Reactive arthritis is a form of arthritis (joint inflammation) caused by an infection elsewhere in the body. In the case of foodborne pathogens (Campylobacter, E. coli, Salmonella, Shigella and Yersinia), the infection starts in the intestines, generally the colon. The arthritis is a “reaction to the gastrointestinal infection.”
The inflammation indicating reactive arthritis is marked by swelling, redness, heat, and pain. Besides this joint inflammation, it is also associated with two other symptoms: redness and inflammation of the eyes (conjunctivitis), and inflammation of the urinary tract (urethritis). These symptoms may occur alone, together, or not at all.
Food poisoning victims who experience any of the symptoms below need immediate medical attention:
- Joint inflammation
- Redness and inflammation of the eyes
- Inflammation of the urinary tract (indicated by painful urination).
Reactive arthritis is also known as a seronegative spondyloarthropathy. The seronegative spondyloarthropathies are a group of disorders that can cause inflammation throughout the body, especially in the spine. When reactive arthritis is caused by an infection in the intestinal tract from eating food or that is contaminated with bacteria, the arthritis is sometimes called enteric or gastrointestinal reactive arthritis.
Reactive arthritis usually lasts 3 to 12 months, although it can return or develop into a long-term disease in a small percentage of people. Every food poisoning victim who suffers from reactive arthritis, no matter how long it lasts, has the right to sue the food manufacturer, restaurant, retailer, and others responsible for the food poisoning.
What Causes Reactive Arthritis?
Reactive arthritis typically begins about 1 to 3 weeks after a food poisoning victim is infected with the foodborne pathogen. Doctors do not know exactly why some people exposed to these bacteria (Campylobacter, E. coli, Salmonella, Shigella and Yersinia) develop reactive arthritis and others do not, but they have identified a genetic factor, human leukocyte antigen (HLA) B27, that increases a person’s chance of developing reactive arthritis. Approximately 80 percent of people with reactive arthritis test positive for HLA-B27. However, inheriting the HLA-B27 gene does not necessarily mean you will get reactive arthritis. Eight percent of healthy people have the HLA-B27 gene, and only about one-fifth of them will develop reactive arthritis if they contract the triggering infections.
Having HLA-B27 does not affect your right to file a lawsuit for money damages or the amount of money you will get.
Is it Contagious?
Reactive arthritis is not contagious; that is, a person with the disorder cannot pass it on to someone else. However, the bacteria can be passed from person to person.
What Are the Symptoms?
As discussed above, reactive arthritis always involves inflammation of the joints, but often also causes inflammation of the eyes and urinary tract. Less common symptoms are mouth ulcers and skin rashes. These symptoms can come and go over a period of several weeks, months, or even years.
Reactive arthritis typically involves pain and swelling in the knees, ankles, and feet. Wrists, fingers, and other joints are affected less often. People with reactive arthritis commonly develop inflammation of the tendons (tendinitis) or at places where tendons attach to the bone (ethesitis). In many people with reactive arthritis, this results in heel pain or irritation of the Achilles tendon at the back of the ankle. Some people also develop heel spurs, which are bony growths in the heel that may cause chronic (long-lasting) foot pain. Approximately half of people with reactive arthritis report low-back and buttock pain.
Reactive arthritis also can cause spondylitis (inflammation of the vertebrae in the spinal column) or sacroiliitis (inflammation of the joints in the lower back that connect the spine to the pelvis). People with reactive arthritis who have the HLA-B27 gene are even more likely to develop spondylitis and/or sacroiliitis.
Money damages for people who develop reactive arthritis from food poisoning can be significant (hundreds of thousands or millions). This depends on a number of factors. Contact attorney Fred Pritzker or another attorney on our food poisoning litigation team for a free consultation. Fred is our lead attorney for these cases, but every one of our other food poisoning lawyers has years of experience with these cases.
Conjunctivitis, an inflammation of the mucous membrane that covers the eyeball and eyelid, develops in approximately half of people with reactive arthritis. Some people may develop uveitis, which is an inflammation of the inner eye. Conjunctivitis and uveitis can cause redness of the eyes, eye pain and irritation, and blurred vision. Some people suffer glaucoma and progressive blindness.
Urogenital Tract Symptoms
Reactive arthritis often affects the urogenital tract, including the prostate or urethra in men and the urethra, uterus, or vagina in women.
Men may notice an increased need to urinate, a burning sensation when urinating, and a fluid discharge. Some men with reactive arthritis develop prostatitis (inflammation of the prostate gland). Symptoms of prostatitis can include fever and chills, as well as an increased need to urinate and a burning sensation when urinating.
Women may develop problems in the urogenital tract, such as cervicitis (inflammation of the cervix) or urethritis (inflammation of the urethra), which can cause a burning sensation during urination. In addition, some women also develop salpingitis (inflammation of the fallopian tubes) or vulvovaginitis (inflammation of the vulva and vagina).
Ulcers and Rashes
A small percentage of men and women develop rashes or small, hard nodules on the soles of the feet and, less often, on the palms of their hands or elsewhere. In addition, some people with reactive arthritis develop mouth ulcers that come and go. In some cases, these ulcers are painless and go unnoticed.
How is it Diagnosed?
Doctors may misdiagnose reactive arthritis because there is not a lab test available to confirm that a person has it. If you have been diagnosed with food poisoning, your doctor should suspect reactive arthritis if you have any of the symptoms discussed above.
Before and after seeing the doctor, it is sometimes useful for the patient to keep a record of the symptoms that occur, when they occur, and how long they last. It is especially important to report any flu-like symptoms, such as fever, vomiting, or diarrhea, because they may be evidence of a bacterial infection. Keeping good records of your illness will also help your legal case against the food processor, restaurant, and/or retailer responsible for your case of food poisoning.
The doctor may use various blood tests besides the HLA-B27 test to help rule out other conditions and confirm a suspected diagnosis of reactive arthritis. For example, the doctor may order rheumatoid factor or antinuclear antibody tests. Most people who have reactive arthritis will have negative results on these tests. Doctors also may order a blood test to determine the erythrocyte sedimentation rate (sed rate), which is the rate at which red blood cells settle to the bottom of a test tube of blood. A high sed rate often indicates inflammation somewhere in the body. Typically, people with rheumatic diseases, including reactive arthritis, have an elevated sed rate.
The doctor also is likely to perform tests for infections that might be associated with reactive arthritis. Patients generally are tested for a Chlamydia infection because studies have shown that early treatment of Chlamydia-induced reactive arthritis may reduce the progression of the disease. The doctor may look for bacterial infections by testing cell samples taken from the patient’s throat as well as the urethra in men or cervix in women. Urine and stool samples also may be tested. A sample of synovial fluid (the fluid that lubricates the joints) may be removed from the arthritic joint. Studies of synovial fluid can help the doctor rule out infection in the joint.
Doctors sometimes use x rays to help diagnose reactive arthritis and to rule out other causes of arthritis. X rays can detect some of the symptoms of reactive arthritis, including spondylitis, sacroiliitis, swelling of soft tissues, damage to cartilage or bone margins of the joint, and calcium deposits where the tendon attaches to the bone.
What Type of Doctor Should I See?
A person with reactive arthritis probably will need to see several different types of doctors because reactive arthritis affects different parts of the body. If you hire our attorneys to represent you, we will make sure you see good doctors who can then testify regarding your expected medical expenses, pain and suffering, and the expected amount of time the you will not be able to work.
The following specialists treat other features that affect different parts of the body.
- Ophthalmologist—treats eye disease
- Gynecologist—treats genital symptoms in women
- Urologist—treats genital symptoms in men and women
- Dermatologist—treats skin symptoms
- Orthopaedist—performs surgery on severely damaged joints
- Physiatrist—supervises exercise regimens.
How is it Treated?
Although there is no cure for reactive arthritis, some treatments relieve symptoms of the disorder. The doctor is likely to use one or more of the following treatments:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin, ibuprofen, naproxen, and naproxen sodium are examples of NSAIDs.
- Corticosteroid injections. For people with severe joint inflammation, injections of corticosteroids directly into the affected joint may reduce inflammation.
- Topical corticosteroids. These corticosteroids come in a cream or lotion and can be applied directly on the skin lesions, such as ulcers, associated with reactive arthritis. Topical corticosteroids reduce inflammation and promote healing.
- Antibiotics. The doctor may prescribe antibiotics to eliminate the foodborne bacterial infection that triggered reactive arthritis. Typically, an antibiotic is taken for 7 to 10 days or longer. Some doctors may recommend a person with reactive arthritis take antibiotics for a long period of time (up to 3 months). Current research shows that in most cases, this practice is necessary.
- Immunosuppressive medicines. A small percentage of patients with reactive arthritis have severe symptoms that cannot be controlled with any of the above treatments. For these people, medicine that suppresses the immune system, such as sulfasalazine or methotrexate, may be effective.
- TNF inhibitors. Several relatively new treatments that suppress tumor necrosis factor (TNF), a protein involved in the body’s inflammatory response, may be effective for reactive arthritis and other spondyloarthropathies. They include etanercept and infliximab.
- Exercise. Exercise, when introduced gradually, may help improve joint function.
What Is the Prognosis for People Who Have Reactive Arthritis?
Most people with reactive arthritis recover fully from the initial flare of symptoms and are able to return to regular activities 2 to 6 months after the first symptoms appear. In such cases, the symptoms of arthritis may last up to 12 months, although these are usually very mild and do not interfere with daily activities.
Approximately 20 percent of people with reactive arthritis will have chronic (long-term) arthritis, which usually is mild. Studies show that between 15 and 50 percent of patients will develop symptoms again sometime after the initial flare has disappeared. It is possible that such relapses may be caused by reinfection. Back pain and arthritis are the symptoms that most commonly reappear. A few patients will have chronic, severe arthritis that is difficult to control with treatment and may cause joint damage.