Reactive Arthritis: 7 Warning Signs & Powerful Treatment Options

Reactive arthritis, as the name suggests, occurs in reaction to something in this case, an infection.

The condition is caused by a bacterial infection in the digestive or urinary tract or the genitals, but arthritis symptoms typically do not set in until after you have recovered from the infection. Inflammation of the joints, eyes, and urinary tract is a hallmark of reactive arthritis, but not everyone gets all three, or they might not occur at the same time.

The knee and ankle joints are frequently affected, and many people also experience pain in the sacroiliac joints, which are located in the lower back. Reactive arthritis is a form of spondyloarthritis, a group of arthritis conditions that typically involve the sacroiliac joints in the lower back, and entheses (places where tendons or ligaments attach to bones). Foot pain in people with reactive arthritis is usually due to inflammation of entheses.

The symptoms often clear up on their own within a few weeks or months, but they may become chronic (long-lasting) in some people. Doctors tailor treatment to each individual’s symptoms, and therapy typically involves a combination of medications and exercise.

Anyone can get reactive arthritis, and it occurs worldwide. A bacterial infection—in the digestive or urinary tract or the genitals—typically precedes it by a few weeks. Although sexually transmitted infections can occur just before the onset of reactive arthritis, many cases of reactive arthritis are associated with other types of infections that are not transmitted sexually. Certain factors increase the risk of the condition, including:

Sex. Both men and women can get reactive arthritis, but men are more likely to develop it as a result of a sexually transmitted infection. Men and women are equally affected if the condition is from a gastrointestinal infection.
Age. It occurs most often in people between the ages of 20 and 40.
Genetics. People who have a gene called HLA-B27 have a higher risk of getting reactive arthritis and of experiencing more severe and more long-lasting symptoms. But people who lack HLA-B27 can still get the condition.
HIV infection. Having AIDS or being infected with HIV increases the risk of reactive arthritis.

Some people with reactive arthritis have mild symptoms, while others have severe symptoms that limit daily activities. The symptoms typically start 1 to 6 weeks after an infection of the digestive or urinary tract or genitals, but the infection has usually resolved by the time symptoms arise. The condition typically begins fairly suddenly, usually over the course of a few days.

Reactive arthritis is characterized by inflammation of the joints, eyes, and urinary tract, but not everyone with the condition will experience all three, or they might not occur at the same time. The main symptoms are:

Joint pain and stiffness.
Joints may become painful, red, and swollen, especially the large joints of the lower limbs, such as the knees and ankles. Morning stiffness or nighttime pain is typical. The affected joints are usually on one side of the body. There may be pain in the lower back and buttocks as well.
Pain in the heel or foot is a sign of enthesitis (inflammation at a place where a tendon or ligament attaches to a bone).
Swollen, inflamed, painful fingers or toes (dactylitis) may also occur.
Inflammation of the urinary tract.
This symptom is more common when reactive arthritis happens after an infection of the genitals or urinary tract.
In women, urinary tract inflammation can develop into inflammation of the cervix, fallopian tubes, vulva, or vagina.
Increased urinary frequency and burning while urinating are signs of urinary tract inflammation.
Eye inflammation.
Conjunctivitis or “pink eye” (inflammation of the transparent layer that covers the white part of the eye and lines the eyelids) and uveitis (inflammation of the middle part of the eye) can cause redness, pain, burning, itching, crusted eyelids, blurred vision, or sensitivity to light.

Other symptoms of reactive arthritis include:

Fatigue or feeling generally unwell.
Fever.
Weight loss.
Diarrhea and abdominal pain.
Small ulcers in the mouth.
In men, small, painless ulcers on the penis.
Skin rash (keratoderma blennorrhagica) consisting of reddish, raised bumps, usually on the palms or soles. The bumps may merge, forming a larger scaly rash.
Thickened nails.

The symptoms of reactive arthritis often clear up on their own within a few weeks or months, but they may become chronic (long-lasting) in some people.

Reactive arthritis is triggered by an infection, frequently a sexually transmitted or food-borne bacterial infection, but it is separate from the infection and typically sets in after the infection has cleared. The bacteria that commonly trigger it are Salmonella, Yersinia, Campylobacter, Shigella, and Chlamydia, but only a small number of people infected with them develop the condition. Scientists do not fully understand why some people are predisposed to getting reactive arthritis.

Genetics seems to partly explain susceptibility to the condition, as many affected individuals have a gene called HLA-B27. However, many people who get reactive arthritis lack this genetic marker, so there are other, unknown genetic and environmental contributing factors.

There is no single test that doctors can use to diagnose reactive arthritis, but they may suspect that you have it if you have joint pain and have had an infection of the digestive or urinary tract or the genitals in the past few weeks.

Other types of spondyloarthritis can exhibit similar symptoms and may need to be ruled out, including:

Psoriatic arthritis.
Ankylosing spondylitis.
Inflammatory bowel disease-associated arthritis.
Undifferentiated spondyloarthritis (a variety of symptoms that are not specific to any one type).

The process doctors use to diagnose reactive arthritis typically involves the following.

Medical History and Physical Exam

During the examination, the doctor usually:

Asks about your symptoms and when they began, including symptoms of a recent infection.
Check your joints for signs of tenderness or swelling, and skin and mucosal surfaces for rashes or ulcers.
Examine your eyes for signs of inflammation.

Lab Tests

The doctor may order the following tests.

HLA-B27. This blood test looks for the presence of HLA-B27, a genetic risk factor for reactive arthritis. Having this marker is consistent with having reactive arthritis, but it is not definitive—people who test negative can still have reactive arthritis, and not everyone who tests positive has the condition.
Bacterial cultures. Culturing stool and urine specimens may reveal the presence of bacteria that frequently trigger reactive arthritis. But a negative result is not conclusive because in most cases, the infection has cleared by the time arthritic symptoms arise.
Joint fluid (synovial fluid) test. This test is to assess the level of inflammation in the joint and to rule out other causes for the pain, such as a joint infection or other conditions, such as gout. The doctor will draw fluid from a joint using a needle and syringe and will send it to a lab for analysis.
Erythrocyte sedimentation rate (sed rate) and C-reactive protein. These blood tests are measures of inflammation, but they are not specific for reactive arthritis. A positive test result can indicate any inflammatory disorder. A negative test result does not rule out reactive arthritis because these markers are usually not elevated in the chronic form of the condition.

Imaging Studies

The doctor may order the following scans.

X-rays can reveal the status of the joints, including signs of reactive arthritis such as inflammation of the sacroiliac joints, which are located in the lower back. They can also help rule out other causes of joint pain. X-rays often do not pick up abnormalities until later in the course of reactive arthritis.
Ultrasounds, computed tomography (CT), and magnetic resonance imaging (MRI). These specialized imaging techniques are especially useful for visualizing joint changes that happen in the early stages of reactive arthritis.

Other Tests

To rule out conditions that have similar symptoms, doctors may order other types of blood tests, such as:

Antibody tests for rheumatoid factor (RF) and anticyclic citrullinated peptide (anti-CCP), which are associated with rheumatoid arthritis.
Antinuclear antibody (ANA) test, which is associated with systemic lupus erythematosus.

There is no cure for reactive arthritis, so treatment is aimed at relieving the symptoms. Doctors tailor treatment to each individual’s symptoms. Your doctor might use one or more of the following:

Medications

Over-the-counter or prescribed anti-inflammatory and pain medications. These can help reduce pain and swelling in the joints.
Corticosteroids. Usually, these are injected into affected joints, but if multiple joints are involved, your doctor may prescribe them by mouth or intravenously. They are potent drugs, so doctors typically prescribe the lowest dose possible to achieve the desired benefit. You may need corticosteroid creams or eye drops for skin and eye symptoms, respectively.
Disease-modifying anti-rheumatic drugs (DMARDs). These medicines suppress the immune system on a broad level, helping to block inflammation in the joints and other tissues. Doctors usually only use them when anti-inflammatories and corticosteroids have not worked.
Antibiotics. Doctors may prescribe antibiotics if there is evidence of a current bacterial infection.

Physical Therapy

Physical therapy can help ease pain and improve joint function. A physical therapist can teach techniques for strengthening the muscles that surround a joint, providing support and improving joint flexibility.

Diagnosing and treating reactive arthritis usually requires a team effort involving several types of health care professionals. The condition is primarily treated by:

- Rheumatologists specialize in arthritis and other diseases of the bones, joints, and muscles.
Other health care specialists who may be involved in your care include:
- Dermatologists specialize in conditions of the skin, hair, and nails.
- Gynecologists specialize in the female reproductive system.
- Mental health professionals, who can help people cope with difficulties in the home and workplace that may result from their medical conditions.
- Occupational therapists teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy.
- Ophthalmologists specialize in treating disorders and diseases of the eye.
- Orthopaedists treat and perform surgery for bone and joint diseases.
- Physical therapists improve quality of life through prescribed exercise, hands-on care, and patient education.
- Primary care doctors, such as family physicians or internal medicine specialists, coordinate care between the different health care providers and treat other problems as they arise.
- Urologists treat diseases of the urinary tract and the male reproductive system.

There are things you can do to help you live with reactive arthritis. These include:

Balance rest and exercise. Exercise is important for maintaining healthy and strong muscles, preserving joint mobility, and maintaining flexibility. Check with your doctor before beginning an exercise routine.
Use heat and cold therapies to reduce joint pain. Heat therapy increases blood flow, tolerance for pain, and flexibility. Cold therapy numbs the nerves around the joint to reduce pain.
Use support devices such as a cane or walker to help you move around safely and lessen pain.
Use shoe inserts or braces to help support your joint and help lower pain and pressure on the area. This can be helpful when you stand or walk.
Visit a mental health professional if emotional problems arise, since having a painful condition like reactive arthritis can be challenging.

Be sure to visit your health care providers regularly and follow their recommendations.

Source:
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Reactive Arthritis.
https://www.niams.nih.gov/health-topics/reactive-arthritis

Diseases

Phone

(951) 781-7700

Fax

(951) 781-0313

Email

info@arthritismedicalclinic.org

Location

6180 Brockton Avenue, STE. #204
Riverside, CA 92506

4244 Riverwalk Parkway, STE. #220
Riverside, CA 92505

Ready to Take the Next Step?

Connect with a lupus specialist who can provide personalised care and treatment plans.

Learn about ANA tests, anti-dsDNA antibodies, and other diagnostic tools used to identify lupus.

Understand genetic, environmental, and hormonal factors that may increase lupus risk.

Access research studies, clinical trials, and evidence-based treatment guidelines.

This information is for educational purposes only and should not replace professional medical advice. Always consult with your healthcare provider for diagnosis and treatment recommendations specific to your condition.

Call Us:
(951) 781-7700

Send Email
info@arthritismedicalclinic.org

6180 Brockton Avenue, STE 204, Riverside, CA 92506

4244 Riverwalk Parkway, Suite 220, Riverside, CA 92505

Infusion
Therapy

Bone Densitometry(dexa)

Musculoskeletal
Ultrasound

Joint
Injection

Clinical Research
Trials