Reactive Arthritis

What is Reactive Arthritis

Reactive arthritis is joint inflammation that is caused by an infection somewhere else in the body. Inflammation often affects the knee, ankle, and foot joints, and may affect other parts of the body as well.

Symptoms of reactive arthritis may last for several months and then go away completely. In some cases, symptoms may go away and then come back. Reactive arthritis also can become a long-term (chronic) illness.

A reactive arthritis is a sterile inflammatory arthritis that occurs within 1 to 3 weeks following an infection by an organism that infects mucosal surfaces, especially the urethra or large bowel.

What are the causes?

Reactive arthritis develops after you have an infection in your body, often in the intestines, genitals, or urinary tract. Infections that may trigger reactive arthritis include:

• Food poisoning caused by bacteria such as salmonella, shigella, campylobacter, or yersinia.
• An STI (sexually transmitted infection) such as chlamydia.

The exact reason why reactive arthritis develops is not known.

The most common GI pathogens causing reactive arthritis are:

• • Yersinia enterocolitica (0:3 and 0:9) or Yersinia pseudotuberculosis
• • Salmonella enteritidis or Salmonella typhimurium
• • Shigella flexneri, then Shigella dysenteriae, and occasionally Shigella sonnei
• • Campylobacter jejuni or Campylobacter coli
• • Clostridium difficile

Approximately 1% to 3% of patients who have an infectious gastroenteritis during an epidemic subsequently develop a reactive arthritis. It may be as high as 20% in Yersinia -infected individuals. Recently, joint pain following a diarrheal illness caused by pathogenic Escherichia coli has been reported.

What increases the risk?

You are more likely to develop this condition if:

• You have a gene that is linked to reactive arthritis (HLA-B27). This gene is passed from parent to child (inherited).
• You are a man who is 20–40 years old.
• You have a weakened disease-fighting (immune) system due to HIV or cancer.

Your condition may be more likely to be chronic if you have:

• The HLA-B27 gene.
• Repeated infections.
• A family history of arthritis.

What are the symptoms of Reactive Arthritis?

• Pain and swelling in your joints. The knee, ankle, and foot joints are often affected. Pain and swelling may also affect your skin, eyes, and the part of your body that drains urine from your bladder (urethra).
• Pain in your lower back, feet, or pelvis.
• Thick, crusty, reddish-purple sores on the palms of your hands and bottoms (soles) of your feet.
• Low-grade fever.
• Frequent or painful urination.
• Genital sores, which may be painful and can become infected.
• Blurred vision, eye pain, and red, sore eyes. Eyelids may stick together in the morning.
• Sores in your mouth. These may be painful or painless.

How is Reactive Arthritis diagnosed?

This condition may be diagnosed based on:

• Your symptoms and medical history. Diagnosis can be difficult because symptoms may develop at different times.
• A physical exam.
• Blood tests to rule out other conditions and check for the HLA-B27 gene.
• X-rays of affected joints.
• Urine tests.

How is this treated?

The goal of treatment is to relieve symptoms and to treat any underlying infection. Treatment may include:

• Antibiotic medicines to treat a triggering infection. However, these medicines may not stop reactive arthritis from developing.
• NSAIDs to reduce joint pain, swelling, and stiffness. These medicines will not prevent further joint damage caused by reactive arthritis.
• Injections of medicines to reduce inflammation (corticosteroids), in cases of severe inflammation.
• Medicines to decrease symptoms of chronic reactive arthritis (disease-modifying antirheumatic drugs, DMARDs). These types of medicines include sulfasalazine or methotrexate. The medicines may take several weeks to become effective, but they can relieve chronic symptoms.
• Medicines that reduce the activity of the body’s immune system (biologics), in severe cases.

Symptoms that affect the eyes and skin (such as sores or blurred vision) often go away without treatment.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic, take it as told by your health care provider. Do not stop taking the antibiotic even if your condition improves.

Managing pain, stiffness, and swelling

• If directed, apply heat to affected areas before you exercise, or as needed. Heat can reduce the stiffness of your muscles and joints. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad.
  • Place a towel between your skin and the heat source.
  • Leave the heat on for 20–30 minutes.
  • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.
• Icing can reduce pain or swelling of your joints. Put ice on affected areas after you exercise, or as needed.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.

General instructions

• Eat a healthy diet that includes plenty of fruits and vegetables, whole grains, lean protein, and low-fat or nonfat dairy products.
• Exercise regularly. Exercise can reduce your pain and help you maintain strength and flexibility. Talk with your health care provider or a physical therapist about what types of exercise are best for you. Your health care provider or physical therapist may recommend:
  • Stretching.
  • Strengthening exercises.
  • Activities that are easier on your joints (low-impact activities), such as swimming, walking, water aerobics, or bicycling.
• Use condoms correctly and consistently when you have sex.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have pain that does not get better with medicine.
• You have swelling or a feeling of warmth in a joint that gets worse.
• You have a fever.
• You have redness, irritation, or pain in your eyes.
• You have blurred vision.

Get help right away if:

• You have vision loss.

Summary

• Reactive arthritis is joint inflammation caused by an infection somewhere else in your body. The infection is often in the intestines, genitals, or urinary tract.
• Pain and swelling affect your knee, ankle, and foot joints. It also may affect your skin, eyes, and the urethra.
• The goal of treatment is to relieve symptoms and to treat any underlying infections.
• Contact your health care provider if you have pain that does not get better with medicine. Get help immediately if you have vision loss.