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Reactive arthritis

Definition

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.

Alternative Names

Reiter syndrome; Post-infectious arthritis

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. Reactive arthritis may occur in children ages 6 to14 after Clostridium difficile gastrointestinal infections.

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.

Infections in the intestine may cause diarrhea and abdominal pain. The diarrhea may be watery or bloody. 

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:

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. If eye problems persist, you should be evaluated by a specialist in eye disease.

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.

If arthritis continues in spite of NSAIDS, sulfasalazine or methotrexate may be helpful. Finally, in patients who do not respond to these medicines, anti-TNF biologic agents, such as etanercept or adalimumab, may be needed. 

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

Augenbraun MH, McCormack WM. Urethritis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 109.

Carter JD, Hudson AP. Undifferentiated spondyloarthritis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley's and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017:chap 76.

Horton DB, Strom BL, Putt ME, Rose CD, Sherry DD, Sammons JS. Epidemiology of clostridium difficile infection-associated reactive arthritis in children: an underdiagnosed, potentially morbid condition. JAMA Pediatr. 2016;170(7):e160217. PMID: 27182697 www.ncbi.nlm.nih.gov/pubmed/27182697.

Link RE, Rosen T. Cutaneous diseases of the external genitalia. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 16.

Schmitt SK. Reactive arthritis. Infect Dis Clin North Am. 2017;31(2):265-277. PMID: 28292540. www.ncbi.nlm.nih.gov/pubmed/28292540.

Weiss PF, Colbert RA. Reactive and postinfectious arthritis. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 157.


Review Date: 4/24/2017
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, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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