Reactive arthritis
Reiter syndrome; Post-infectious arthritisReactive arthritis is a type of arthritis that follows an infection. It may also cause inflammation of the eyes, skin and urinary and genital systems.
Causes
The exact cause of reactive arthritis is unknown. However, it most often follows an infection, but the joint itself is not infected. Reactive arthritis most often occurs in men between the ages of 20 and 40, although it does sometimes affect women. It may follow an infection in the urethra after unprotected sex. The most common bacteria that cause such infections is called Chlamydia trachomatis. Reactive arthritis can also follow a gastrointestinal infection (such as food poisoning). In up to one half of people thought to have reactive arthritis, there may be no infection. It is possible that such cases are a form of spondyloarthritis.
Spondyloarthritis
Ankylosing spondylitis (AS) is a chronic form of arthritis. It mostly affects the bones and joints at the base of the spine where it connects with t...
Read Article Now Book Mark ArticleCertain genes may make you more likely to get this condition.
The disorder is rare in young children, but it may occur in teenagers. Reactive arthritis may occur in children ages 6 to 14 after Clostridium difficile gastrointestinal infections.
Symptoms
Urinary symptoms will appear within days or weeks of an infection. These symptoms may include:
- Burning when urinating
- Fluid leaking from the urethra (discharge)
- Problems starting or continuing a urine stream
- Needing to urinate more often than normal
A low fever along with eye discharge, burning, or redness (conjunctivitis or "pink eye") can develop over the next several weeks.
Conjunctivitis
The conjunctiva is a clear layer of tissue lining the eyelids and covering the white of the eye. Conjunctivitis occurs when the conjunctiva becomes ...
Read Article Now Book Mark ArticleInfections in the intestine may cause diarrhea and abdominal pain. The diarrhea may be watery or bloody.
Joint pain and stiffness also begin during this time period. The arthritis may be mild or severe. Arthritis symptoms may include:
- Heel pain or pain in the Achilles tendon
Heel pain
Heel pain is most often the result of overuse. However, it may be caused by an injury. Your heel may become tender or swollen from:Shoes with poor s...
Read Article Now Book Mark Article - Pain in the hip, knee, ankle, and low back
- Pain and swelling that affects one or more joints
Symptoms may include skin sores on the palms and soles that look like psoriasis. There may also be small, painless ulcers in the mouth, tongue, and penis.
Skin sores
Rashes involve changes in the color, feeling or texture of your skin.
Read Article Now Book Mark ArticlePsoriasis
Psoriasis is a skin condition that causes skin redness, silvery scales, and irritation. Most people with psoriasis have thick, red, well-defined pat...
Read Article Now Book Mark ArticleUlcers
An ulcer is a crater-like sore on the skin or mucous membrane. Ulcers form when the top layers of skin or tissue have been removed. They can occur ...
Read Article Now Book Mark ArticlePenis
The penis is the male organ used for urination and sexual intercourse. The penis is located above the scrotum. It is made of spongy tissue and bloo...
Read Article Now Book Mark ArticleExams and Tests
Your health care provider will diagnose the condition based on your symptoms. A physical exam may show signs of conjunctivitis or skin sores. All symptoms may not appear at the same time, so there may be a delay in getting a diagnosis.
You may have the following tests:
- HLA-B27 antigen
HLA-B27 antigen
HLA-B27 is a blood test to look for a protein that is found on the surface of white blood cells. The protein is called human leukocyte antigen B27 (...
Read Article Now Book Mark Article - Joint x-rays
Joint x-rays
This test is an x-ray of a knee, shoulder, hip, wrist, ankle, or other joint.
Read Article Now Book Mark Article - Blood tests to rule out other types of arthritis such as rheumatoid arthritis, gout, or systemic lupus erythematosus
- Erythrocyte sedimentation rate (ESR)
ESR
ESR stands for erythrocyte sedimentation rate. It is commonly called a "sed rate. "It is a test that indirectly measures the level of certain protei...
Read Article Now Book Mark Article - Urinalysis
Urinalysis
Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds th...
Read Article Now Book Mark Article - Culture of stool if you have diarrhea
- Urine tests for bacterial DNA such as Chlamydia trachomatis
- Aspiration of a swollen joint
Treatment
The goal of treatment is to relieve symptoms and treat the infection that is causing this condition.
Eye problems and skin sores do not need to be treated most of the time. They will go away on their own. If eye problems persist, you should be evaluated by a specialist in eye disease (ophthalmologist).
Your provider will prescribe antibiotics if you have an infection. Nonsteroidal anti-inflammatory drugs (NSAIDs) and pain relievers may help with joint pain. If a joint is very swollen for a long period of time, you may have corticosteroid medicine injected into the joint.
Pain relievers
Over-the-counter (OTC) pain relievers can help relieve pain or lower a fever. Over-the-counter means you can buy these medicines without a prescript...
Read Article Now Book Mark ArticleIf arthritis continues in spite of NSAIDs, sulfasalazine or methotrexate may be helpful. Finally, people who do not respond to these medicines may need anti-tumor necrosis factor (TNF) biologic agents such as etanercept (Enbrel) or adalimumab (Humira) to suppress the immune system.
Physical therapy can help ease the pain. It can also help you move better and maintain muscle strength.
Outlook (Prognosis)
Reactive arthritis may go away in a few weeks, but it can last for a few months and require medicines during that time. Symptoms may return over a period of years in up to one half of the people who have this condition.
Rarely, the condition can lead to abnormal heart rhythm or problems with the aortic heart valve.
When to Contact a Medical Professional
See your provider if you develop symptoms of this condition.
Prevention
Avoid infections that can bring on reactive arthritis by practicing safe sex and avoiding things that can cause food poisoning.
Food poisoning
This article explains safe ways to prepare and store food to prevent food poisoning. It includes tips about what foods to avoid, eating outside of y...
Read Article Now Book Mark ArticleReferences
Babu TM, Urban MA, Augenbraun MH. Urethritis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 107.
Carter JD, Hudson AP. Reactive arthritis. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 81.
Horton DB, Strom BL, Putt ME, Rose CD, Sherry DD, Sammons JS. Epidemiology of clostridium difficile infection-associated reactive arthritis in children: an underdiagnosed, potentially morbid condition. JAMA Pediatr. 2016;170(7):e160217. PMID: 27182697 pubmed.ncbi.nlm.nih.gov/27182697/.
Link RE, Tang N. Cutaneous diseases of the external genitalia. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 59.
Misra R, Gupta L. Epidemiology: time to revisit the concept of reactive arthritis. Nat Rev Rheumatol. 2017;13(6):327-328. PMID: 28490789 pubmed.ncbi.nlm.nih.gov/28490789/.
Okamoto H. Prevalence of chlamydia-associated reactive arthritis. Scand J Rheumatol. 2017;46(5):415-416. PMID: 28067600 pubmed.ncbi.nlm.nih.gov/28067600/.
Patterson JW. The psoriasiform reaction pattern. In: Patterson JW, ed. Weedon's Skin Pathology. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 5.
Schmitt SK. Reactive arthritis. Infect Dis Clin North Am. 2017;31(2):265-277. PMID: 28292540 pubmed.ncbi.nlm.nih.gov/28292540/.
Weiss PF, Colbert RA. Reactive and postinfectious arthritis. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 182.
Reactive arthritis - view of the feet - illustration
Reactive arthritis is a disease which classically consists of inflammation of the joints (arthritis), urethra (urethritis), and eye. It frequently includes skin manifestations and is thought to be triggered in some people by an infection. This is a fairly typical rash on the feet. This type of rash may also appear on the hands.
Reactive arthritis - view of the feet
illustration
Reactive arthritis - view of the feet - illustration
Reactive arthritis is a disease which classically consists of inflammation of the joints (arthritis), urethra (urethritis), and eye. It frequently includes skin manifestations and is thought to be triggered in some people by an infection. This is a fairly typical rash on the feet. This type of rash may also appear on the hands.
Reactive arthritis - view of the feet
illustration
Review Date: 4/30/2023
Reviewed By: Neil J. Gonter, MD, Assistant Professor of Medicine, Columbia University, New York, NY, and private practice specializing in Rheumatology at Rheumatology Associates of North Jersey, Teaneck, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.