While reactive arthritis can affect both sexes, men between the ages of 20 and 40 are most likely to develop it.
Inflammation is your body’s natural reaction to injury or disease and is marked by:
SwellingRednessHeatPain
Specific reactive arthritis symptoms and related complications can vary depending on what part(s) of the body are affected, be it the joints, urogenital tract, eyes, or skin.
Joints
Reactive arthritis typically involves joint pain and swelling in the knees, ankles, and feet, but the wrists, fingers, and other joints can also be affected.
People with reactive arthritis commonly develop tendonitis, which often leads to pain in the ankle or Achilles tendon. Some cases involve heel spurs—bony growths in the heel that may cause chronic foot pain.
Furthermore, approximately half of the people with reactive arthritis report low-back and buttock pain. Reactive arthritis also can cause spondylitis or sacroiliitis (inflammation of the sacroiliac joints at the base of the spine).
Urogenital Tract
Reactive arthritis often affects the urogenital tract, with different symptoms in men and women.
In men, it impacts the prostate and urethra. Men may notice:
Increased need to urinateBurning sensation when urinatingPenis painFluid discharge from the penis
Some men with reactive arthritis develop prostatitis, which can cause fever and chills, along with an increased need to urinate and a burning sensation when peeing.
In women, this disease affects the urethra, uterus, and vagina. Additionally, women with reactive arthritis may develop inflammation of the:
Cervix (cervicitis): May include bleeding between periods, abnormal vaginal discharge, and pain with intercourse Urethra (urethritis): Can cause a burning sensation during urination and frequent urination Fallopian tubes (salpingitis, pelvic inflammatory disease): Can cause abnormal vaginal discharge, spotting between periods, painful periods, pain during sex, painful urination, nausea and vomiting, fever, lower back pain, abdominal pain, and fever Vulva and vagina (vulvovaginitis, vulvitis, vaginitis): May cause irritation, itching, strong-smelling vaginal discharge, and pain during urination
Eyes
Conjunctivitis, an inflammation of the mucous membrane that covers the eyeball and eyelid, develops in approximately half of people with reactive arthritis.
Some people may develop uveitis, which is inflammation of the uvea (the pigmented layer in the eye, including the iris).
Conjunctivitis and uveitis can cause:
Redness of the eyesEye pain and irritationBlurred vision
Eye involvement typically occurs early in the course of reactive arthritis, and symptoms may disappear only to return again.
Skin
Skin symptoms, involving sores and rashes, tend to be less common. Small percentages of people with reactive arthritis develop:
Small, shallow, painless sores on the end of the penis Rashes Red and scaly patches on the soles of the feet, palms of the hands, or elsewhere Mouth ulcers that come and go; may be painless and go unnoticed
These symptoms usually wax and wane over a period of several weeks to several months.
In others, it’s caused by an infection in the gastrointestinal tract from eating food or handling substances that are contaminated with bacteria. This form is sometimes called enteric or gastrointestinal reactive arthritis.
Chlamydia
The bacterium most often associated with reactive arthritis is Chlamydia trachomatis, commonly known as chlamydia. A chlamydia infection can lead to reactive arthritis typically about two to four weeks after infection.
You may not be aware of the chlamydia infection, but your healthcare provider will likely test you for it if they suspect reactive arthritis but you haven’t had recent GI symptoms.
Chlamydia is usually acquired through sexual contact. Some evidence also shows that respiratory infections with Chlamydia pneumoniae may trigger reactive arthritis as well.
Men are nine times more likely than women to develop reactive arthritis due to venereal infections.
GI Tract Infections
Infections in the digestive tract that may trigger reactive arthritis include:
Salmonella Shigella Yersinia Campylobacter
These infections are usually the result of food poisoning, which occurs when you either eat or handle contaminated foods. Women and men are equally likely to develop reactive arthritis as a result of foodborne infections.
Genetic Predisposition
Healthcare providers don’t know exactly why some people exposed to the above bacteria develop reactive arthritis and others don’t, but they have identified a genetic factor—human leukocyte antigen (HLA) B27—that increases the chance of developing reactive arthritis.
Up to 80% of people with reactive arthritis test positive for HLA-B27, but that doesn’t mean inheriting the gene always results in the disease. While about 6% of healthy people have the HLA-B27 gene, only about 15% of them will develop reactive arthritis if they contract a triggering infection.
Researchers are trying to better understand why this is so, as well as why an infection can trigger arthritis at all. Scientists are also studying why people with the genetic factor HLA-B27 are more at risk than others.
Interestingly, people who have the HLA-B27 gene are more likely to develop spine-related issues as a result of reactive arthritis than those without the gene.
Your Medical Team
A rheumatologist (a practitioner specializing in arthritis and related issues) is typically the “quarterback” of a reactive arthritis medical team. They serve as the main person coordinating the treatment plan, with the input of other specialists, and also monitor for any side effects.
The other specialists involved (and their areas of focus) may include:
Ophthalmologist: Eye diseases Gynecologist: Genital symptoms in women Urologist: Genital symptoms in men and women Dermatologist: Skin symptoms Orthopedist: Surgery on severely damaged joints Physiatrist: Exercise regimens
Examination
At the beginning of an examination, expect a healthcare provider to take a complete medical history and ask about your current symptoms. It can help if you keep a record of your symptoms, when they occur, and how long they last.
It is especially important to report any flu-like symptoms such as the following, as they may be evidence of a bacterial infection:
FeverVomitingDiarrhea
Tests
There’s no single test that can diagnose reactive arthritis, so your healthcare provider will likely look at several factors before making a diagnosis. If your infection was mild and didn’t require medical treatment, it can make the diagnostic process harder.
Your practitioner may order any combination of the following tests and other tests deemed necessary:
Genetic factor HLA-B27 blood test, though a positive result does not always mean your have the disorder—just that you’re pre-disposed Rheumatoid factor or antinuclear antibody tests to help identify other causes of arthritis (e. g. , rheumatoid arthritis or lupus) Erythrocyte sedimentation rate, as a high “sed rate” often indicates inflammation somewhere in the body, which can point to rheumatic disease
Your healthcare providers may further test for infections that might be associated with reactive arthritis, such as chlamydia. Swabs may be taken from the throat, the urethra (in men), or cervix (in women).
Your urine and stool samples also may be tested.
To rule out infection in a painful joint, a practitioner may remove and test a sample of synovial fluid.
Imaging
Healthcare providers sometimes use X-rays to help diagnose reactive arthritis and to rule out other causes of arthritis. X-rays can detect other symptoms, including:
SpondylitisSacroiliitisSoft tissue swellingDamage to cartilage and jointsCalcium deposits
Antibiotics
Antibiotics help eliminate bacterial infections that trigger reactive arthritis. The specific antibiotic prescribed depends on the type of bacterial infection you have.
Some healthcare providers may recommend antibiotics for a long period of time (up to three months), but the research on this practice is inconsistent and the source of some disagreement in the medical community, especially when it comes to cases triggered by GI infections.
NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce joint inflammation and are commonly used to treat patients with reactive arthritis. Some NSAIDs are available without a prescription, such as:
Aspirin Advil, Motrin (ibuprofen)
Other NSAIDs that are usually more effective for reactive arthritis must be prescribed by a healthcare provider, including:
Tivorbex (indomethacin)Tolmetin
Topical Corticosteroids
These corticosteroids come in a cream or lotion form that can be applied directly to skin sores associated with reactive arthritis. Topical corticosteroids reduce inflammation and promote healing.
Corticosteroid Shots
For those with severe joint inflammation, injections of corticosteroids directly into the affected joint may reduce inflammation.
Immunosuppressants/DMARDs
Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate or sulfasalzine may help control severe symptoms that cannot be controlled by other drugs.
TNF Blockers
If your case proves hard to treat with the above options, your healthcare provider may prescribe a TNF blocker, such as Enbrel (etanercept) or Remicade (infliximab).
Exercise
Exercise may help improve your joint function, but it’s important to introduce it gradually and with guidance from a physiatrist or physical therapist. Recommended types of exercise include:
Strengthening exercises to build up muscles around the joint for better supportRange-of-motion exercises to improve flexibility and movementMuscle-tightening exercises that don’t involve joint movement: These may be helpful if you have too much inflammation and pain for other types of exercise.
If you have pain and inflammation in the spine, exercises that stretch and extend your back may be particularly helpful in preventing long-term disability.
Aquatic exercise also may be helpful, as water’s buoyancy greatly reduces the pressure on your joints.
Approximately 30% to 50% of people with reactive arthritis will develop symptoms again sometime after the initial flare has disappeared. Some will develop chronic (long-term) arthritis, which usually is mild.
It is possible that such relapses may be due to reinfection. Back pain and arthritis are the symptoms that most commonly reappear.
A small percentage of patients will have chronic, severe arthritis that is difficult to control with treatment and may cause joint deformity.
