Reactive Arthritis (Reiter’s Syndrome)

What is reactive arthritis?

Reactive arthritis is a type of arthritis that occurs because of an infection. Arthritis is when joints become inflamed and painful. Reactive arthritis is not contagious. It affects people assigned male at birth more often than people assigned female at birth. It develops most often between ages 20 and 50.

What causes reactive arthritis?

Reactive arthritis is triggered by an infection. The reactive arthritis is separate from the infection. It often sets in once the infection has cleared. Bacteria that often trigger reactive arthritis include chlamydia and salmonella. But very few people infected with these bacteria will go on to have reactive arthritis.

Reactive arthritis may also be linked to genes. People with this condition often have the HLA-B27 gene. But many people have this gene without getting reactive arthritis.

Who is at risk for reactive arthritis?

Risk factors for getting reactive arthritis include:

• Having an infection from sexual contact

• Having an illness from contaminated food

• Being a person who was assigned male at birth

What are the symptoms of reactive arthritis?

Reactive arthritis may cause arthritis symptoms such as joint pain and inflammation. It can also cause urinary tract symptoms and eye infection (conjunctivitis). Symptoms can last from 3 to 12 months. In a small number of people, the symptoms may turn into a long-term (chronic) disease. Symptoms can happen a bit differently in each person and may include:

Many of these symptoms can be caused by other health conditions. See your healthcare provider for a diagnosis.

How is reactive arthritis diagnosed?

The process starts with a health history and a physical exam. Diagnosis can be hard. This is because there are no specific tests that can confirm the condition. Some blood tests may be done to rule out other conditions, such as rheumatoid arthritis and lupus. Other tests may include:

• Erythrocyte sedimentation rate (ESR or sed rate).  This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood’s proteins clump together. They become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation.

• Tests for infections.  This includes a test for chlamydia. It may also include tests for other infections that are linked to reactive arthritis.

• Joint aspiration (arthrocentesis).  A small sample of the synovial fluid is taken from a joint. It’s tested to see if crystals, bacteria, or viruses are present.

• Urine and stool samples.  These are used to look for bacteria or other signs of disease.

• X-rays. This test uses a small amount of radiation to create images of tissues, bones, and organs. X-rays are used to look for swelling or damage to the joint. This can check for signs of spondylitis or sacroiliitis.

• Gene testing.  A test may be done to check for HLA-B27. This gene is seen more often in people with reactive arthritis. But not everyone who has this gene will get reactive arthritis.

You may also have testing to rule out other forms of arthritis.

How is reactive arthritis treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may also include:

• Antibiotics to treat the infection

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation

• Corticosteroids to reduce inflammation

• Immunosuppressive medicines such as methotrexate to control inflammation

• Strong biological immunosuppressants given as a shot

• Rest to ease pain and inflammation

• Exercise to strengthen muscles and improve joint function

What are possible complications of reactive arthritis?

The main symptoms of reactive arthritis will often go away in a few months. Some people may have mild arthritis symptoms for up to a year. Others may develop mild, long-term arthritis. Up to half of people will have a flare-up of reactive arthritis in the future. In rare cases, the condition may lead to chronic, severe arthritis. This can lead to joint damage.

When should I call my healthcare provider?

Call your healthcare provider if any of these occur:

Key points about reactive arthritis

• Reactive arthritis is a type of arthritis caused by an infection. It may be caused by Chlamydia trachomatis, salmonella, or another infection.

• The condition may cause arthritis symptoms such as joint pain and inflammation. It may also cause symptoms in the urinary tract and eyes.

• Treatment includes antibiotics for the infection. And medicines to reduce the joint pain and inflammation.

• Most people recover fully from reactive arthritis.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.