Reactive Arthritis

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.

• 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.

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:

• HLA-B27 antigen – to look for a specific protein that is found on cell surfaces; being positive for this protein suggests a greater than average risk for developing certain autoimmune disorders, including reactive arthritis.
• Erythrocyte sedimentation rate (ESR) – to check for inflammation; increased with reactive arthritis as well as other diseases
• C-reactive protein (CRP) – to check for inflammation; increased with reactive arthritis as well as other diseases

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:

• Rheumatoid factor (RF) – to help rule out other diseases, such as rheumatoid arthritis; negative with reactive arthritis
• Antinuclear antibody (ANA) – to help rule out other diseases, such as lupus

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 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.