthritis and other rheumatic diseases. Other doctors may feel less comfortable diagnosing reactive arthritis, because reactive arthritis diagnosis is based on clinical features and not only the diagnostic tests.
Diagnosis is largely based on symptoms of the inducing infections and appearance of typical musculoskeletal (joint and muscle) involvement. If indicated, doctors might order a test for Chlamydia infection or test for the HLA-B27 gene. The test for Chlamydia uses a urine sample or a swab of the genitals. During the physical exam, your doctor is likely to check your joints for signs and symptoms of inflammation, such as swelling, warmth and tenderness, and test range of motion in your spine and affected joints. Your doctor might also check your eyes for inflammation and your skin for rashes.
Blood tests
Your doctor might recommend that a sample of your blood be tested for:
- Evidence of past or current infection
- Signs of inflammation
- Antibodies associated with other types of arthritis
- A genetic marker HLA B27 linked to reactive arthritis
Joint fluid tests
Your doctor might use a needle to withdraw a sample of synovial fluid from within an affected joint. This fluid will be tested for:
- White blood cell count: An increased number of white blood cells might indicate inflammation or an infection.
- Infections: Bacteria in your joint fluid might indicate septic arthritis, which can result in severe joint damage.
- Crystals: Uric acid crystals in your joint fluid might indicate gout. This is a very painful type of arthritis and often affects the big toe.
Imaging tests
X-rays of the lower back, pelvis and joints can indicate whether you have any of the characteristic signs of reactive arthritis. X-rays can also rule out other types of arthritis.
Reactive Arthritis Treatment
The type of treatment for reactive arthritis depends on the stage of reactive arthritis.
The early stage of reactive arthritis is considered acute (early). Acute inflammation can be treated with nonsteroidal anti-inflammatory drugs (often referred to as NSAIDs). These drugs suppress swelling and pain. They include naproxen (Aleve), diclofenac (Voltaren), indomethacin (Indocin) or celecoxib (Celebrex). The exact effective dose varies from patient to patient. The risk of side effects of these drugs, such as gastrointestinal (often called GI) bleeding, also varies. Your doctor will consider your risk of GI bleeding in suggesting an NSAID.
The late stage of reactive arthritis is considered chronic. Chronic reactive arthritis may require treatment with a disease-modifying antirheumatic drug (sometimes called a DMARD) such as sulfasalazine or methotrexate. Sulfasalazine may be more useful when the reactive arthritis is triggered by a gastrointestinal (GI) infection. In some cases, very inflamed joints may benefit from corticosteroid injections (cortisone shots). In more severe cases, stronger immune lowering medications called “biologics” may be used such as Etanercept (Enbrel) or Adalimumab (Humira).
Medications
If your reactive arthritis was triggered by a bacterial infection, your doctor might prescribe an antibiotic if there is evidence of persistent infection. Which antibiotic you take depends on the bacteria that are present.
Other medications might include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Prescription NSAIDs, such as indomethacin (Indocin), can relieve the inflammation and pain of reactive arthritis.
- Corticosteroids: Injection of a corticosteroid into affected joints can reduce inflammation and allow you to return to your normal activity level.
- Topical steroids: These might be used for skin rashes caused by reactive arthritis.
- Rheumatoid arthritis drugs: Limited evidence suggests that medications such as sulfasalazine (Azulfidine), methotrexate (Trexall) or etanercept (Enbrel) can relieve pain and stiffness for some people with reactive arthritis.
Physical therapy
A physical therapist can provide you with targeted exercises for your joints and muscles. Strengthening exercises develop the muscles around your affected joints, which increase the joint’s support. Range-of-motion exercises can increase your joints’ flexibility and reduce stiffness.
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