Patient education: Reactive arthritis (Beyond the Basics)
- David T Yu, MD
David T Yu, MD
- Emeritus Professor
- University of California Los Angeles
REACTIVE ARTHRITIS OVERVIEW
Reactive arthritis is a very uncommon type of arthritis in which the joints become painful and swollen soon after an infection in another part of your body. The infection might have been in the intestines, genitals, or urinary tract.
Reactive arthritis is a form of "spondyloarthritis" (SpA), which is a family of arthritis-associated diseases. Diseases in the SpA family fall into one of two groups, which sometimes overlap:
●Peripheral SpA – These conditions affect the joints of the arms and legs, fingers and toes, and heels. Almost all people with reactive arthritis have this type of SpA, but it a relatively rare cause of peripheral SpA.
●Axial SpA (axSpA) – These conditions involve the spine. The prime example of this type is ankylosing spondylitis. (See "Patient education: Ankylosing spondylitis and other spondyloarthritis (Beyond the Basics)".)
In the past, clinicians sometimes used the term "Reiter syndrome" instead of "reactive arthritis."
REACTIVE ARTHRITIS CAUSES
Two types of bacteria are regarded as being responsible for most cases of reactive arthritis:
●Bacteria that cause bowel infections – These include the bacterial species Salmonella, Shigella, Campylobacter, and Yersinia. These bacteria often cause diarrhea, which can last up to one month. (See "Patient education: Food poisoning (foodborne illness) (Beyond the Basics)".)
●Bacteria that cause genital infections – These include Chlamydia trachomatis, a sexually transmitted infection. Chlamydia can cause pelvic pain, burning with urination, and a pus-like or watery vaginal or penile discharge. Some people have no symptoms with their infection. (See "Patient education: Chlamydia (Beyond the Basics)".)
GENETIC RISK FACTOR
One of the genetic risk factors is a particular variant of the human leukocyte antigen (HLA)-B gene known as HLA-B27. However, not all patients with reactive arthritis carry the HLA-B27 gene.
REACTIVE ARTHRITIS SYMPTOMS
Typical symptoms of reactive arthritis include joint pain and swelling that develops suddenly, usually one to four weeks after an episode of infection. Frequently, the pain and swelling involve a small number of joints (three or less), typically including the knee, ankle, or joints of the feet.
Some patients have tendonitis affecting the Achilles tendon, behind the ankle, or the plantar fascia, on the sole of the foot where it attaches to the heel. Some patients develop swelling of one or more fingers or toes.
Conjunctivitis (inflammation of the covering of the eyes) can also occur in people with reactive arthritis.
REACTIVE ARTHRITIS DIAGNOSIS
Diagnosis depends first on the distribution and location of pain and swelling of the extremities, and secondly on a history of recent prior symptoms of diarrhea or a sexually transmitted disease. It is helpful to identify the bacterial cause in the case of genital infections, as this will help guide treatment; however, it is not always necessary in the case of gastrointestinal infections. In either form of reactive arthritis, there is no need to do joint biopsy for the purpose of identifying the causative bacteria.
REACTIVE ARTHRITIS TREATMENT
Antibiotics — Antibiotics may be used to treat an active genital infection. However, there is no convincing evidence that standard regimens of antibiotics will improve joint pain or will shorten the course of reactive arthritis after the joint pain has developed.
Nonsteroidal antiinflammatory drugs — Nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or indomethacin are usually recommended to reduce joint pain and swelling. Relatively large doses of an NSAID may be needed on a regular basis for up to two weeks to determine if the NSAID is effective. (See "Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)".)
Other treatments — If you do not improve with NSAIDs, your clinician may recommend a glucocorticoid (also called a steroid) injection into the joint. Additional treatment with glucocorticoids (taken by mouth or as an injection) might be necessary for a short period if you have severe pain or joint swelling.
Another medication, such as one of the disease-modifying antirheumatic drugs (DMARDs; eg, sulfasalazine or methotrexate), or a medication that interferes with the action of tumor necrosis factor (TNF; a TNF inhibitor or blocker such as etanercept, infliximab, or adalimumab) may be recommended if your symptoms do not improve with NSAIDs or glucocorticoid treatment. In this case, you should see a specialist in inflammatory joint diseases (a rheumatologist) to confirm that your symptoms are caused by reactive arthritis. (See "Patient education: Disease-modifying antirheumatic drugs (DMARDs) (Beyond the Basics)" and "Patient education: Sulfasalazine and the 5-aminosalicylates (Beyond the Basics)".)
Eye treatment — Eye inflammation can occur in people with reactive arthritis and is sometimes treated with glucocorticoid eye drops. If you develop eye pain or blurry vision, you should see an ophthalmologist to determine if your symptoms are due to conjunctivitis or a more serious eye problem such as inflammation of the iris (called iritis or anterior uveitis). (See "Uveitis: Etiology, clinical manifestations, and diagnosis".)
WHEN WILL I GET BETTER?
Most people with reactive arthritis have a mild course of joint pain that resolves spontaneously and that never comes back. In some people, the disease will intermittently cause symptoms. In others, the disease is persistent.
If your back becomes painful and stiff and does not improve with time, reactive arthritis may have developed into a spondyloarthropathy. (See "Clinical manifestations and diagnosis of peripheral spondyloarthritis in adults" and "Patient education: Ankylosing spondylitis and other spondyloarthritis (Beyond the Basics)".)
WHERE TO GET MORE INFORMATION
Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Ankylosing spondylitis and other spondyloarthritis (Beyond the Basics)
Patient education: Psoriatic arthritis (Beyond the Basics)
Patient education: Crohn disease (Beyond the Basics)
Patient education: Ulcerative colitis (Beyond the Basics)
Patient education: Food poisoning (foodborne illness) (Beyond the Basics)
Patient education: Chlamydia (Beyond the Basics)
Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)
Patient education: Disease-modifying antirheumatic drugs (DMARDs) (Beyond the Basics)
Patient education: Sulfasalazine and the 5-aminosalicylates (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
The following organizations also provide reliable health information.
●National Library of Medicine
●Spondylitis Association of America
●National Institute of Arthritis and Musculoskeletal and Skin Diseases
●American College of Rheumatology
●The Arthritis Foundation
- Healy PJ, Helliwell PS. Classification of the spondyloarthropathies. Curr Opin Rheumatol 2005; 17:395.
- D'Agostino MA, Olivieri I. Enthesitis. Best Pract Res Clin Rheumatol 2006; 20:473.
- Leirisalo-Repo M. Reactive arthritis. Scand J Rheumatol 2005; 34:251.
- Sieper J, Rudwaleit M, Braun J, van der Heijde D. Diagnosing reactive arthritis: role of clinical setting in the value of serologic and microbiologic assays. Arthritis Rheum 2002; 46:319.
- Schmitt SK. Reactive Arthritis. Infect Dis Clin North Am 2017; 31:265.
All topics are updated as new information becomes available. Our peer review process typically takes one to six weeks depending on the issue.