Reactive Arthritis

people in huddle

Reactive arthritis is a painful form of inflammatory arthritis (joint disease due to inflammation). It occurs in reaction to an infection by certain bacteria. Most often, these bacteria are in the genitals (Chlamydia trachomatis) or the bowel (Campylobacter, Salmonella, Shigella and Yersinia). Chlamydia most often transmits by sex. It often has no symptoms, but can cause a pus-like or watery discharge from the genitals. The bowel bacteria can cause diarrhea. If you develop arthritis within one month of diarrhea or a genital infection – especially with a discharge – see a health care provider. You may have reactive arthritis.

In the past, it went by the name “Reiter’s syndrome.” Now it belongs to the family of arthritis called “spondyloarthritis.”

Fast Facts

  • Reactive arthritis can affect the heels, toes, fingers, low back, and joints, especially of the knees or ankles.
  • Though it often goes away on its own, reactive arthritis can be prolonged and severe enough to require seeing a specialist. Effective treatment is available for reactive arthritis.
  • Reactive arthritis tends to occur most often in men between ages 20 and 50.
  • Most cases of reactive arthritis appear as a short episode. Occasionally, it becomes chronic.

What causes reactive arthritis?

The bacteria induce (cause) arthritis by distorting your body’s defense against infections, as well as your genetic environment. How exactly each of these factors plays a role in the disease likely varies from patient to patient. This is a focus of research.

Reactive arthritis can have any or all of these features:

  • Pain and swelling of certain joints, often the knees and/or ankles
  • Swelling and pain at the heels
  • Extensive swelling of the toes or fingers
  • Persistent low back pain, which tends to be worse at night or in the morning

Some patients with this type of arthritis also have eye redness and irritation. Still other signs and symptoms include burning with urination and a rash on the palms or the soles of the feet.

Who gets reactive arthritis?

The bacteria that cause reactive arthritis are very common. In theory, anyone who becomes infected with these germs might develop reactive arthritis. Yet very few people with bacterial diarrhea actually go on to have serious reactive arthritis. What remains unclear is the role of Chlamydia infection that has no symptoms. It is possible that some cases of arthritis of unknown cause are due to Chlamydia.

Reactive arthritis tends to occur most often in men between ages 20 and 50. Some patients with reactive arthritis carry a gene called HLA-B27. Patients who test positive for HLA-B27 often have a more sudden and severe onset of symptoms. They also are more likely to have chronic (long-lasting) symptoms. Yet, patients who are HLA-B27 negative (do not have the gene) can still get reactive arthritis after exposure to an organism that causes it.

Patients with weakened immune systems due to AIDS and HIV can also develop reactive arthritis.

How is reactive arthritis diagnosed?

Rheumatologists are experts in diagnosing arthritis and other rheumatic diseases. Other doctors may feel less comfortable diagnosing reactive arthritis. This is because diagnosis is based on clinical features and not on tests.

Diagnosis is largely based on symptoms of the inducing infections and appearance of typical musculoskeletal (joint and muscle) involvement. If indicated, doctors might order a test for Chlamydia infection or test for the HLA-B27 gene. The test for Chlamydia uses a urine sample or a swab of the genitals.

How is reactive arthritis treated?

The type of treatment for reactive arthritis depends on the stage of reactive arthritis.

The early stage of reactive arthritis is considered acute (early). Acute inflammation can be treated with nonsteroidal anti-inflammatory drugs (often referred to as NSAIDs). These drugs suppress swelling and pain. They include naproxen (Aleve), diclofenac (Voltaren), indomethacin (Indocin) or celecoxib (Celebrex). The exact effective dose varies from patient to patient. The risk of side effects of these drugs, such as gastrointestinal (often called GI) bleeding, also varies. Your doctor will consider your risk of GI bleeding in suggesting an NSAID.

The late stage of reactive arthritis is considered chronic. Chronic reactive arthritis may require treatment with a disease-modifying antirheumatic drug (sometimes called a DMARD) such as sulfasalazine or methotrexate. Sulfasalazine may be more useful when the reactive arthritis is triggered by a gastrointestinal (GI) infection. In some cases, very inflamed joints may benefit from corticosteroid injections (cortisone shots).

Talk to your physician about what to expect from treatment with NSAIDs and DMARDs. New research suggests that a prolonged course of two or more antibiotics might be effective in patients with chronic Chlamydia-induced reactive arthritis. However, more studies are needed.

Updated May 2015. Written by Vivian Bykerk, MD, edited and reviewed by David Yu, MD, John Carter, MD and the American College of Rheumatology Communications and Marketing Committee. This patient fact sheet is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

© 2015 American College of Rheumatology