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Reactive arthritis
Definition
Reactive arthritis is a group of conditions that may involve the joints, urethra, and eyes. These areas become swollen and inflamed, often in response to certain infections.
Alternative Names
Reiter syndrome; Post-infectious arthritis
Causes
The exact cause of reactive arthritis is unknown. It occurs most often in men before age 40. It may follow an infection with Chlamydia, Campylobacter, Salmonella, or Yersinia.
Certain genes may make you more likely to get this condition.
The disorder is rare in younger children, but it may occur in teenagers.
Symptoms
Urinary symptoms usually 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) can develop over the next several weeks.
Joint pain and stiffness also begin during this time period. The arthritis may be mild or severe, and:
- Cause heel pain or pain in the Achilles tendon
- Affect the hip, knee, ankle, and low back
- Affect only one side of the body or more than one joint
Skin sores on the palms and soles of the feet may look like psoriasis. There may also be small, painless ulcers in the mouth, tongue, and penis.
Exams and Tests
The diagnosis is based on symptoms. Because the symptoms may occur at different times, the diagnosis may be delayed. A physical examination may show signs of conjunctivitis or skin sores.
Tests that may be done include:
- C-reactive protein
- HLA-B27 antigen
- Joint x-rays
- Sed rate (ESR)
- Urinalysis
Treatment
The goal of treatment is to relieve symptoms and treat the infection causing this condition.
Eye problems and skin sores usually do not need to be treated. They will go away on their own.
Your doctor will prescribe antibiotics if you have an infection. Nonsteroidal anti-inflammatory drugs (NSAIDS) and pain relievers may be recommended for joint pain. If a joint is very swollen over a long period of time, your health care provider may inject a strong anti-inflammatory medicine (corticosteroid) into the area.
Physical therapy can help you relieve pain, move better, and maintain muscle strength. You may need to make changes if your job requires heavy lifting or heavy use of your back.
People with a severe case of the disease may need therapy to suppress the immune system, but this treatment is not used very often.
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 affected.
Rarely, people may have an abnormal heart rhythm or problems with the aortic heart valve.
When to Contact a Medical Professional
Call for an appointment with your health care provider if symptoms of this condition develop.
Prevention
Practice safe sex and avoid getting infections when cooking, eating, and storing food to help prevent reactive arthritis.
References
Carter JD, Hudson AP. Reactive arthritis: clinical aspects and medical management. Infect Dis Clin North Am. 2009;35(1).
Inman RD. The spondyloarthropathies. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 273.
Reviewed By: Ariel D. Teitel, MD, MBA, Clinical Associate Professor of Medicine, NYU Langone Medical Center. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
