Arthritis More Arthritis Types & Related Conditions What Is Reactive Arthritis? By Carol Eustice Carol Eustice Facebook Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis. Learn about our editorial process Updated on August 12, 2021 Medically reviewed by Grant Hughes, MD Medically reviewed by Grant Hughes, MD on June 14, 2020 LinkedIn Grant Hughes, MD, is board-certified in rheumatology and is the head of rheumatology at Seattle's Harborview Medical Center. Learn about our Medical Review Board Print Reactive arthritis is a type of joint pain and inflammation that occurs as a reaction to an infection elsewhere in the body. The joints most likely to be affected by reactive arthritis are your knees, ankles, and feet. However, the inflammatory reaction can also involve your eyes and the urinary tract, as well as associated genital structures. BSIP / Getty Images While reactive arthritis can affect both sexes, men between the ages of 20 and 40 are most likely to develop it. Also Known As Reactive arthritis was formerly known as Reiter’s syndrome. Your doctor may also refer to it as a seronegative spondyloarthropathy. Reactive Arthritis Symptoms The seronegative spondyloarthropathies are a group of disorders that can cause inflammation throughout the body, especially in the spine. Other disorders in this group include psoriatic arthritis, ankylosing spondylitis, and certain forms of arthritis associated with ulcerative colitis and Crohn’s disease. Inflammation is your body’s natural reaction to injury or disease and is marked by: SwellingRednessHeatPain Specific reactive arthritis symptoms and related complications can vary depending on what part(s) of the body are affected, be it the joints, urogenital tract, eyes, or skin. Joints Reactive arthritis typically involves joint pain and swelling in the knees, ankles, and feet, but the wrists, fingers, and other joints can also be affected. People with reactive arthritis commonly develop tendonitis, which often leads to pain in the ankle or Achilles tendon. Some cases involve heel spurs—bony growths in the heel that may cause chronic foot pain. Furthermore, approximately half of the people with reactive arthritis report low-back and buttock pain. Reactive arthritis also can cause spondylitis or sacroiliitis (inflammation of the sacroiliac joints at the base of the spine). Urogenital Tract Reactive arthritis often affects the urogenital tract, with different symptoms in men and women. In men, it impacts the prostate and urethra. Men may notice: Increased need to urinateBurning sensation when urinatingPenis painFluid discharge from the penis Some men with reactive arthritis develop prostatitis, which can cause fever and chills, along with an increased need to urinate and a burning sensation when peeing. Urethritis in Men In women, this disease affects the urethra, uterus, and vagina. Additionally, women with reactive arthritis may develop inflammation of the: Cervix (cervicitis): May include bleeding between periods, abnormal vaginal discharge, and pain with intercourse Urethra (urethritis): Can cause a burning sensation during urination and frequent urination Fallopian tubes (salpingitis, pelvic inflammatory disease): Can cause abnormal vaginal discharge, spotting between periods, painful periods, pain during sex, painful urination, nausea and vomiting, fever, lower back pain, abdominal pain, and fever Vulva and vagina (vulvovaginitis, vulvitis, vaginitis): May cause irritation, itching, strong-smelling vaginal discharge, and pain during urination When to See a Doctor for Urethral Pain Eyes Conjunctivitis, an inflammation of the mucous membrane that covers the eyeball and eyelid, develops in approximately half of people with reactive arthritis. Some people may develop uveitis, which is inflammation of the uvea (the pigmented layer in the eye, including the iris). Conjunctivitis and uveitis can cause: Redness of the eyesEye pain and irritationBlurred vision Eye involvement typically occurs early in the course of reactive arthritis, and symptoms may disappear only to return again. Skin Skin symptoms, involving sores and rashes, tend to be less common. Small percentages of people with reactive arthritis develop: Small, shallow, painless sores on the end of the penis Rashes Red and scaly patches on the soles of the feet, palms of the hands, or elsewhere Mouth ulcers that come and go; may be painless and go unnoticed These symptoms usually wax and wane over a period of several weeks to several months. Symptoms of reactive arthritis usually last between three and 12 months. Generally speaking, women with reactive arthritis often have milder symptoms than men. In a small percentage of people, symptoms can come and go or develop into a long-term disease. Causes In many people, reactive arthritis is triggered by sexually transmitted infections (STIs). This form of the disorder is sometimes called genitourinary or urogenital reactive arthritis. In others, it’s caused by an infection in the gastrointestinal tract from eating food or handling substances that are contaminated with bacteria. This form is sometimes called enteric or gastrointestinal reactive arthritis. Chlamydia The bacterium most often associated with reactive arthritis is Chlamydia trachomatis, commonly known as chlamydia. A chlamydia infection can lead to reactive arthritis typically about two to four weeks after infection. You may not be aware of the chlamydia infection, but your doctor will likely test you for it if they suspect reactive arthritis but you haven’t had recent GI symptoms. Chlamydia is usually acquired through sexual contact. Some evidence also shows that respiratory infections with Chlamydia pneumoniae may trigger reactive arthritis as well. Men are nine times more likely than women to develop reactive arthritis due to venereal infections. GI Tract Infections Infections in the digestive tract that may trigger reactive arthritis include: Salmonella Shigella Yersinia Campylobacter These infections are usually the result of food poisoning, which occurs when you either eat or handle contaminated foods. Women and men are equally likely to develop reactive arthritis as a result of foodborne infections. Is It Contagious? While the bacteria that trigger reactive arthritis can be passed from person to person, reactive arthritis itself is not contagious. Genetic Predisposition Doctors don’t know exactly why some people exposed to the above bacteria develop reactive arthritis and others don’t, but they have identified a genetic factor—human leukocyte antigen (HLA) B27—that increases the chance of developing reactive arthritis. Up to 80% of people with reactive arthritis test positive for HLA-B27, but that doesn’t mean inheriting the gene always results in the disease. While about 6% of healthy people have the HLA-B27 gene, only about 15% of them will develop reactive arthritis if they contract a triggering infection. Researchers are trying to better understand why this is so, as well as why an infection can trigger arthritis at all. Scientists are also studying why people with the genetic factor HLA-B27 are more at risk than others. Interestingly, people who have the HLA-B27 gene are more likely to develop spine-related issues as a result of reactive arthritis than those without the gene. Diagnosis Reactive arthritis affects several parts of the body, so to properly diagnose and treat it, you may need to see several different types of doctors, each of whom will conduct their own examinations and may run (or repeat) certain tests. Your Medical Team A rheumatologist (a doctor specializing in arthritis and related issues) is typically the “quarterback” of a reactive arthritis medical team. They serve as the main person coordinating the treatment plan, with the input of other specialists, and also monitor for any side effects. The other specialists involved (and their areas of focus) may include: Ophthalmologist: Eye diseases Gynecologist: Genital symptoms in women Urologist: Genital symptoms in men and women Dermatologist: Skin symptoms Orthopedist: Surgery on severely damaged joints Physiatrist: Exercise regimens Examination At the beginning of an examination, expect a doctor to take a complete medical history and ask about your current symptoms. It can help if you keep a record of your symptoms, when they occur, and how long they last. It is especially important to report any flu-like symptoms such as the following, as they may be evidence of a bacterial infection: FeverVomitingDiarrhea Tests There’s no single test that can diagnose reactive arthritis, so your doctor will likely look at several factors before making a diagnosis. If your infection was mild and didn’t require medical treatment, it can make the diagnostic process harder. Your doctor may order any combination of the following tests and other tests deemed necessary: Genetic factor HLA-B27 blood test, though a positive result does not always mean your have the disorder—just that you’re pre-disposed Rheumatoid factor or antinuclear antibody tests to help identify other causes of arthritis (e.g., rheumatoid arthritis or lupus) Erythrocyte sedimentation rate, as a high “sed rate” often indicates inflammation somewhere in the body, which can point to rheumatic disease Your doctors may further test for infections that might be associated with reactive arthritis, such as chlamydia. Swabs may be taken from the throat, the urethra (in men), or cervix (in women). Your urine and stool samples also may be tested. To rule out infection in a painful joint, a doctor may remove and test a sample of synovial fluid. Researchers are developing methods to detect the location of the triggering bacteria in the body. Some scientists suspect that after the bacteria enter the body, they are transported to the joints, where they can remain in small amounts indefinitely. Imaging Doctors sometimes use X-rays to help diagnose reactive arthritis and to rule out other causes of arthritis. X-rays can detect other symptoms, including: SpondylitisSacroiliitisSoft tissue swellingDamage to cartilage and jointsCalcium deposits Treatment Although there is no cure for reactive arthritis, several treatments are available that may relieve your symptoms. Antibiotics Antibiotics help eliminate bacterial infections that trigger reactive arthritis. The specific antibiotic prescribed depends on the type of bacterial infection you have. Some doctors may recommend antibiotics for a long period of time (up to three months), but the research on this practice is inconsistent and the source of some disagreement in the medical community, especially when it comes to cases triggered by GI infections. NSAIDs Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce joint inflammation and are commonly used to treat patients with reactive arthritis. Some NSAIDs are available without a prescription, such as: Aspirin Advil, Motrin (ibuprofen) Other NSAIDs that are usually more effective for reactive arthritis must be prescribed by a doctor, including: Tivorbex (indomethacin)Tolmetin Topical Corticosteroids These corticosteroids come in a cream or lotion form that can be applied directly to skin sores associated with reactive arthritis. Topical corticosteroids reduce inflammation and promote healing. Corticosteroid Shots For those with severe joint inflammation, injections of corticosteroids directly into the affected joint may reduce inflammation. Immunosuppressants/DMARDs Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate or sulfasalzine may help control severe symptoms that cannot be controlled by other drugs. TNF Blockers If your case proves hard to treat with the above options, your doctor may prescribe a TNF blocker, such as Enbrel (etanercept) or Remicade (infliximab). Researchers are testing combination treatments for reactive arthritis. In particular, they are testing the use of antibiotics in combination with TNF inhibitors and with other immunosuppressant medicines, such as methotrexate and sulfasalazine. Exercise Exercise may help improve your joint function, but it’s important to introduce it gradually and with guidance from a physiatrist or physical therapist. Recommended types of exercise include: Strengthening exercises to build up muscles around the joint for better supportRange-of-motion exercises to improve flexibility and movementMuscle-tightening exercises that don’t involve joint movement: These may be helpful if you have too much inflammation and pain for other types of exercise. If you have pain and inflammation in the spine, exercises that stretch and extend your back may be particularly helpful in preventing long-term disability. Aquatic exercise also may be helpful, as water’s buoyancy greatly reduces the pressure on your joints. How to Exercise Safely When You Have Arthritis Prognosis Most people with reactive arthritis recover fully from the initial flare of symptoms and are able to return to regular activities two to six months after the first symptoms appear. Mild symptoms may linger for up to 12 months, but they generally don’t interfere with daily activities. Approximately 30% to 50% of people with reactive arthritis will develop symptoms again sometime after the initial flare has disappeared. Some will develop chronic (long-term) arthritis, which usually is mild. It is possible that such relapses may be due to reinfection. Back pain and arthritis are the symptoms that most commonly reappear. A small percentage of patients will have chronic, severe arthritis that is difficult to control with treatment and may cause joint deformity. Was this page helpful? Thanks for your feedback! Dealing with chronic inflammation? An anti-inflammatory diet can help. Our free recipe guide shows you the best foods to fight inflammation. Get yours today! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Reactive arthritis. Updated October 2016. National Organization for Rare Disorders. Reactive arthritis. Yasser R, Yasser E, Hanan D, Nashwa ES, Rasker JJ. Enthesitis in seronegative spondyloarthropathies with special attention to the knee joint by MRI: a step forward toward understanding disease pathogenesis. Clin Rheumatol. 2011;30(3):313‐322. doi:10.1007/s10067-010-1655-4 UC San Diego Health. Acute salpingitis. Updated April 1, 2020. MedlinePlus. Vaginitis. Updated July 30, 2021. Carter JD, Hudson AP. Recent advances and future directions in understanding and treating Chlamydia-induced reactive arthritis. Expert Rev Clin Immunol. 2017;13(3):197‐206. doi:10.1080/1744666X.2017.1233816 Schafranski MD. Infliximab for reactive arthritis secondary to Chlamydia trachomatis infection. Rheumatol Int. 2010;30(5):679‐680. doi:10.1007/s00296-009-0965-9 Dumusc A, Hügle T. Arthrite réactionnelle [Reactive arthritis]. Rev Med Suisse. 2018;14(597):534‐537. Johns Hopkins Medicine. Reactive arthritis. Reveille JD, Hirsch R, Dillon CF, Carroll MD, Weisman MH. The prevalence of HLA-B27 in the US: data from the US National Health and Nutrition Examination Survey, 2009. Arthritis Rheum. 2012;64(5):1407‐1411. doi:10.1002/art.33503 Selmi C, Gershwin ME. Diagnosis and classification of reactive arthritis. Autoimmun Rev. 2014;13(4-5):546‐549. doi:10.1016/j.autrev.2014.01.005 American College of Rheumatology. Reactive arthritis. Updated March 2019. Cedars-Sinai. Bacterial gastroenteritis. UW Medicine Orthopaedics and Sports Medicine. Infectious arthritis. Brzank M, Wollenhaupt J. Infektinduzierte reaktive arthritiden: ätiopathogenese—klinische manifestationen—therapie [Infection-induced reactive arthritis: etiopathogenesis, clinical spectrum, therapy]. Z Rheumatol. 2013;72(10):977‐985. doi:10.1007/s00393-013-1281-z [article in German; abstract referenced] Sutton A. Arthritis sourcebook. 3rd ed. Omnigraphics; 2010.