Reactive arthritis is a type of arthritis that an infection in the body triggers. Typically, a sexually transmitted infection (STI) or bacterial infection in the intestines causes reactive arthritis. It is considered to be an autoimmune disease. The arthritis often doesn’t develop until after the infection has been successfully treated.
People with reactive arthritis usually experience symptoms in the larger joints of the lower extremity. A form of the condition known as Reiter’s syndrome affects the eyes (conjunctivitis) and the urinary tract (urethritis).
The condition isn’t very common. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), men develop reactive arthritis more often than women. The average age of onset is 30 years old. Men also tend to experience more severe joint pain than women.
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 (chlamydia). 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 who has the HLA B27 gene will develop reactive arthritis if they have an infection.
There are three distinct sets of symptoms associated with reactive arthritis.
Musculoskeletal symptoms include joint pain and swelling. Reactive arthritis most often affects joints in the knees, ankles, and sacroiliac joints of your pelvis. You may also experience joint pain, tightness, and swelling in your fingers, back, buttocks, or heels (Achilles’ tendon area).
A condition called urethritis causes urinary symptoms. The urethra is the tube that carries urine from the 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 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 the skin and mouth. Conjunctivitis is the inflammation of the eye membranes. Symptoms include pain, itching, and discharge.
Mouth sores and skin rashes are less common. However, they can accompany other symptoms of reactive arthritis.
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 where the fluid in the joint is removed with a needle and studies are done on the fluid that was removed.
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.
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 and naproxen 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 the body produces naturally. These drugs work by fighting off white blood cells and other chemicals in the body that can cause inflammation.
You can take corticosteroids orally or inject them directly into the affected joints. On occasion when these don’t help, immunosuppressive agents might be necessary.
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.
The outlook for patients with reactive arthritis is positive. Most people 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.