Reactive Arthritis: When You Feel That You Are Alive

Christopher Columbus (1451-1506)

Source of the image.

I would like to give some information about reactive arthritis, also with the historical background.

The term Reiter`s syndrome was commonly used, now it is rather avoided, because dr. Hans Reiter (1881-1969), who described this illness in 1916, was a member of SS, and a nazi war criminal, convicted for medical experiments he conducted at the concentration camp at Buchenwald.

Reactive arthritis is due to an autoimmune response to some bacterial infection that could be sexuallly transmitted (i.a. Chlamydia) or might be an effect of food poisoning (i.a. Yersinia, Campylobacter, Shigella, Salmonella). Some persons are genetically more susceptible to it – those who have human leukocyte antigen (HLA) B27.

Symptoms of the full syndrome could be explained very simply: “one can`t see, can`t pee, can`t climb a tree”.

Symptoms appear 1-4 weeks after infection, when – in a lot of cases – the initial disease is not detectable anymore. Asymmetrical inflammation and swelling of several joints is common, sometimes also eyes and/or uretha became inflammed. Skin rash may also occur. It is not clear whether bacteria or at least some product of their metabolism are present in affected joints. Reactive arthritis lasts most often a few long months, when almost every move is painful, and then – usually – resolves on its own, but sometimes patients become permanently disabled. It is not contagious.

The disease has a strong tendency for relapses (in about 1/3 of cases). Scientists don`t know why it happens, some of them speculate, it could be due to reinfection. It is also possible that bacteria remains in the body in a latent form.

Sometimes sulfasalazine or methotrexate is prescribed, but, frankly speaking, there is no cure for reactive arthritis. Nevertheless, symptoms could be relieved (usually by taking nonsteroidal anti-inflammatory drugs, moderate physical activity – when possible – and warm baths are recommended).

The illness was already known in ancient Greece:

“Hippocrates described young men not suffering from gout until after having had sexual contact, although it is not stated that the arthritis was due to venereal disease. It has been suggested that this constitutes the first description of Reiter’s syndrome, although it is difficult to know if this is true or whether the disease was of venereal origin [2, 3]. The majority of descriptions of the initial disease symptoms are associated with enteric infections.” Source.

Reactive arthritis was probably the problem of Christopher Columbus. Unfortunalely, he didn`t find his happiness in America:

“D.J. Allison [4], in an interesting letter published in Lancet in 1980 speculated that Christopher Columbus was the first European patient to develop reactive arthritis. There is some evidence that after arriving in the New World, Christopher Columbus became “lame”, possibly due to an infection such as shigella flexneri common in the tropics during this time. From his description of his voyages on the high seas between Puerto Rico and Santa Domingo in September of 1494, Columbus presented with a picture of fever, confusion, and severe arthritis of the lower extremities. In 1498, he had a relapse with fevers and acute articular symptoms. Six weeks thereafter, he developed articular inflammation and eye pain: “I have never had such affliction of my eyes with hemorrhage and pain as in this time” [4]. In 1504, Columbus was “paralyzed and bedridden” because of “gout.” The term “gout” was used indiscriminately to refer to inflammatory arthritis in the 16th century. […] Christopher Columbus was incapacitated by arthritis and died in 1506.” Source. For more details about this case see here, and here.

Read for example here to find out more information about the disease.

I developed reactive arthritis about 6 years ago, some days after gastric infection by Yersinia enterocolitica (very rare bacteria in Poland at that time). I had only problems with joints. It almost fully resolved after about six months, but from that time on I have had back pain occasionally.

I`m afraid, I have a relapse now, as a consequence some gastric problems. I only hope, it will take a milder form.

It could be difficult to avoid food poisoning, but it`s much easier to avoid Chlamydia infection, which is a common problem now (it is estimated that a few percent of sexually active persons in developed countries have it; data for the U.S.; data for Europe); fortunately, in the majority of cases it could be easily treated with antibiotics, so it`s important to test for Chlamydia (this infection might not be noticed!).