Reactive arthritis is a form of arthritis that can occur after a person has fought a bacterial infection, often in the bowel or genital areas. They may have been infected with these bacteria as a result of food poisoning, or sexual activity.
The joints of the knees and ankles are most commonly affected. Unlike other forms of arthritis, reactive arthritis does not destroy the affected joint. Reactive arthritis was formerly known as Reiter’s syndrome.
Normally, when a person is suffering from an infection, the immune system steps in to fight the foreign body. In a person with reactive arthritis, however, this immune system activity continues after the infection has been cleared. This leads to swelling of the joints, although the joints themselves are not infected.
While reactive arthritis can occur at any age, it tends to affect people (mostly men) aged between 20 and 50 years. In most cases, the condition resolves by itself over the course of a few months. In some cases, the symptoms may linger for longer or may recur. Reactive arthritis is not contagious.
Symptoms of reactive arthritis
The symptoms of reactive arthritis develop some weeks after the infection, and may include:
- pain, swelling or stiffness in a joint (arthritis)
- muscular aches and pains
- pain in the lower back and buttocks
- pain and inflammation of tendons may occur, such as the Achilles tendon at the back of the heel
- pain and redness in the eyes. Some people may develop conjunctivitis or uveitis
- rash on the palms of the hands or soles of the feet.
Causes of reactive arthritis
Bacterial infections that are known to cause reactive arthritis include:
- the food poisoning bacterium Salmonella
- bacteria that cause gastrointestinal illness such as Shigella, Yersinia or Campylobacter
- the sexually transmitted infection chlamydia (caused by the bacterium Chlamydia trachomatis).
Most people who catch one of these bacterial infections don’t develop reactive arthritis. The reason for this is unclear. About half the people who develop reactive arthritis have a certain gene known as HLA-B27. It seems that people who develop reactive arthritis may be genetically predisposed.
Diagnosis of reactive arthritis
There is no specific test for reactive arthritis. Diagnosis may include:
- physical examination
- medical history
- urine tests
- full blood count tests
- x-ray examinations
- arthrocentesis – a sample of joint fluid is taken and tested in a laboratory (this is done to rule out conditions such as gout that may cause similar symptoms).
Treatment for reactive arthritis
There is no cure for reactive arthritis. Medical care aims to manage the symptoms until the person gets better. Treatment may include:
- Antibiotics aim to destroy the bacteria that caused the initial infection; however, antibiotics don’t treat the symptoms of reactive arthritis.
- If the condition developed as a result of infection with the bacterium Chlamydia trachomatis, the person’s sexual partner or partners must also be treated with antibiotics.
- Non-steroidal anti-inflammatory drugs (NSAIDs) may help to ease the joint inflammation and pain.
- Corticosteroids may be used to treat tendon inflammation.
- Cortisone injections into the joint may be given in severe cases.
- Disease-modifying anti-rheumatic drugs (DMARDs) may be given in cases of prolonged reactive arthritis.
- Physical therapy (such as stretching and gentle exercises) can help to keep the affected joint mobile and strengthen the surrounding ligaments, tendons and muscles.
- Low-impact exercises such as walking, stationary cycling, water aerobics or swimming may be recommended. Consult with your doctor before starting any exercise program.
- Uveitis requires specialist treatment. Your doctor may refer you to an ophthalmologist for treatment.
Self-care suggestions for reactive arthritis
- Work with your healthcare team.
- Become more informed about your condition.
- Learn ways to manage pain – this may include heat or cold packs to ease muscular aches and joint pain.
- Use relaxation strategies.
- Stay physically active and eat a healthy, well balanced diet.
Where to get help
- Your doctor
- Arthritis and Osteoporosis Victoria MSK Help Line Tel. (03) 8531 8000 or 1800 263 265
Things to remember
- Reactive arthritis is a type of arthritis caused by certain types of bacterial infection.
- Unlike other forms of arthritis, reactive arthritis does not destroy the affected joint.
- There is no cure for reactive arthritis – medical treatment aims to manage the symptoms until the person gets better.
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