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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.”
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:
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.
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.
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.
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). In more severe cases, stronger immune lowering medications called “biologics” may be used such as Etanercept (Enbrel) or Adalimumab (Humira).
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 March 2017 by Suleman Bhana, MD and reviewed by the American College of Rheumatology Committee on Communications and Marketing.
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.