Reactive Arthritis

What is reactive arthritis? 

Reactive arthritis is joint inflammation and swelling that results from an infection elsewhere in the body. Unlike conditions like septic arthritis, reactive arthritis is not an infection of the joint. Instead, the condition, sometimes referred to as Reiter syndrome, is temporary inflammatory arthritis that fades when the underlying infection resolves. 

The condition typically clears within a matter of months and does not cause extensive damage or lasting complications. While not common, reactive arthritis can affect anyone, though the condition more often affects men between ages 20 and 40.

What causes reactive arthritis?

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The most common causes of reactive arthritis are bowel infections or sexually transmitted infections (STIs). These types of infections trigger a more intense reaction to the infection, causing the immune system to attack healthy areas of the body along with the infected area. If the reaction to the originating infection is mild, you may not experience symptoms of an infection or reactive arthritis. It is unknown why the body reacts to certain types of bacteria and causes reactive arthritis to occur. 

Most often, the source of the bacteria causing the reactive arthritis starts in the urethra or gastrointestinal system. The most frequent bacterial infections that cause reactive arthritis include the following foodborne and STIs:

  • Salmonella 
  • Escherichia coli (E. coli) 
  • Chlamydia 
  • Shigella (shigellosis)
  • Yersinia (yersiniosis)
  • Campylobacter (campylobacteriosis)
  • Clostridioides difficile (C. diff)

Even when exposed to the bacteria that causes reactive arthritis, you may not develop the infection. In fact, reactive arthritis is not a common occurrence for people who have these bacterial infections. While the condition is not contagious, you can spread the infection-causing bacteria person-to-person through contaminated food or sexually.

What are symptoms of reactive arthritis?

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The symptoms of reactive arthritis can resemble other forms of arthritis or inflammation, so it is important to recognize the difference and know when to seek medical attention. Symptoms can appear in any joints of the body, but they tend to appear most frequently in the knees, ankles, heels, lower back, hips, or fingers. You may not notice symptoms until a few days or weeks after an infection starts. 

At the onset of reactive arthritis, you may notice:

  • Burning sensation when urinating 
  • Fever
  • Common symptoms of conjunctivitis (pink eye), such as redness or eye discharge
  • Abdominal pain or diarrhea 
  • Persistent joint pain 
  • Joint stiffness 
  • Swelling of the joints 
  • Sores on the palms of your hands, soles of your feet, or in the mouth 

In addition to symptoms of reactive arthritis, you may also experience symptoms of infection, depending on the type of infection causing the reactive arthritis and the stage of the infection. Common symptoms of the originating bacterial infection include:

  • Nausea 
  • Vomiting 
  • Headache 
  • Chills 
  • Fever 
  • Diarrhea 
  • Abnormal discharge from genitals 
  • Dehydration 

Symptoms of both the arthritis and the infection can be mild or severe and may get worse over time without prompt treatment. Men and women can also experience symptoms differently, especially if the originating infection is caused by an STI. If you notice any symptoms of infection and/or reactive arthritis, be sure to contact a medical professional for assistance and treatment before the symptoms have the chance to worsen.

Are there any risk factors or groups for reactive arthritis?

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Even though the exact cause of reactive arthritis is unknown, there are certain risk factors associated with a higher likelihood of developing the condition. The condition is rare and affects 5 out of 100,000 of those in the United States. Research is still needed to confirm the exact cause of the condition to pinpoint a person’s true risk of the condition. 

The following risk factors are linked with a higher risk of reactive arthritis. 

Sex: While men and women can both develop reactive arthritis, men are more likely to have the condition. The cases of reactive arthritis caused by foodborne illnesses seem to affect men and women more evenly. However, sexually transmitted bacteria cause reactive arthritis at a higher rate for men than women. 

Age: Reactive arthritis most commonly occurs between the ages of 20 and 40 though people of all ages can develop the condition. 

Genetics and Family History: Reactive arthritis is not a condition that can be passed down to generations. There is research to show that a specific genetic marker, the HLA-B27 gene, shows up more often in people with cases of reactive arthritis. Your genetic makeup is influenced by family history, so the HLA-B27 gene, if present and passed down through generations, can increase your risk. At the same time, many people who get reactive arthritis do not have this gene marker, and many who have the gene marker never develop the condition.

How is reactive arthritis diagnosed?

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Once you begin experiencing physical symptoms of reactive arthritis, you should see a doctor who will be able to diagnose your condition. During a diagnosis appointment, your doctor will review your medical history, document your symptoms, and perform a physical exam of the impacted areas. In some early cases of reactive arthritis, your doctor may need to see you for a follow up visit if only a few symptoms are present to see if more develop over time that point to reactive arthritis. 

To confirm a reactive arthritis diagnosis, your doctor may order a variety of tests to rule out other conditions and identify the type and severity of infection. 

  • Blood test: Blood tests can show evidence of infection, inflammation, and antibodies linked to specific infections. This type of test is also useful to rule out other conditions like lupus or rheumatoid arthritis. 
  • Joint aspiration: For this test, a needle is inserted into the affected joint to collect a sample of the synovial fluid to look for bacteria, viruses, or other concerning materials that help determine the source of the infection and can inform the best treatment. 
  • Genetic testing: Genetic testing looks for the HLA-B27 gene marker. Since this gene is common in cases of reactive arthritis, it can be helpful to look for this genetic marker. 
  • Infection tests: Testing for the presence of various causes of reactive arthritis, such as foodborne illnesses and STIs, can help your doctor know if you have one of the underlying infections that results in the condition. Testing may involve collecting a stool or urine sample to check for bacteria or other cultures. 
  • Imaging tests: Imaging tests like X-rays can help detect infection in the joints and assess any damage to the joints and surrounding tissue. 


How is reactive arthritis treated?

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Treating reactive arthritis aims to relieve symptoms of the infection and arthritis to improve joint mobility and lessen pain. The main priority of treatment is to control the infection causing the reactive arthritis and resolve the infection with the right course of antibiotics. To help with pain, your doctor may also prescribe pain relievers if the pain you have is severe or persistent. As symptoms come and go, your treatment plan may change to adjust to the symptoms you are currently facing. 

Longer term treatment for reactive arthritis involves physical therapy to help restore muscle strength and movement to the joints, which helps ease pain. In some cases, a doctor may prescribe corticosteroid injections for the joints if the cushion of the joint was damaged and to reduce inflammation. For the majority of cases, reactive arthritis and its symptoms will go away with time. 

Should you see a doctor for reactive arthritis?

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You should see a doctor for reactive arthritis when you notice any symptoms start to appear. If you have other conditions that impact the joints, it can be hard to tell if the symptoms are new. Your primary care physician will likely refer you to a rheumatologist, who specializes in arthritis. However, communicating your symptoms with your doctor can help assess your risk of the condition and receive treatment for the condition. Some symptoms of infection require more immediate attention, so seek medical attention if you think you have an infection in your joints.

What is the outlook for people living with reactive arthritis?

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Reactive arthritis has a positive outlook since most cases resolve in a matter of weeks with the right medication and treatment plan. You may notice some symptoms return over time, but the condition is typically not chronic. New occurrence of symptoms could indicate a new infection, so communicate with your doctor if symptoms appear again. Other rare complications of reactive arthritis include certain heart problems that impact the rhythm and valves.

How can you prevent reactive arthritis?

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You can take preventative measures to avoid the root causes of reactive arthritis and be aware of your risk of developing the condition. For example, you can practice safe food handling to make sure your food is cleaned thoroughly and cooked properly to avoid infections like E. coli and salmonella. Similarly, you can practice safe sex to avoid contracting or passing STIs that may cause reactive arthritis. Even if a person is genetically predisposed to reactive arthritis, there are still some preventative measures in your control to keep yourself safe from infections. No measure will be wholly effective at preventing the condition, but they can help lower your risk.