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While reactive arthritis can affect anyone, men between the ages of 20 and 40 are most likely to develop it.
This article will discuss symptoms of reactive arthritis in different parts of your body, including your joints and urogenital tract. It will cover what infections can cause reactive arthritis and how a team of medical specialists can coordinate its diagnosis. The article will then discuss available treatment options and outcomes for people with reactive arthritis.
Also Known AsReactive arthritis was formerly known as Reiter’s syndrome. Your healthcare provider may also refer to it as a seronegativespondyloarthropathy.
Also Known As
Reactive arthritis was formerly known as Reiter’s syndrome. Your healthcare provider may also refer to it as a seronegativespondyloarthropathy.
Reactive Arthritis Symptoms
Seronegative spondyloarthropathies are a group of disorders that can cause inflammation throughout the body, especially in the spine. Other disorders in this group includepsoriatic arthritis,ankylosing spondylitis, and certain forms of arthritis associated withulcerative colitisandCrohn’s disease.
Specific reactive arthritis symptoms and related complications can vary depending on what part(s) of the body are affected: the joints, urogenital tract, eyes, or skin.
Joints
Reactive arthritis typically involves joint pain and swelling in the knees, ankles, and feet. Wrists, fingers, and other joints can also be affected.
People with reactive arthritis commonly developtendonitis, which often leads to pain in the ankle or Achilles tendon. Some cases involveheel spurs—bony growths in the heel that may cause chronicfoot pain.
About half of all people with reactive arthritis report low back and buttock pain.Reactive arthritis also can cause spondylitis orsacroiliitis(inflammation of the sacroiliac joints at the base of the spine).
Urogenital Tract
Reactive arthritis often affects the urogenital tract.
In people with a penis, reactive arthritis may impact theprostateandurethra. You may notice:
Sometimes, reactive arthritis will lead you to developprostatitis, which can cause fever and chills, along with an increased need to urinate and a burning sensation when peeing.
Urethritis in Men
In people with avagina, reactive arthritis affects the urethra,uterus, and vagina itself. Additionally, you may develop inflammation of the:
When to See a Healthcare Provider for Urethral Pain
Eyes
About half of people with reactive arthritis developconjunctivitis, an inflammation of the mucous membrane that covers the eyeball and eyelid.
Some people may developuveitis, which is inflammation of the uvea (the pigmented layer in the eye, including the iris).
Conjunctivitis and uveitis can cause:
Eye involvement typically occurs early in the course of reactive arthritis, and symptoms may disappear and return again.
Skin
Skin symptoms, involving sores and rashes, tend to be less common. Small percentages of people with reactive arthritis develop:
These symptoms usually wax and wane over a period of several weeks to several months.
Symptoms of reactive arthritis usually last between three and 12 months. Generally speaking, women with reactive arthritis often have milder symptoms than men. In a small percentage of people, symptoms can come and go or develop into a long-term disease.
What Are the Causes of Reactive Arthritis?
Chlamydia
The bacterium most often associated with reactive arthritis isChlamydia trachomatis, commonly known aschlamydia.A chlamydia infection can lead to reactive arthritis typically about two to four weeks after infection.
You may not be aware of the chlamydia infection, but your healthcare provider will likelytest you for itif they suspect reactive arthritis but you haven’t had recent GI symptoms.
Chlamydia is usually acquired through sexual contact. Respiratory infections withChlamydia pneumoniaemay trigger reactive arthritis as well.
Men are nine times more likely than women to develop reactive arthritis due to sexually transmitted infections.
GI Tract Infections
Infections in the digestive tract that may trigger reactive arthritis include:
These infections are usually the result offood poisoning, which occurs when you either eat or handle contaminated foods. Women and men are equally likely to develop reactive arthritis as a result of foodborne infections.
Is It Contagious?While the bacteria that trigger reactive arthritis can be passed from person to person, reactive arthritis itself is not contagious.
Is It Contagious?
While the bacteria that trigger reactive arthritis can be passed from person to person, reactive arthritis itself is not contagious.
Genetic Predisposition
It’s not known exactly why some people exposed to the above bacteria develop reactive arthritis and others don’t, but a genetic factor has been identified: Human leukocyte antigen (HLA) B27 increases the chances of developing reactive arthritis.
Up to 80% of people with reactive arthritis test positive for HLA-B27, but that doesn’t mean inheriting the gene always results in the disease. While about 6% of healthy people have the HLA-B27 gene, only about 15% of them will develop reactive arthritis if they contract a triggering infection.
Researchers are trying to better understand why this is the case—and why an infection can trigger arthritis at all. They are also studying why people with the genetic factor HLA-B27 are more at risk than others.
Interestingly, people who have the HLA-B27 gene are more likely to develop spine-related issues as a result of reactive arthritis than those without the gene.
How Do You Test For Reactive Arthritis?Reactive arthritis affects several parts of the body, so you may need to see several different types of healthcare providers to diagnose and treat it. Each will conduct their own examinations and may run (or repeat) certain tests.Your Medical TeamArheumatologist(a practitioner specializing in arthritis and related issues) serves as the main person coordinating the treatment plan, with the input of other specialists, and also monitors for any side effects.Your medical team may include the following specialists:Ophthalmologist:For eye diseasesGynecologist:Genital symptoms in womenUrologist: Genital symptoms in men and womenDermatologist:Skin symptomsOrthopedist: Surgery on severely damaged jointsPhysiatrist: Exercise regimensExaminationAt the beginning of an examination, expect a healthcare provider to take a complete medical history and ask about your current symptoms. It can help to keep a record of your symptoms, including when they occur and how long they last.It is especially important to report any of the following flu-like symptoms, as they may be evidence of a bacterial infection:FeverVomitingDiarrheaTestsThere’s no single test that can diagnose reactive arthritis, so your healthcare provider will likely look at several factors before making a diagnosis. If your infection was mild and didn’t require medical treatment, it can make the diagnostic process harder.Your practitioner may order any combination of the following tests and other tests deemed necessary:Genetic factor HLA-B27 blood test, though a positive result does not always mean you have the disorder—just that you’re pre-disposedRheumatoid factoror antinuclear antibody teststo help identify other causes of arthritis (e.g.,rheumatoid arthritisorlupus)Erythrocyte sedimentation rate, as a high “sed rate” often indicates inflammation somewhere in the body, which can point to rheumatic diseaseYour healthcare providers may further test for infections that might be associated with reactive arthritis, such as chlamydia. Swabs may be taken from the throat, the urethra (if you have a penis), or cervix.Your urine andstool samplesalso may be tested.To rule out infection in a painful joint, a practitioner may remove and test a sample ofsynovial fluid.Researchers are developing methods to detect the location of the triggering bacteria in the body. Some suspect that after the bacteria enter the body, they are transported to the joints, where they can remain in small amounts indefinitely.ImagingHealthcare providers sometimes use X-rays to help diagnose reactive arthritis and to rule out other causes of arthritis. X-rays can detect other symptoms, including:SpondylitisSacroiliitisSoft tissue swellingDamage to cartilage and jointsCalcium deposits
How Do You Test For Reactive Arthritis?
Reactive arthritis affects several parts of the body, so you may need to see several different types of healthcare providers to diagnose and treat it. Each will conduct their own examinations and may run (or repeat) certain tests.
Your Medical Team
Arheumatologist(a practitioner specializing in arthritis and related issues) serves as the main person coordinating the treatment plan, with the input of other specialists, and also monitors for any side effects.
Your medical team may include the following specialists:
Examination
At the beginning of an examination, expect a healthcare provider to take a complete medical history and ask about your current symptoms. It can help to keep a record of your symptoms, including when they occur and how long they last.
It is especially important to report any of the following flu-like symptoms, as they may be evidence of a bacterial infection:
Tests
There’s no single test that can diagnose reactive arthritis, so your healthcare provider will likely look at several factors before making a diagnosis. If your infection was mild and didn’t require medical treatment, it can make the diagnostic process harder.
Your practitioner may order any combination of the following tests and other tests deemed necessary:
Your healthcare providers may further test for infections that might be associated with reactive arthritis, such as chlamydia. Swabs may be taken from the throat, the urethra (if you have a penis), or cervix.
Your urine andstool samplesalso may be tested.
To rule out infection in a painful joint, a practitioner may remove and test a sample ofsynovial fluid.
Researchers are developing methods to detect the location of the triggering bacteria in the body. Some suspect that after the bacteria enter the body, they are transported to the joints, where they can remain in small amounts indefinitely.
Imaging
Healthcare providers sometimes use X-rays to help diagnose reactive arthritis and to rule out other causes of arthritis. X-rays can detect other symptoms, including:
What Is the Treatment for Reactive Arthritis?
Although there is no cure for reactive arthritis, several treatments are available that may relieve your symptoms.
Antibiotics
Antibiotics help eliminate bacterial infections that trigger reactive arthritis. The specific antibiotic prescribed depends on the type of bacterial infection you have. If your infection is ongoing, you will likely be prescribed antibiotics for seven to 10 days.
In cases of chlamydia infection, your healthcare provider may ask that you stay on the antibiotic treatment for three months. Some studies have shown that longer treatment helps prevent reactive arthritis, but there is disagreement as to whether prolonged antibiotic use is beneficial in general.
If a GI infection triggered your reactive arthritis, antibiotics are unlikely to be prescribed. These medications are typically only used in severe cases or for people who are immunocompromised.
NSAIDs
Nonsteroidal anti-inflammatory drugs(NSAIDs)reduce joint inflammation and are commonly used to treat patients with reactive arthritis. Some NSAIDs are available without a prescription, such as:
Topical Corticosteroids
These corticosteroids come in a cream or lotion form. They can be applied directly to skin sores associated with reactive arthritis to reduce inflammation and promote healing.
Corticosteroid Shots
For those with severe joint inflammation,injections of corticosteroidsdirectly into the affected joint may reduce inflammation.
Immunosuppressants/DMARDs
TNF Blockers
If your case proves hard to treat with the above options, your healthcare provider may prescribe aTNF blocker,such as Enbrel (etanercept) or Remicade (infliximab).
Researchers are testing combination treatments for reactive arthritis. In particular, they are testing the use of antibiotics in combination with TNF inhibitors and with other immunosuppressant medicines, such as methotrexate and sulfasalazine.
Exercise
Exercise may help improve your joint function, but it’s important to introduce it gradually and with guidance from a physiatrist or physical therapist. Recommended types of exercise include:
If you have pain and inflammation in the spine, exercises that stretch and extend your back may be particularly helpful in preventing long-term disability.
Aquatic exercise also may be helpful, as water’s buoyancy greatly reduces the pressure on your joints.
Does Reactive Arthritis Go Away?Most people with reactive arthritis recover fully from the initial flare of symptoms and are able to return to regular activities two to six months after the first symptoms appear. Mild symptoms may linger for up to 12 months, but they generally don’t interfere with daily activities.Approximately 30% to 50% of people with reactive arthritis will develop symptoms again sometime after the initial flare has disappeared. Some will develop chronic (long-term) arthritis, which usually is mild.It is possible that such relapses may be due to reinfection. Back pain and arthritis are the symptoms that most commonly reappear.A small percentage of patients will have chronic, severe arthritis that is difficult to control with treatment and may cause joint deformity.
Does Reactive Arthritis Go Away?
Most people with reactive arthritis recover fully from the initial flare of symptoms and are able to return to regular activities two to six months after the first symptoms appear. Mild symptoms may linger for up to 12 months, but they generally don’t interfere with daily activities.
Approximately 30% to 50% of people with reactive arthritis will develop symptoms again sometime after the initial flare has disappeared. Some will develop chronic (long-term) arthritis, which usually is mild.
It is possible that such relapses may be due to reinfection. Back pain and arthritis are the symptoms that most commonly reappear.
A small percentage of patients will have chronic, severe arthritis that is difficult to control with treatment and may cause joint deformity.
Summary
Reactive arthritis involves joint pain and inflammation that occurs due to sexually transmitted infections (most commonly chlamydia) or GI tract infections. A genetic factor might increase the chances of you developing reactive arthritis after an infection.
There is no cure for reactive arthritis, but certain medications may relieve your symptoms, including antibiotics, NSAIDs (such as aspirin or Tivorbex), topical corticosteroids, immunosuppressants (such as methotrexate or sulfasalazine), and TNF blockers (such as Enbrel or Remicade). Exercise under the guidance of a physiatrist or physical therapist may also help.
Most people with reactive arthritis recover fully from their first flare-up. They are able to return to regular activities after two to six months of symptoms. Some may develop chronic arthritis, which is usually mild.
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