What You Should Know About Reactive Arthritis

After a bad go of food poisoning, it’s natural to feel achy in your joints. That usually goes away in a day or two. But if your joints are still sore – maybe even red – a couple of weeks later, you could have reactive arthritis.

As its name suggests, reactive arthritis (formerly referred to as Reiter’s syndrome) is a rare form of arthritis that occurs as a “reaction” to an infection, such as a foodborne illness or a sexually transmitted infection (STI). However, reactive arthritis itself is not contagious.

There are more than 100 different types of arthritis, so don’t worry if you have never heard of this one. Read on to better understand reactive arthritis, its causes, symptoms and your treatment options.

What is reactive arthritis?

Reactive arthritis occurs as a ‘reaction’ to a bacterial infection, often in another body part. It causes your joints to hurt and swell. It can also cause inflammation and pain in your eyes, skin and urinary tract (the organs that make urine and remove it from your body).

Usually, when you have an infection, your immune system fights off the foreign body (in this case, bacteria) and settles down. However, with reactive arthritis, your immune system attacks the infection and healthy body parts, causing pain and swelling.

“This type of arthritis is a form of spondyloarthritis (SpA), which is a family of inflammatory rheumatic diseases that cause arthritis in the lower back and entheses (where the tendons and ligaments attach to bone),” said Bart Hunter, a family nurse practitioner with Banner - University Medicine, who specializes in rheumatology.

Other kinds of spondyloarthropathies include psoriatic arthritis and ankylosing spondylitis.

What causes reactive arthritis?

Reactive arthritis develops due to an infection, often in your intestines, genitals or urinary tract.

“It is typically triggered by certain infections, such as STIs like chlamydia, and by gastrointestinal infections in your gut from bacteria like salmonella, shigella, campylobacter and yersinia,” Hunter said.

Reactive arthritis is not contagious. However, the bacteria that cause it can be shared through sexual activity or contaminated food.

Am I at risk for reactive arthritis if I have food poisoning or an STI?

Very few people infected with these bacteria will develop this condition. It is unclear why some people get reactive arthritis while others don’t, but your genes may be a factor.

“If you were born with a gene called HLA-B27, it puts you at greater risk for this kind of arthritis,” Hunter said. “About 75% of those with the condition have a positive blood test for this gene.”

Other factors that can increase your risk for reactive arthritis include:

Gender. It is most often found in men. Men are nine times more likely than women to get reactive arthritis from sexual activity.
Age. It occurs most often in people between the ages of 20 and 40.
Gastroenteritis. If you develop an infection in your gut from contaminated food.

Reactive arthritis is also common in people living with HIV (human immunodeficiency virus).

What symptoms should I watch out for?

Symptoms can range from mild to severe and typically start about one week to a month after an infection. It can begin suddenly and severely or more gradually with remissions and flare-ups.

You might experience one or more of the following symptoms:

Joints: Sudden pain, stiffness and swelling in the knees, ankles and feet and sometimes the wrists, fingers, toes and lower back
Eyes: Pain and redness in your eyes, blurry vision or conjunctivitis (pink eye)
Urethra: Burning feeling when you pee, fluid leaking from penis and inflammation in the prostate, cervix fallopian tubes, vulva and vagina

Other symptoms may also include:

Fever
Weight loss
Mouth ulcers (sores)
Skin rash on the bottom of your hands, feet and scalp

How is reactive arthritis diagnosed?

Unfortunately, there is no specific test for diagnosing this type of arthritis. Your health care provider or a rheumatologist, a doctor who diagnoses and treats arthritis and other immune-related diseases, will use a combination of tests and a physical exam to confirm your diagnosis.

These may include:

Reviewing your medical history
Examining your joints, spine, eyes and skin
Lab tests, such as blood, urine or stool (poop) samples
Swabbing your throat, penis or vagina to check for signs of an infection
Imaging, such as an X-ray, to look for signs of arthritis
Removing fluid from the painful joint with a needle to see if there are uric acid crystals, bacteria or viruses are present
Gene testing to check for HLA-B27

How is reactive arthritis treated?

Your treatment will depend on the underlying infection that caused the condition and the severity of your symptoms.

If you still have an infection, such as chlamydia, your provider will prescribe antibiotics.

For mild arthritis, your provider may recommend non-steroidal anti-inflammatory drugs (NSAIDs). “NSAIDs are the first line of treatment because they quickly reduce inflammation and pain,” Hunter said.

[Read “How to Choose the Right Pain Reliever.”]

For more severe arthritis, your provider may recommend steroid shots (corticosteroids) and immunosuppressive medicines.

You may also be referred to a physical therapist to strengthen your muscles and improve joint flexibility.

In addition to following your provider’s treatment plan, there are other things you can do to manage your symptoms:

Get regular physical exercise. Gentle exercise or movement is best and can help prevent your joints from becoming stiff.
Eat a healthy, balanced diet. Eating a well-balanced diet can improve energy levels and help maintain weight.
Get plenty of rest. Make sure to pace yourself and do not overdo it with exercise.

What is the outlook for this condition?

For many people with reactive arthritis, the condition goes away within six months. However, some people may experience symptoms for longer. In more severe cases, reactive arthritis may cause permanent joint damage and vision problems.

Can I prevent reactive arthritis?

While you can’t prevent reactive arthritis, you can reduce your risk by avoiding STIs and food-borne illnesses. Use safe sex practices and get tested regularly if you are sexually active. Wash your hands regularly and ensure your food is prepared and stored correctly.

Takeaway

Reactive arthritis is a painful condition caused by a bacterial infection. It can come and go over several months and may go away within several months.

If you have chronic pain or swelling and believe you have reactive arthritis, see your health care provider or a rheumatologist. To find a Banner Health specialist near you, visit bannerhealth.com.