Reactive Arthritis (Reiter's Syndrome)
What is reactive arthritis?
Reactive arthritis is a type of arthritis that occurs due to an infection. Arthritis is when joints become inflamed and painful. Reactive arthritis is not contagious. It's also known as Reiter's Syndrome. It mostly affects men ages 20 to 40.
What causes reactive arthritis?
Reactive arthritis is not contagious, but it’s caused by some infections that are contagious. The infections that most often cause the disease are spread through sexual contact. One cause is the bacteria Chlamydia trachomatis. It can cause infections in the bladder, urethra, penis, or vagina. This is also known as genitourinary Reiter's syndrome.
Other infections that can cause reactive arthritis infect the gut. One cause is salmonella. This infection can come from eating food or handling objects that have the bacteria. This form of the disease is known as gastrointestinal Reiter's syndrome. It’s also known as enteric Reiter's syndrome.
Reactive arthritis may also be linked to genes. About 80 percent of people who get the disease have a gene called HLA-B27.
Who is at risk for reactive arthritis?
Risk factors for getting reactive arthritis include:
- Having an infection from sexual contact
- Having an illness from contaminated food
- Being male
What are the symptoms of reactive arthritis?
Reactive arthritis may cause arthritis symptoms, such as joint pain and inflammation. It can also cause symptoms in the urinary tract symptoms and an infection of the eye (conjunctivitis). Symptoms can last from 3 to 12 months. In a small number of people, the symptoms may turn into chronic disease. Symptoms can occur a bit differently in each person, and may include:
- Joint pain and inflammation that often affect the knees, feet, and ankles
- Inflammation of tendon that is attached to bone (enthesopathy), which may cause heel pain or shortening and thickening of the fingers
- Bony growths in the heel (heel spurs) that can cause chronic pain
- Inflammation of the spine (spondylitis)
- Inflammation of the lower back joints (sacroiliitis)
Urinary tract symptoms
- Increased urinary output
- Burning sensation during urination
- Discharge from penis
- Inflamed prostate gland (prostatitis)
- Inflamed cervix
- Inflamed urethra, causing a burning sensation during urination
- Inflamed fallopian tubes (salpingitis)
- Inflamed vulva and vagina (vulvovaginitis)
- Red eyes
- Painful and irritated eyes
- Blurry vision
- Inflamed mucous membrane that covers the eyeball and eyelid (conjunctivitis)
- Inflammation of the inner eye (uveitis)
The symptoms of reactive arthritis can be like other health conditions. Make sure to see your health care provider for a diagnosis.
How is reactive arthritis diagnosed?
The process starts with a medical history and a physical exam. Diagnosis can be difficult. This is because there are no specific tests that can confirm the condition. Some blood tests may be done to rule out other conditions, such as rheumatoid arthritis and lupus. Other tests may include:
- Erythrocyte sedimentation rate (ESR or sed rate). This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood's proteins clump together and become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation.
- Tests for infections. This includes a test for Chlamydia. It may also include tests for other infections that are associated with reactive arthritis.
- Joint aspiration (arthrocentesis). A small sample of the synovial fluid is taken from a joint. It's tested to see if crystals, bacteria, or viruses are present.
- Urine and stool samples. These are used to look for bacteria or other signs of disease.
- X-rays. This test uses a small amount of radiation to create images of tissues, bones, and organs. X-rays are used to look for swelling or damage to the joint. This can check for signs of spondylitis or sacroiliitis.
- Gene testing. A test may be done to check for HLA-B27.
How is reactive arthritis treated?
Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is. Treatment may also include:
- Antibiotics, to treat the infection
- Nonsteroidal anti-inflammatory medications, to reduce inflammation
- Corticosteroids, to reduce inflammation
- Immunosuppressive medications, such as methotrexate to suppress inflammation
- Rest, to reduce pain and inflammation
- Exercise, to strengthen muscles and improve joint function
What are the complications of reactive arthritis?
The main symptoms of reactive arthritis will often go away in a few months. Some people may have mild arthritis symptoms for up to a year. Others may develop mild long-term arthritis. Up to half of people will have a flare-up of reactive arthritis in the future. In rare cases, the condition may lead to chronic, severe arthritis. This can result in joint damage.
When should I call my health care provider?
If your symptoms get worse or you have new symptoms, let your health care provider know.
Key points about reactive arthritis
- Reactive arthritis is a type of arthritis caused by an infection. It may be caused by Chlamydia trachomatis, salmonella, or another infection.
- The condition may cause arthritis symptoms, such as joint pain and inflammation. It may also cause symptoms in the urinary tract and eyes.
- Treatment includes antibiotics for the infection, plus medications to reduce the joint pain and inflammation.
- Most people recover fully from reactive arthritis.
Tips to help you get the most from a visit to your health care provider:
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.