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Reactive arthritis

Reiter syndrome; Post-infectious arthritis

 

Reactive arthritis is a group of conditions that may involve the joints, eyes, and urinary and genital systems. These areas become swollen and inflamed. It is often in response to infections.

Causes

 

The exact cause of reactive arthritis is unknown. It occurs most often in men younger than age 40. It may follow an infection in the urethra after unprotected sex. It can also follow an intestinal infection (such as food poisoning). However, the joint itself is not infected.

Certain genes may make you more likely to get this condition.

The disorder is rare in young children, but it may occur in teenagers.

 

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.

Joint pain and stiffness also begins during this time period. The arthritis may be mild or severe. Arthritis symptoms may include:

  • Heel pain or pain in the Achilles tendon
  • Pain in the hip, knee, ankle, and low back
  • Pain that affects only one side of the body or more than one joint

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.

 

Exams 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
  • Joint x-rays
  • Erythrocyte sedimentation rate (ESR)
  • Urinalysis

 

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.

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.

Physical therapy can help ease the pain. It can also help you move better and maintain muscle strength. Rarely, people with a severe case of the disease may need medicine to suppress the immune system.

 

Outlook (Prognosis)

 

Reactive arthritis may go away in a few weeks, but it can last for a few months. Symptoms may return over a period of years in up to 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.

 

 

References

Carter JD, Hudson AP. Reactive arthritis: clinical aspects and medical management. Rheum Dis Clin North Am. 2009;35(1):21-44. PMID: 19480995 www.ncbi.nlm.nih.gov/pubmed/19480995.

Hill JS. Reactive arthritis and undifferentiated spondyloarthritis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 76.

Morris D, Inman RD. Reactive arthritis: developments and challenges in diagnosis and treatment. Curr Rheumatol Rep. 2012;14(5):390-4. PMID: 22821199 www.ncbi.nlm.nih.gov/pubmed/22821199.

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          Review Date: 4/28/2015

          Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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