Reactive arthritis is an uncommon form of arthritis. It occurs as a reaction to a bacterial infection elsewhere in the body, such as a urinary tract infection. Experts believe that some viruses can cause reactive arthritis.

Arthritis is a condition that affects the joints, causing inflammation, stiffness, and pain.

Unlike other types of conditions, reactive arthritis usually resolves on its own within a few months.

After the initial infection, reactive arthritis can appear after several days to weeks. Experts believe it is caused by an overreaction by the body’s immune system.

Although bacteria are the typical trigger for reactive arthritis, some viruses, such as parvoviruses, may play a role in reactive arthritis.

This article reveals whether viruses can cause reactive arthritis.

Can a virus cause reactive arthritis?

Reactive arthritis is a poorly defined condition. However, doctors widely consider it to be caused by bacterial infections elsewhere in the body.

These infectious agents may occur in the genitourinary or gastrointestinal tracts. Examples of bacteria found in the genitourinary system include:

• • Chlamydia trachomatis

• • Neisseria gonorrhoeae
• • Mycoplasma hominis
• • Ureaplasma urealyticum

• • Escherichia coli

Infectious agents of the gastrointestinal tract include:

• Intestinal Salmonella
• Shigella flexneri and Shigella disenteriae
• Yersinia enterocolitica
• Campylobacter jejuni
• Clostridium difficile

Arthritic symptoms usually appear in the large joints about 1 to 4 weeks after the injury.

However, doctors now believe that reactive arthritis, a type of spondyloarthritis, may develop after an infection, including a viral infection. While infectious agents may not cause direct damage to the joint, they can affect how the immune system responds to them. An atypical response can cause arthritis.

There is little research discussing whether viruses can cause reactive arthritis. However, it can lead to viral arthritis.

What is viral arthritis?

Various viruses can cause viral arthritis, but the most common include:

• Alphavirus
• Cytomegalovirus
• Flavivirus
• Epstein-Barr virus
• Rubella
• Parvovirus
• Hepatitis B and C
• Herpes
• HIV
• Mumps

Doctors now believe that HIV-induced arthritis is more common than they previously suspected. Around 30% of people with HIV might experience viral-induced arthritis as the first sign of their illness. Some of these individuals may develop either reactive arthritis or psoriatic arthritis.

How does the virus cause it?

The mechanism of viral arthritis is not fully understood

It is believed that viruses invade the joint and cause an immune complex formation.

Immune complex formation occurs when the body’s immune system makes antibodies to fight the infection. And when these antibodies bind to viral antigens, they form a complex. These compounds can get trapped in the joints and cause inflammation.

The synovium is the soft connective tissue membrane that lines the joint capsule. It contains many viruses that cause arthritis. These viruses can recruit inflammatory cells to the joints and cause a cascade of infections.

For example, with alphaviruses, infection in macrophages – a type of white blood cell – in the synovium is responsible for the inflammation. Macrophages are specialized cells that detect and destroy harmful organisms. They can also release pro-inflammatory cytokines, which contribute to the cycle of inflammation.

Risk factors for viral reactive arthritis

Reactive arthritis usually affects white males between the ages of 20 and 40. Females usually have milder symptoms and may not always be diagnosed.

However, everyone from children to older adults can be at risk.

Males are about nine times more likely to become infected after a sexually transmitted infection. In addition, the risk of infection after a gastrointestinal infection is the same for everyone.

Symptoms of reactive arthritis

Reactive arthritis symptoms can usually last from several days to several weeks and may come and go. However, in up to 50% of people, symptoms may return at a later time or become chronic. Most symptoms disappear within 6 months.

Some affected individuals have mild symptoms of arthritis. Others may not have symptoms, and only laboratory tests detect the pathogen. People usually develop inflammation in the following areas:

• Joints: Usually, two or more joints are affected within a few days, and the disease progresses rapidly. Symptoms can include:

• o pain
• o swelling and pain in lower joints, such as knees, feet, and ankles
• o swelling in the upper joints, such as the hands
• o heel pain
• o inflammation in the spine or the lower back where the spine connects to the pelvis

• Urinary tract: the bladder or urethra can be affected.

Symptoms include:

• o pain when urinating
• o a need to urinate more often
• o females experiencing inflammation of the cervix, fallopian tubes, vulva, and vagina

• Eyes: can cause symptoms of inflammation in the eye area or conjunctiva.

Symptoms include:

• o pain
• o irritation
• o redness
• o blurry vision
• o atypical sensitivity to light, which doctors call photophobia

Reactive arthritis can also affect other parts of the body.

A rash can occur on the palms and soles that look like psoriasis. The patient may develop painless sores in the genital area and mouth. He may suffer from diarrhea that can occur with gastrointestinal infections.

Diagnosing reactive arthritis

The diagnosis of reactive arthritis is clinical, and no single test can confirm the diagnosis.

A serum test may help identify pathogens in some cases. These tests measure the amount of antibodies in the blood – these antibodies may be specific to bacteria or a virus.

However, a positive serological test does not always mean that a person currently has an infection. It may only indicate that they were previously infected.

Doctors may use imaging studies to rule out other causes of arthritis or to evaluate the condition of the joints:

• X-ray

• Ultrasound

• MRI

In addition, the doctor may perform an arthroscopy to rule out other causes of joint swelling, including septic arthritis or crystal arthritis. In reactive arthritis, the virus cannot be cultured from the joint. The joint fluid of reactive arthritis usually shows nonspecific inflammatory changes.

If someone has complications, such as uveitis – an inflammation of the eye, they should see an ophthalmologist for further diagnostic testing and treatment.

Reactive arthritis treatment

The goal of treatment is to relieve pain and improve the function of the affected areas.

If it is in the early and acute stage, NSAIDs are prescribed. These medications can reduce inflammation, swelling, and pain.

• Naproxen (Aleve)

• Naproxen (Aleve)

• Celecoxib (Celebrex)

During the chronic phase, reactive arthritis may require disease-modifying antirheumatic drugs. Examples of this type of medication include methotrexate or sulfasalazine.

Sulfasalazine is most useful when a gastrointestinal infection is causing reactive arthritis.

In some cases, highly inflamed joints may benefit from corticosteroid injections.

For active underlying infections, such as infections of the genitourinary tract, antibiotics are recommended.

Summary

Reactive arthritis is a form of arthritis that develops as a response to a bacterial infection. Little is known about the association of viruses with causing reactive arthritis.

Arthritis conditions cause pain, redness, and swelling in the joints. Reactive arthritis can also cause inflammation of the urinary tract, eyes, and other tissues.

Doctors usually diagnose reactive arthritis clinically, and no single test can confirm the diagnosis. Treatment focuses on relieving symptoms and improving function.