Reactive Arthritis

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  • Also Known As:
  • Post-infectious Arthritis
  • Reiter Syndrome (formerly known as)
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What is reactive arthritis?

Reactive arthritis is an autoimmune condition, named for the fact that it normally occurs as a reaction to an infection somewhere in the body. It is an uncommon but painful form of inflammatory arthritis that affects the heels, toes, fingers, lower back, and joints, such as in the knees or ankles. It is also associated with inflammation of the urethra, the eyes, and sometimes skin and mucous membranes.

There are two types of bacteria that most commonly cause reactive arthritis– bacteria associated with intestinal infections and bacteria associated genital infections. Chlamydia trachomatis, the bacterium that causes chlamydia, is known to be a trigger of reactive arthritis. But it can be triggered by other sexually transmitted diseases as well as certain intestinal infections. Common intestinal pathogens include Campylobacter, Shigella, Salmonella, and Yersinia, often the cause of food contamination.

Reactive arthritis is uncommon and not everyone who gets one of these infections will develop reactive arthritis. Risk factors for reactive arthritis include gender and genetic predisposition. The disorder is most commonly seen in men between the ages of 20 and 50, though it can occur at any age. To a lesser extent, women can also have reactive arthritis.

Some people are at increased risk because they are positive for HLA-B27, a specific protein (termed a human leukocyte antigen or HLA) that is found on cell surfaces. The gene that codes for the HLA-B27 is estimated to be present in about 65% to 96% of individuals with reactive arthritis, while HLA-B27 is found in only about 6% of the general U.S. population. Although having HLA-B27 is a risk factor for reactive arthritis, it is still possible for people who are HLA-B27 negative to develop reactive arthritis, and it may be that other genetic factors are involved.

 

About Reactive Arthritis

Signs and Symptoms

Signs and symptoms of reactive arthritis may include pain and swelling in several joints that develops suddenly 1 to 4 weeks following infection. Non-joint inflammation may occur in the eyes as conjunctivitis,  the urinary tract (urethra prostate gland, bladder), the skin, mouth, or reproductive organs. Symptoms may resolve spontaneously and never recur, or the condition can become persistent.

Approximately one third of the people who develop reactive arthritis will experience the following:

  • Urethritis – inflammation of the tube that connects the bladder to the outside of the body (urethra). This causes discharge that is seen at the tip of the penis or in the vaginal area; it also causes pain or burning on urination. Men may also develop inflammation of the prostate gland (prostatitis) and women may have inflammation of the cervix (cervicitis), although urethritis is often absent in women.
  • Conjunctivitis or uveitis – inflammation of the thin membrane that covers the eyeball and lines the eyelids (conjunctiva) or of the inner eye (uveitis). Conjunctivitis causes redness and itching while uveitis is more serious and causes pain, blurring of vision, and light sensitivity, as well as redness in the eye.
  • Arthritis – pain, redness and swelling affecting typically the knees, ankles, and feet; often results in heel pain; can cause swollen fingers and toes; often associated with lower back and buttock pain; can cause spondylitis (inflammation of the joints between vertebrae in the spine)

Reactive arthritis can also be associated with skin symptoms, including oral ulcers, rash or bumps on the soles of the feet or palms of the hands, and painless penile lesions.

Tests

Laboratory tests

Since there is no single test to diagnose reactive arthritis, a diagnosis is mostly based on the person’s signs and symptoms, such as pain or swelling in affected joints, and evidence of a current or past infection. Healthcare practitioners may order the following tests to help confirm the diagnosis:

Healthcare practitioners may also order tests to identify the infection that triggered the reaction, such as:

  • Synovial fluid analysis – to look for an infection in the joint
  • Chlamydia test – to look for evidence of infection by the bacterium Chlamydia trachomatis; if this is positive, early treatment can reduce arthritis progression.
  • Stool culture – to look for Salmonella, Shigella, Campylobacter, E. coli, Yersinia
  • Urinalysis and urine culture–to detect a urinary tract infection
  • HIV test – to determine if someone is HIV-positive, although it is generally thought that reactive arthritis is related to other infections to which those with HIV have been exposed rather than to HIV infection itself.

A few tests may be ordered to rule out other causes of the symptoms:

Non-laboratory tests

Non-laboratory tests include X-rays that may be performed to examine the joint for any damage or inflammation or to rule out other types of arthritis.

Treatment

Treatment of reactive arthritis involves treating any underlying infection with antibiotics and use of medications such as ibuprofen and acetaminophen to relieve symptoms.

Inflamed joints can be injected with corticosteroids or prednisone, which may be taken orally, may help. Occasionally the fluid can be drained, relieving pressure and reducing the pain. If the disease is severe and lasts over a couple of months, use of disease modifying anti-rheumatic drugs (DMARDs) such as sulfasalazine and methotrexate may be considered. Tumor necrosis factor (TNF) inhibitors may also be effective.

Topical corticosteroids may be useful for treating skin lesions and localized inflammation.

Often, rest is required initially to control the pain, though physical therapy is also used to maintain a full range of movement of the joints.

Related Content

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Sources Used in Current Review

American College of Rheumatology. 2017. Reactive Arthritis. Available online at https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Reactive-Arthritis. Accessed July 23, 2017.

Lazada, Carlos J. 2017. Reactive Arthritis Workup. Available online at http://emedicine.medscape.com/article/331347-workup#c6. Accessed July 23, 2017.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. 2016. Questions and Answers about Reactive Arthritis. Available online at https://www.niams.nih.gov/health_info/Reactive_Arthritis/default.asp#g. Accessed July 23, 2017.

Yu, David T. 2016. Patient education: Reactive arthritis. Beyond the Basics. Available online at http://www.uptodate.com/contents/reactive-arthritis-beyond-the-basics?source=search_result&search=reactive+arthritis&selectedTitle=1%7E4. Accessed July 23, 2017.

Sources Used in Previous Reviews

MedlinePlus Medical Encyclopedia. Reactive arthritis. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000440.htm. Accessed September 2013.

FamilyDoctor.org. Reactive Arthritis. Available online at http://familydoctor.org/familydoctor/en/diseases-conditions/reactive-arthritis.printerview.all.html. Accessed September 2013.

MayoClinic.com. Reactive arthritis. Available online at http://www.mayoclinic.com/health/reactive-arthritis/DS00486. Accessed September 2013.

Arthritis Foundation. Reactive Arthritis. Available online at http://www.arthritis.org/conditions-treatments/disease-center/reactive-arthritis/. Accessed September 2013.

American College of Rheumatology. Reactive Arthritis. Available online at http://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Reactive_Arthritis/. Accessed September 2013.

Spondylitis Association of America. Medications For Ankylosing Spondylitis & Related Disorders. Available online at http://www.spondylitis.org/about/medications.aspx. Accessed September 2013.

Lozada CJ et al. Reactive Arthritis. Medscape. Available online at http://emedicine.medscape.com/article/331347-overview. Accessed September 2013.

Reveille JD, Hirsch R, Dillon CF, Carroll MD, Weisman MH. The prevalence of HLA-B27 in the US: data from the US National Health and Nutrition Examination Survey, 2009. Arthritis Rheum 2012 May;64(5):1407-11. Available online at http://www.ncbi.nlm.nih.gov/pubmed/22139851. Accessed September 2013.

Yu DT. Reactive arthritis (formerly Reiter syndrome). UpToDate. Available online at http://www.uptodate.com/contents/reactive-arthritis-formerly-reiter-syndrome. Accessed September 2013.

MedlinePlus Medical Encyclopedia. Reactive arthritis. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000440.htm. Accessed September 2010.

Arthritis Foundation. Reactive Arthritis. Available online at http://www.arthritis.org/disease-center.php?disease_id=23. Accessed September 2010.

NIAMS. Questions and Answers about Reactive Arthritis. Available online at http://www.niams.nih.gov/Health_Info/Reactive_Arthritis/default.asp. Accessed September 2010.

FamilyDoctor.org. Reactive Arthritis. Available online at http://familydoctor.org/online/famdocen/home/common/sexinfections/sti/448.printerview.html. Accessed September 2010.

MayoClinic.com. Reactive arthritis. Available online at http://www.mayoclinic.com/health/reactive-arthritis/DS00486. Accessed September 2010.