Patient information: Reactive arthritis (formerly Reiter syndrome) (Beyond the Basics)

REACTIVE ARTHRITIS OVERVIEW

Reactive arthritis is a type of arthritis in which the joints become painful and swollen after an episode of infection. The infection might have been in the intestines, genitals, or the urinary tract.

Reactive arthritis belongs to a family of arthritis conditions called spondyloarthritis (spondyloarthropathies or spondyloarthritides). This family of arthritis disorders includes ankylosing spondylitis; undifferentiated spondyloarthritis; and arthritis associated with psoriasis (psoriatic arthritis), Crohn's disease, and ulcerative colitis. (See "Patient information: Ankylosing spondylitis and other spondyloarthritis (Beyond the Basics)" and "Patient information: Psoriatic arthritis (Beyond the Basics)" and "Patient information: Crohn's disease (Beyond the Basics)" and "Patient information: Ulcerative colitis (Beyond the Basics)".)

Some clinicians use the term “Reiter syndrome” instead of “reactive arthritis.”

REACTIVE ARTHRITIS CAUSES

Two types of bacteria are 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 information: Food poisoning (food-borne 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 information: Chlamydia (Beyond the Basics)".)

REACTIVE ARTHRITIS RISK FACTORS

The risk factors are:

• A preceding infection — As discussed above, predisposing infections are typically either foodborne diseases or sexually transmitted diseases.
• Genetic predisposition — Genetic risk is associated with having a particular variant of the HLA-B gene known as HLA-B27.

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.

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 having had symptoms of diarrhea or of a sexually transmitted disease.

REACTIVE ARTHRITIS TREATMENT

Antibiotics — Antibiotics may be used to treat an active genital infection. However, there is no convincing evidence that 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 information: 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 with 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 information: Disease-modifying antirheumatic drugs (DMARDs) (Beyond the Basics)" and "Patient information: 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, diagnosis, and management of undifferentiated spondyloarthritis and related spondyloarthritides" and "Patient information: 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.

Patient information: Reactive arthritis (Reiter syndrome) (The Basics)
Patient information: Ankylosing spondylitis (The Basics)
Patient information: Osteomyelitis (The Basics)

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 information: Ankylosing spondylitis and other spondyloarthritis (Beyond the Basics)
Patient information: Psoriatic arthritis (Beyond the Basics)
Patient information: Crohn's disease (Beyond the Basics)
Patient information: Ulcerative colitis (Beyond the Basics)
Patient information: Food poisoning (food-borne illness) (Beyond the Basics)
Patient information: Chlamydia (Beyond the Basics)
Patient information: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)
Patient information: Disease-modifying antirheumatic drugs (DMARDs) (Beyond the Basics)
Patient information: 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.

Neutrophilic dermatoses
Pathogenesis of spondyloarthritis
Reactive arthritis (formerly Reiter syndrome)
Uveitis: Etiology, clinical manifestations, and diagnosis

The following organizations also provide reliable health information.

• National Library of Medicine
  (www.nlm.nih.gov/medlineplus/healthtopics.html)
• Spondylitis Association of America
  (www.spondylitis.org)
• National Institute of Arthritis and Musculoskeletal and Skin Diseases
  (301) 496-8188
  (www.nih.gov/niams/)
• American College of Rheumatology
  (404) 633-3777
  (www.rheumatology.org)
• The Arthritis Foundation
  (800) 283-7800
  (www.arthritis.org)

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