Reiter's Syndrome (Reactive Arthritis)

Reactive Arthritis (Reiter's Syndrome)

Reactive arthritis is a type of arthritis that occurs because of an infection. Arthritis is when joints become inflamed and painful. Reactive arthritis is not contagious. It affects men more often than women. It develops most often between ages 20 and 50.

What causes reactive arthritis?

Reactive arthritis is not contagious, but it’s caused by some infections that are contagious. The infections that most often cause the disease are spread through sexual contact from the bacterium Chlamydia trachomatis. It can cause infections in the bladder, urethra, penis, or vagina.

Other infections that can cause reactive arthritis to infect the bowel. One cause is salmonella. This infection can come from eating food or handling objects that have the bacteria.

Reactive arthritis may also be linked to genes. People with reactive arthritis often have the HLA-B27 gene. But many people have this gene without getting reactive arthritis.

Who is at risk for reactive arthritis?

Risk factors for getting reactive arthritis include:

• Having an infection from sexual contact
• Having an illness from contaminated food
• Being male

What are the symptoms of reactive arthritis?

Reactive arthritis may cause arthritis symptoms, such as joint pain and inflammation. It can also cause urinary tract symptoms and eye infection (conjunctivitis). Symptoms can last from 3 to 12 months. In a small number of people, the symptoms may turn into chronic disease. Symptoms can happen a bit differently in each person and may include:

Symptom area	Symptoms
Arthritis symptoms	Joint pain and inflammation that often affect the knees, feet, and ankles Inflammation of a tendon that is attached to bone. This may cause heel pain or shortening and thickening of the fingers. Bony growths in the heel (heel spurs) that can cause chronic pain Inflammation of the spine (spondylitis) Inflammation of the lower back joints (sacroiliitis)
Urinary tract symptoms	Men: Increased urine Burning sensation during urination Discharge from penis Inflamed prostate gland (prostatitis) Women: Inflamed cervix Inflamed urethra. This causes a burning sensation during urination. Inflamed fallopian tubes (salpingitis) Inflamed vulva and vagina (vulvovaginitis)
Eye symptoms	Red eyes Painful and irritated eyes Blurry vision Inflamed mucous membrane that covers the eyeball and eyelid (conjunctivitis) Inflammation of the inner eye (uveitis)

The symptoms of reactive arthritis can be like other health conditions. Make sure to see your healthcare provider for a diagnosis.

How is reactive arthritis diagnosed?

The process starts with a health history and a physical exam. Diagnosis can be difficult. This is because there are no specific tests that can confirm the condition. Some blood tests may be done to rule out other conditions, such as rheumatoid arthritis and lupus. Other tests may include:

• Erythrocyte sedimentation rate (ESR or sed rate).  This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood’s proteins clump together and become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation.
• Tests for infections.  This includes a test for chlamydia. It may also include tests for other infections that are linked to reactive arthritis.
• Joint aspiration (arthrocentesis).  A small sample of the synovial fluid is taken from a joint. It’s tested to see if crystals, bacteria, or viruses are present.
• Urine and stool samples.  These are used to look for bacteria or other signs of disease.
• X-rays. This test uses a small amount of radiation to create images of tissues, bones, and organs. X-rays are used to look for swelling or damage to the joint. This can check for signs of spondylitis or sacroiliitis.
• Gene testing.  A test may be done to check for HLA-B27. This gene is seen more often in people with reactive arthritis. But not everyone who has this gene will get reactive arthritis.

You may also have testing to rule out other forms of arthritis.

How is reactive arthritis treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may also include:

• Antibiotics to treat the infection
• Nonsteroidal anti-inflammatory medicines to reduce inflammation
• Corticosteroids to reduce inflammation
• Immunosuppressive medicines such as methotrexate to control inflammation
• Strong biological immunosuppressants given as a shot
• Rest to ease pain and inflammation
• Exercise to strengthen muscles and improve joint function

What are possible complications of reactive arthritis?

The main symptoms of reactive arthritis will often go away in a few months. Some people may have mild arthritis symptoms for up to a year. Others may develop mild, long-term arthritis. Up to half of people will have a flare-up of reactive arthritis in the future. In rare cases, the condition may lead to chronic, severe arthritis. This can lead to joint damage.

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, let your healthcare provider know.

Key points about reactive arthritis

• Reactive arthritis is a type of arthritis caused by an infection. It may be caused by Chlamydia trachomatis, salmonella, or another infection.
• The condition may cause arthritis symptoms, such as joint pain and inflammation. It may also cause symptoms in the urinary tract and eyes.
• Treatment includes antibiotics for the infection, plus medicines to reduce the joint pain and inflammation.
• Most people recover fully from reactive arthritis.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.