Reactive Arthritis

What is Reactive Arthritis?

Reactive arthritis is an inflammatory type of arthritis which affects the joints, and may affect the eyes, skin and urinary tract (bladder, vagina, urethra). It occurs when bacteria enters the blood stream from one or both of the following areas of the body:

• Urogenital tract. Bacteria can enter through the vagina or urethra during sexual contact and spread to the bladder.
• Gastrointestinal (GI) tract. Bacteria can enter the body if you eat spoiled food or food that came into contact with contaminated surfaces.

Usually the knees, ankles or toes becomes swollen, stiff and painful. Sometimes, the fingers may be affected. 

Two other conditions are associated with reactive arthritis:

• Conjunctivitis. Also called pink eye, it causes eye redness and swelling.
• Urethritis. This is inflammation of the tube that carries urine from the bladder to the outside of the body.

Reactive arthritis typically begins within 2 to 4 weeks after infection. It’s not contagious, but the bacterium that triggers the disease can pass from person to person.

Who’s Affected?

Men age 40 and younger are most commonly affected. Evidence shows that they are nine times more likely than women to get the disease due to a sexually transmitted infection. However, both sexes are equally likely to get it from a food-related infection.

Reactive Arthritis Symptoms

The most common symptoms of reactive arthritis are inflammation in the joints, eyes, bladder and urethra (the tube that helps remove urine from the body). Sometimes, mouth sores and skin rashes may occur.

Here are some possible symptoms identified by body area.

Joint Symptoms

• Pain and swelling in knees, ankles, feet and sometimes the fingers and wrists
• Swelling of the tendons (tendinitis) or where tendons attach to the bone (enthesitis)
• Heel pain and heel spurs (bony growths in the heel)
• Lower back and buttock pain
• Inflammation in the spine (spondylitis) or in the lower back that connect the spine to the pelvis (sacroliitis)

Eye Symptoms

• Redness of the eyes
• Eye pain and irritation
• Blurred vision

These symptoms can be signs of inflammation of the eyeball and eyelid (conjunctivitis, commonly known as “pink eye”) or the inner eye (uveitis).

Urinary Symptoms

• Pain during urination
• Need to urinate more frequently

Reactive arthritis symptoms can be very mild and come and go over several weeks to months. So they may not be noticeable in the early stages. Urinary symptoms usually appear first but may absent in women. This symptom may occur with, or be followed by conjunctivitis. Arthritis is usually the last symptom to appear.

With proper treatment, most people with reactive arthritis recover fully and can resume normal activities a few months after initial symptoms. However, arthritis symptoms may last up to a year, but they are usually mild and do not interfere with daily life. Some people with reactive arthritis will have long-term, but mild, arthritis. Studies show that between 15 and 50 percent of patients will develop symptoms again, possibly due to re-infection. Back pain and arthritis are the symptoms that most commonly reappear. A few patients will have chronic, severe arthritis that is difficult to control with treatment and may cause joint damage.

Reactive Arthritis Causes

Exposure to certain bacteria has been linked to reactive arthritis. The ones most commonly associated with reactive arthritis are:

• Chlamydia trachomatis. It is spread through sexual contact. The infection may begin in the vagina, bladder or the urethra.
• Salmonella, Shigella, Yersinia and Campylobacter. These bacteria typically infect the gastrointestinal tract.

In rare cases, the bacterium Chlamydia pneumoniae, which causes respiratory infections, may also cause reactive arthritis.

Doctors are not sure why some people exposed to these bacteria get the disease and others don’t. However, researchers have identified a gene, called human leukocyte antigen (HLA) B27, that makes a person more likely to get reactive arthritis. Not everyone who inherits this gene will get the disease.

Reactive Arthritis Diagnosis

Reactive arthritis can be difficult to diagnose because there is no specific laboratory test to confirm that a person has it. The patient may be referred to a rheumatologist, depending on the severity of symptoms.

Here are some of the methods used to diagnose reactive arthritis:

• Physical Examination. The doctor will ask about the patient's medical history, symptoms and current medical problems. He will examine the joints for signs of inflammation and test their range of motion. The eyes, skin, and pelvic and genital areas are also examined.
• Laboratory tests. Blood, urine and stool sample tests can help rule out other conditions and confirm the diagnosis. Tests will be done to check for many things, including high levels of inflammation; antibodies linked to other types of arthritis; signs of a current or recent infection; and a gene called HLA B27, which is sometimes seen in people with this disease.
• Tissue samples. Samples of tissue from the throat, urethra (men) and cervix (women) may be taken to look for signs of this disease.
• Joint fluid tests. The doctor may take a sample of joint fluid from the knee to look for signs of infection or inflammation. It will also be examined for the presence of uric acid crystals, which may signal an arthritis-related condition called gout.
• X-rays. The doctor may order views of the joints, pelvis and spine to look for signs of swelling, joint damage, calcium deposits and other signs of reactive arthritis.

Reactive Arthritis Treatment

There is no cure for reactive arthritis. The goal of treatment is to treat infections and manage symptoms.

Healthcare Team

Since reactive arthritis may affect different parts of the body, more than one doctor may be involved in the patient's care. A rheumatologist (a doctor with specialized training in arthritis treatment) will likely be the primary doctor. Other specialists may include:

• Dermatologist to treat skin symptoms
• Gynecologist to treat genital symptoms in women
• Ophthalmologist to treat eye disease
• Orthopaedist to perform surgery if joints are severely damaged
• Physical therapist or physiatrist to oversee the patient's exercise routine
• Urologist to treat genital symptoms in men and women

Medications

An antibiotic is prescribed to treat the infection. Other medications are prescribed to manage pain and inflammation. They include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). These are often the first type of medicine used and include aspirin, ibuprofen and naproxen. All NSAIDs work similarly by blocking substances called prostaglandins that contribute to inflammation and pain. They are available as tablets, capsules and powders.
• Corticosteroids. These medicines help to quickly reduce inflammation. For people with severe joint inflammation, they may be injected into the affected joint. Doctors usually prescribe these injections when NSAIDs have not helped ease symptoms. Corticosteroids also are available in topical forms, which are cream or lotion applied directly to the skin.
• Disease-modifying antirheumatic drugs (DMARDs). A small number of patients with reactive arthritis have severe symptoms that cannot be controlled with the above-mentioned treatments. In this case, the doctor may prescribe medicines called disease-modifying antirheumatic drugs (DMARDs). Such drugs suppress the immune system. There are two main types: traditional DMARDs and a newer class called biologics.

Physical Activity

Exercise helps maintain and improve joint function. Strengthening exercises build up the muscles around the joint and provide better support. Range-of-motion exercises improve movement and flexibility and reduce stiffness in the affected joint. Stretching and water exercises can also be helpful for joints and muscles. Before beginning an exercise program, ask a doctor to recommend appropriate exercises or for a referral to a certified fitness or physical therapy expert.

Reactive Arthritis Self Care

Taking a proactive role in treatment is an important part of getting better. This process is called self management.

Self care for reactive arthritis includes making sure food is stored at proper temperatures and cooked properly. These helps prevent foodborne bacteria that can cause reactive arthritis. Some sexually transmitted infections can trigger reactive arthritis. Using condoms may lower one's risk.

Staying physically active is the key to keeping joints flexible. Too little movement can lead to joint stiffness. Strong muscles help to protect joints. But it’s important to talk to a doctor before beginning an exercise program. Managing weight, eating a nutritious diet and getting a good balance of rest and activity each day are important, too.