Reactive arthritis

Definition

Reactive arthritis is a group of inflammatory conditions that involves the joints, urethra, and eyes. There may also be sores (lesions) on the skin and mucus membranes.

Alternative Names

Reiter syndrome; Post-infectious arthritis

Causes, incidence, and risk factors

The exact cause of reactive arthritis is unknown. It occurs most commonly in men before the age of 40. It may follow an infection with Chlamydia, Campylobacter, Salmonella, or Yersinia. Certain genes may make you more prone to the syndrome.

The disorder is rare in younger children, but may occur in adolescents.

Symptoms

Urinary symptoms usually appear within days or weeks of an infection. Low-grade fever, inflammation of the conjunctiva of the eye (conjunctivitis), and arthritis develop over the next several weeks. The arthritis may be mild or severe, and may affect only one side of the body or more than one joint.

Muscle and joint symptoms include:

• Achilles tendon pain
• Heel pain
• Joint pain in the large joints (hip pain, knee pain, and ankle pain are common)
• Low back pain

Eye and skin symptoms include:

• Eye discharge
• Eye pain - burning
• Eye redness
• Skin lesions on the palms and soles that may resemble psoriasis
• Small, painless ulcers in the mouth, tongue, and glans penis

Urinary and genital symptoms may include:

• Genital lesions (male)
• Incontinence
• Penis pain
• Skin redness or inflammation
• Urethral discharge
• Urinary hesitancy
• Urinary urgency
• Urination - burning or stinging

Signs and tests

The diagnosis is based on symptoms. Since the symptoms may occur at different times, the diagnosis may be delayed. A physical examination may reveal conjunctivitis or typical skin lesions.

Tests that may be performed include:

• HLA-B27 antigen
• Joint x-rays
• Urinalysis

Treatment

The goal of treatment is to relieve symptoms and treat any underlying infection.

Conjunctivitis and skin lesions associated with the syndrome do not require treatment, and will go away on their own.

Your doctor will prescribe antibiotics if you have an infection. Nonsteroidal anti-inflammatory drugs (NSAIDS) and pain relievers may be recommended for those with joint pain. If a joint is persistently inflamed, a doctor may inject a strong anti-inflammatory medicine (corticosteroid) into the area.

Physical therapy can help relieve pain, help you move better, and maintain muscle strength. You may need to make adjustments if your job requires heavy lifting or strenuous use of the back.

Therapy to suppress the immune system may be considered for individuals with a severe case of the disease, but this treatment is not used in most people because of toxic side effects.

Expectations (prognosis)

Reactive arthritis may go away in a few weeks, but can last for a few months. Symptoms may return over a period of several years in up to half of the people affected. The condition may become chronic.

Complications

• Aortic insufficiency (rare)
• Arrhythmias (rare)
• Uveitis

Calling your health care provider

Call for an appointment with your health care provider if symptoms of this condition develop.

Prevention

Preventing sexually transmitted diseases and gastrointestinal infection may help prevent this disease. Always wear a condom during intercourse. Wash your hands and surface areas thoroughly before and after preparing food.

References

Carter JD, Hudson AP. Reactive arthritis: clinical aspects and medical management. Infect Dis Clin North Am. 2009;35(1).