Overview

Reactive arthritis is a type of spondyloarthritis, a group of disorders that can cause inflammation throughout the body (especially in the spine). Reactive arthritis is associated with inflammation of the joints, eyes, and urinary tract and its associated genital structures. These symptoms may occur alone, together, or not at all. Any of these symptoms may be so mild that you may not notice them.

The symptoms of reactive arthritis usually last several months, although symptoms can return or develop into a long-term disease in a small percentage of people.

Reactive arthritis is not contagious; that is, a person with the disorder cannot pass the arthritis on to someone else. However, the bacteria that can trigger reactive arthritis can be passed from person to person.

Most people with reactive arthritis recover fully from the initial flare of symptoms. They may have mild arthritis symptoms that last up to a year, although symptoms don’t usually interfere with daily activities. Some people will have long-term, mild arthritis. A few patients will have long-term, severe arthritis that is difficult to control with treatment and may cause joint damage.

Some patients will re-develop symptoms, such as back pain and arthritis, after the initial flare has disappeared. These relapses may be caused by reinfection.

What happens in reactive arthritis?

In many patients, reactive arthritis is triggered by an infection in the bladder, urethra, or vagina that is often transmitted through sexual contact. Another form of reactive arthritis is caused by an intestinal infection from eating food or handling substances that are contaminated with bacteria.

Who Gets

Men are nine times more likely than women to develop reactive arthritis caused by sexually acquired infections. However, women and men are equally likely to develop reactive arthritis as a result of food-borne infections. Women with reactive arthritis often have milder symptoms than men.

Symptoms

Symptoms of reactive arthritis can include:

  • Joint symptoms, including:
    • Pain and swelling in the knees, ankles, and feet. Wrists, fingers, and other joints are affected less often.
    • Inflammation of the tendons or at places where tendons attach to the bone.
    • Heel spurs, which are bony growths in the heel that may cause long-lasting foot pain.
    • Low-back and buttock pain.
    • Inflammation of the bones in the spinal column or where the spine connects to the pelvis.
  • Inflammation of the urinary and genital tract.
  • Eye symptoms, including:
    • Inflammation.
    • Redness.
    • Pain and irritation.
    • Blurred vision.
  • Mouth sores and skin rashes.

Causes

In many patients, reactive arthritis is triggered by a bacterial infection in the bladder, urethra, or vagina that is often transmitted through sexual contact. Another form of reactive arthritis is caused by an intestinal infection from eating food or handling substances that are contaminated with bacteria. Reactive arthritis typically begins within two to four weeks after infection.

Doctors do not know exactly why some people exposed to these bacteria develop reactive arthritis and others do not. One gene, human leukocyte antigen (HLA) B27, increases a person’s chance of developing reactive arthritis. However, inheriting the HLA B27 gene does not necessarily mean you will get reactive arthritis.

A person with the disorder cannot pass the arthritis on to someone else. However, the bacteria that can trigger reactive arthritis can be passed from person to person.

Diagnosis

Although there is no single test for reactive arthritis, your doctor may do the following to diagnosis you with the condition:

  • Medical history to learn about your symptoms and any previous medical problems or infections.
  • Blood tests to:
    • Detect the genetic factor HLA B27. A positive result does not always mean that you the disorder.
    • Confirm inflammation somewhere in the body.
    • Rule out other conditions.
  • Take samples from the throat, urethra, cervix, urine, stool, or joints to test for bacteria.
  • X-rays to help diagnose reactive arthritis and to rule out other causes of arthritis.

Treatment

Although there is no cure for reactive arthritis, certain medications can relieve symptoms of the disorder:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat pain and inflammation. Ibuprofen and naproxen sodium are available over the counter, whereas other NSAIDS are available by prescription only.
  • Corticosteroids, strong inflammation-fighting drugs, may be applied directly on skin ulcers, or injected into a joint to temporarily relieve pain. Because they are potent drugs, your doctor will seek the lowest dose required to achieve the desired benefit.
  • Antibiotics eliminate the bacterial infection that triggered reactive arthritis.
  • Immunosuppressive medicines or biologics to stop the immune system from attacking the tissues.

Who Treats

Diagnosing and treating reactive arthritis requires a team effort involving you and several types of health care professionals. These may include:

  • Rheumatologists, who specialize in arthritis and other diseases of the bones, joints, and muscles. Your rheumatologist will also coordinate care between the different health providers.
  • Ophthalmologists, who treat eye disease.
  • Urologists or gynecologists, who treat genital symptoms.
  • Dermatologists, who treat skin symptoms.
  • Orthopaedists, who perform surgery on severely damaged joints.
  • Physiatrists, who supervise exercise regimens.

Living With

Exercise can reduce joint pain and stiffness and increase flexibility, muscle strength, and endurance. Exercise also helps people lose weight, which reduces stress on painful joints. You should speak to your doctor about a safe, well-rounded exercise program, which could include:

  • Strengthening exercises can be performed with weights or exercise bands to strengthen muscles that support joints affected by arthritis.
  • Muscle tightening exercises do not move any joints, so they can be done even when you have inflammation and pain.
  • Range-of-motion activities improve movement and flexibility and reduce joint stiffness.
  • Exercises to stretch the back and aquatic exercises can help if you have spine pain or inflammation.

Research Progress

Researchers continue to investigate the causes of reactive arthritis and study treatments for the condition. Recent research has explored:

  • The relationship between infection and reactive arthritis: Researchers are trying to better understand why an infection triggers arthritis and why this only occurs in some people. Scientists also are studying why people with the genetic factor HLA B27 are more at risk than others.
  • Locating the triggering bacteria in the body: Some scientists suspect that bacteria travel to the joints, where they can remain in small amounts over long periods of time.
  • Combination treatments, such as antibiotics in combination with immunosuppressant medicines.
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