Reactive arthritis is an uncommon inflammatory arthritis that occurs after an infection.

Treating reactive arthritis

Reactive arthritis (ReA) is a type of inflammatory arthritis triggered by an infection in your body. Bacteria and viruses can cause ReA. A bladder cancer treatment called Bacillus Calmette-Guerin (BCG) may cause ReA in some cases.

This type of arthritis is uncommon, yet genetic factors can affect your risk.

Reactive arthritis begins within 4 weeks after a digestive, genital, or bladder infection. One or more joints of the back, knees, or ankles swell suddenly and become painful.

You may also experience:

There is no cure for ReA. But the symptoms can go into remission and not require treatment until another flare occurs. Treatments for reactive arthritis can help relieve your symptoms. A doctor may suggest multiple treatment approaches.

Because ReA attacks joints with inflammation, antibiotics won’t treat ReA once it has started. Yet an antibiotic can help clear up the bacterial infection in your urinary, genital, or digestive system that triggered the attack.

The antibiotic you take will depend on the kind of bacterial infection you have. A recent clinical review published in 2021 notes that if the bacteria Chlamydia trachomatis is the cause of illness, the primary treatment of ReA will be antibiotics.

Bacterial infections that can cause ReA can include:

A doctor may need to run tests to determine which infection is present.

Viral infections may also cause ReA but are harder to identify and will not be treated with antibiotics.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and inflammation from ReA. They are the primary treatment for ReA. Over-the-counter (OTC) NSAIDs include:

  • ibuprofen (Advil, Motrin IB)
  • naproxen (Aleve, Anaprox, Naprosyn)

If these don’t work, your doctor may prescribe different NSAIDs, such as:

NSAIDs can cause side effects, including stomach bleeding, so always take them with food. A doctor or pharmacist can help you evaluate any risks.

NSAIDs may not be enough to control the inflammation. A doctor may prescribe steroids, such as prednisone or methylprednisolone.

These can be taken by mouth or given by injection for short-term relief.

Steroids suppress your immune system, slowing its attack on your body and relieving pain. But steroids don’t cure ReA and can have substantial side effects with long-term use.

To treat reactive arthritis that lasts longer than 6 months, a doctor may prescribe disease-modifying anti-rheumatic drugs (DMARDs), such as:

DMARDs can help with pain and inflammation. In addition, because arthritis damages joints over time, taking DMARDs can help protect your joints from damage.

Using DMARDs for reactive arthritis is considered off-label drug usage. The Food and Drug Administration approves drugs for specific purposes researched in clinical trials.

However, following the guidelines of published, peer-reviewed studies and standards of care, a doctor can still use the drug for similar non-FDA-approved purposes, called off-label use.

Because DMARDs partially shut down your immune system, you might become susceptible to infections that most people can fight off.

Tumor necrosis factor (TNF)-blockers are another off-label treatment option for reactive arthritis. TNF is a protein formed in your body’s inflammation process. TNF-blockers stop this protein’s action, relieving pain and stiffness and helping swollen or tender joints, according to the American College of Rheumatology.

A 2020 review outlines their effectiveness in ReA and shows they may be used when NSAIDs fail.

TNF-blockers used to treat ReA can include:

Each TNF-blocker works slightly differently, so if one doesn’t help, another might. And like DMARDs, TNF-blockers can reduce your body’s ability to fight off infections.

Exercise can be added to medication therapy and help improve your joint function. A physical therapist can guide you through exercise routines to help build your strength.

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

Heat and cold therapy can supplement medication treatment. Heat can reduce pain and soreness, while cold can help decrease swelling.

Symptoms of reactive arthritis usually occur in three clusters: joint pain, bladder irritation, and conjunctivitis.

Bladder symptoms include a burning sensation when urinating or needing to urinate more often. Conjunctivitis looks like swollen eyes with redness, itching, burning, or discharge.

If you develop these three problems at the same time, check with a doctor right away.

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

ReA is a type of inflammatory arthritis that begins following an infection.

Your joints may become swollen and painful. You may also experience other symptoms such as red eyes and an inflamed urinary tract.

There is no cure for ReA. Treatment typically involves NSAIDs to reduce inflammation. It may also involve antibiotics for an underlying bacterial infection. A doctor may recommend other therapies depending on how you respond to those treatments.