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Reactive Arthritis

What is reactive arthritis?

Reactive arthritis is a type of arthritis that an infection in the body can trigger. Most commonly, a sexually transmitted infection or bacterial infection in the intestines triggers development of reactive arthritis.

It’s considered to be an autoimmune disease of the spondyloarthritis group. The arthritis often doesn’t develop until after the infection has been successfully treated.

People with reactive arthritis often experience symptoms in the larger joints of the lower extremity. Reactive arthritis was previously known as Reiter’s syndrome, a triad of arthritis, eye inflammation (conjunctivitis), and urinary tract inflammation (urethritis).

The condition was previously thought to be uncommon. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), men develop reactive arthritis more often than women, but the diagnosis is more difficult in women. The average age of onset is 30 years old. Men also tend to experience more severe joint pain than women.

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Causes

What are the causes of reactive arthritis?

Bacterial infection of the urinary tract or intestines is the most common cause of reactive arthritis. The most common bacterium associated with reactive arthritis is Chlamydia trachomatis (which is responsible for chlamydia infections). This bacterium usually spreads through sexual contact.

Bacteria that cause food poisoning can also produce reactive arthritis symptoms. Examples of these bacteria include Shigella and Salmonella.

Genetics may be a factor in whether or not you develop reactive arthritis. According to NIAMS, people who have the gene HLA B27 are more likely to develop reactive arthritis. However, not everyone with the HLA B27 gene will develop reactive arthritis if they get an infection.

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Symptoms

What are the symptoms of reactive arthritis?

There are three distinct sets of symptoms associated with reactive arthritis.

Musculoskeletal system

Musculoskeletal symptoms include joint pain and swelling. Reactive arthritis most often affects joints in your knees, ankles, and the sacroiliac joints of your pelvis. You may also experience joint pain, tightness, and swelling in your fingers, back, buttocks (sacroiliac joints), or heels (Achilles tendon area).

Urinary system

A condition called urethritis causes urinary symptoms. The urethra is the tube that carries urine from your bladder to the outside of your body. Urethritis is the inflammation of this tube. Symptoms can include pain or burning with urination and a frequent urge to urinate.

Men may develop prostatitis as part of reactive arthritis. Prostatitis is the inflammation of the prostate gland. Cervicitis is the inflammation of the cervix in females. It can also be a sign of reactive arthritis.

Eyes and skin

Eye inflammation is one of the main symptoms of reactive arthritis. Reactive arthritis may also involve your skin and mouth. Conjunctivitis is the inflammation of the eye membranes. Symptoms include pain, itching, and discharge.

Skin rashes, including keratoma blennorrhagica (small pustules on the soles of the feet), may also occur. Mouth sores are less common. However, they can accompany other symptoms of reactive arthritis.

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Diagnosis

How is reactive arthritis diagnosed?

Your doctor will evaluate your medical history, perform a physical examination of your symptoms, and run blood tests to check for infection or inflammation. A blood test can also determine if you carry the HLA B27 gene that increases your likelihood of developing reactive arthritis.

Your doctor may run additional tests to rule out sexually transmitted infections if your symptoms indicate a chlamydia infection. Your doctor will swab the urethra in men and will perform a pelvic exam and cervical swab on women. Your doctor may also do an arthrocentesis, which involves removing the fluid in your joint with a needle. Tests are then done on this fluid.

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Treatment

What are the treatments for reactive arthritis?

Treatment for reactive arthritis depends on the cause of the condition. Your doctor will prescribe antibiotic medications to treat an underlying infection. They may prescribe additional medications for conjunctivitis, mouth ulcers, or skin rashes if needed.

Medication

The goal of treatment once the underlying infection is under control turns to pain relief and management. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) and naproxen (Aleve) help relieve pain and reduce inflammation.

Your doctor may prescribe stronger anti-inflammatories if over-the-counter medications don’t relieve your pain. Corticosteroids are man-made drugs that mimic cortisol, a hormone that your body produces naturally. These drugs work by broadly suppressing inflammation in the body.

You can take corticosteroids orally or inject them directly into the affected joints. On occasion when these don’t help, immunomodulating agents, like sulfasalazine (Azulfidine), might be necessary. Doxycycline (Acticlate, Doryx) has also been used for treatment, given its anti-inflammatory properties. In severe cases that aren’t responding to standard therapies, TNF inhibitors (biologics) can be effective.

Exercise

Incorporate exercise into your daily routine to promote joint health. Exercise keeps your joints flexible and helps you retain your range of motion. Range of motion is the extent to which you can flex and extend your joints.

Talk to your doctor if stiffness and pain limit your range of motion. They might refer you to a physical therapist. Physical therapy is a gradual treatment process. The goal is to return to your healthy range of motion without pain.

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Outlook

What is the long-term outlook?

The outlook for people with reactive arthritis is positive. Most make a full recovery. However, recovery time can range from a few months to almost a year in some cases. According to NIAMS, between 15 and 50 percent of people with reactive arthritis experience a relapse of symptoms after initial treatment.

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