Reactive arthritis အရေပြားအဆစ်အမြစ်ရောင်ရောဂါ

RA has the triad of arthritis, urethritis, and conjunctivitis, and is autoimmune disease that results from infection, usually bacterial.

Formerly known as Reiter’s syndrome, which is usually preceded by an infection caused by bacteria, such as Chlamydia trachomatis (a sexually transmitted disease) or Salmonella (a bacteria that can contaminate foods).

The bacteria can cause infection of bladder, urethra, vagina or penis which lead to Circinate balanitis of the glans penis in male.

75% of Reiter’s syndrome is associated with HLA B27.

Other species that can also cause Reiter’s syndrome

• Ureaplasma urealyticum
• Species of Yersinia
• Species of Campylobacter
• Species of Shigella

The symptoms occur within a few weeks of the initial infection

Symptoms 

• Inflammation of the eye (conjunctivitis and/or uveitis)
• Inflammation of the urethra in men (causing painful urination). There may also be prostate inflammation (Prostatitis)
• Inflammation of big joint (especially knee)
• Inflammation of the uterine cervix in women. There may also be inflammation of the fallopian tubes (Salpingitis) or vulva/vagina (vulvovaginitis)

Other symptoms

• Psoriasis-like skin lesions
• Nodules on the soles of the feet (keratoderma blennorrhagicum)
• Mouth ulcers
• Heel pain cause by enthesitis, an inflammation of the junction between tendons and bone
• Achilles tendonitis
• circinate balanitis – serpiginous ring-shaped dermatitis
• Swelling of the toes or fingers

Erythematous patch with keratotic annular borders on glans penis

Treatment 

Acute 

• Nonsteroidal anti-inflammatory medications -naproxen, diclofenac, indomethacin, celecoxib
• Corticosteroids (to reduce inflammation)

Chronic

• Immunosuppressive medications -methotrexate, sulfasalazine
• Biologics – Eternacept, Adalimumab (For serve uncontrollably case)

For circinate balanitis

Topical steroid 

Topical calcineurin inhibitor (tacrolimus, Pimecrolimus)