Treating reactive arthritis

To treat reactive arthritis, your doctor will likely suggest a multipronged approach. Arthritis occurs when your immune system is misdirected to attack your joints, causing swelling and pain.

Reactive arthritis is a type of inflammatory arthritis that can be triggered by an infection somewhere in your body. This infection causes the misdirected immune system response.

There is no cure for reactive arthritis. But the symptoms can go into remission and not require treatment, unless a subsequent flare occurs. Treatments for reactive arthritis can help relieve your symptoms.

Because reactive arthritis is an autoimmune reaction, antibiotics can’t treat the inflammation in your joints.

If you have obvious signs of a bacterial infection in your urinary tract or gastrointestinal system, antibiotics can help it clear up. Which antibiotic you take will depend on what kind of bacterial infection you have. Your doctor may need to run tests to find out. Viral and fungal infections are harder to treat.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and inflammation from arthritis. Over-the-counter NSAIDs include:

If these don’t work, your doctor may prescribe different NSAIDs, such as indomethacin (Tivorbex) or celecoxib (Celebrex).

NSAIDs can cause stomach bleeding, so always take them with food. Your doctor can help you evaluate any risks.

If NSAIDs aren’t enough to get inflammation under control, your doctor may give you corticosteroid injections. Steroids suppress your immune system, slowing its attack on your body. However, steroids don’t slow down the progression of arthritis itself.

To treat arthritis directly, your doctor may give you disease-modifying antirheumatic drugs (DMARDs), such as sulfasalazine (Azulfidine) or methotrexate. DMARDs don’t directly help pain or inflammation but can slow the progression of your arthritis.

Since arthritis damages joints slowly over time, taking DMARDs can help protect your joints from this damage.

Using DMARDs for reactive arthritis is considered off-label drug usage. Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that hasn’t been approved.

However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So your doctor can prescribe a drug however they think is best for your care.

These drugs partially shut down your immune system. They slow its attack on your body, but also prevent your body from properly defending itself against infections.

You might become immunocompromised, meaning you are vulnerable to infections that most people can resist. For this reason, immunosuppressant drugs aren’t commonly used to treat reactive arthritis.

Tumor necrosis factor (TNF) blockers are another alternative treatment option. TNF is a protein that’s part of your body’s inflammatory response in arthritis. TNF blockers interfere with this protein, relieving pain and stiffness and helping swollen or tender joints.

TNF blockers include etanercept (Enbrel) and infliximab (Remicade). Each TNF blocker works in a different way, so if one doesn’t help, another might.

Taking TNF blockers for reactive arthritis is also considered to be off-label drug use.

Exercise can help improve your joint function. A physical therapist can give you exercise routines to help build up your strength.

Strengthening the muscles around your joints helps support them. Range-of-motion exercises improve flexibility and reduce stiffness. Water exercise may be a good way to exercise without causing stress to your joints.

Heat and cold therapy may also help: Heat reduces pain and soreness, and cold helps decrease swelling.

Symptoms of reactive arthritis usually occur in three clusters. Joint pain, stiffness, and pain in the heel, or Achilles tendon, are common. You may have bladder symptoms, including a burning sensation when urinating or need to urinate more often. You can also get conjunctivitis, or swollen eyelids. This can be accompanied by redness, itching or burning, and discharge.

Even though no treatment can cure reactive arthritis, treating the symptoms can help reduce your joint pain. Talk to your doctor about a treatment plan that works for you.