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What is Reactive Arthritis?

Natan Rosenfeld Natan Rosenfeld April 26, 2021
Medically reviewed by Susan Kerrigan, MD and Marianne Madsen

You’ve probably heard of osteoarthritis, a type of arthritis that is often diagnosed in older people that causes joint pain and stiffness. But reactive arthritis (formerly called “Reiter’s syndrome”) is an entirely different condition and is rarely diagnosed (30 cases per 100,000 people). What causes this disease, what makes it different from “regular” or osteoarthritis, and how can it be treated?

 

Reactive arthritis vs osteoarthritis: Causes and risk factors

 

Osteoarthritis and reactive arthritis are two different forms of arthritis. Osteoarthritis is caused by a combination of factors that can include joint injury, obesity, and genetics. However, reactive arthritis is related to certain infections. Two common infections that could lead to reactive arthritis are sexually transmitted diseases (STDs) and infections, such as food poisoning, that cause diarrhea. The types of bacteria that may cause reactive arthritis include chlamydia (sexually transmitted), salmonella (foodborne), and yersinia (foodborne). 

Only a very few people who have such infections get reactive arthritis. People with a genetic risk factor (presence of a gene marker–HLA B 27) are at high risk for this disease. Young males between the ages of 20-40 are at high risk for reactive arthritis following an STD. Both genders are equally likely to get it following infections that cause diarrhea. 

 

Symptoms of reactive arthritis

 

Reactive arthritis affects the joints and the tendons around the joints, usually those in the lower extremities. It could also cause inflammation in the eyes, mucosa, and the skin. Symptoms of reactive arthritis may include:

 

  • Joint pain, swelling, and stiffness
  • Swelling of finger or toes 
  • Low grade fever
  • Severe fatigue
  • Skin rash
  • Mouth sores 
  • Inflammation of urethra (signaled by increased frequency and/or painful urination) 
  • Back pain
  • Eye inflammation (redness, pain, blurry vision)

 

Prognosis 

 

For many people with reactive arthritis, symptoms resolve within 3-4 months. However, around 50% continue to have joint inflammation and other symptoms for more than a year, increasing the risk of joint damage. Symptoms may be persistent, or they may come and go. These patients need long-term treatment. 

 

I think I have reactive arthritis. What should I do?

 

If you’ve been experiencing symptoms of reactive arthritis, make an appointment with your primary care physician and a rheumatologist if your symptoms have lasted for several months. The disease is diagnosed based on the history and physical examination; there is no one standard test to diagnose this condition. Your doctor may:

 

  • Test your joints for inflammation
  • Order a blood or urine test
  • Perform a joint fluid test
  • Order an x-ray examination

 

Once your diagnosis is confirmed, you can begin treatment.

Treating reactive arthritis

 

Treating reactive arthritis involves a combination of antibiotic medications, anti-inflammatory drugs, and, occasionally, steroids. Some common drugs prescribed to treat reactive arthritis include:

 

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These can also reduce inflammation and pain. 
  • Corticosteroids. These could be delivered by mouth or by injection into the joint. 
  • Disease-modifying anti-rheumatic drugs (DMARDs). These are rarely used but may be considered when patients do not respond to the above treatments and symptoms persist for several months. These drugs can weaken the immune system and increase your risk for contracting infections, so they should be used carefully.

 

In addition to the above, exercise is encouraged to promote healthy joints and reduce symptoms. Eating a healthy diet and controlling your weight can also relieve stiffness in your joints. Work with your doctor to determine which of these treatments can help you best.

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