Reactive Arthritis: Causes, Symptoms, and Treatment

What Is Reactive Arthritis?

Reactive arthritis is an inflammatory condition that develops when your immune system overreacts to certain bacterial infections, typically affecting the genitourinary or gastrointestinal tract. It causes joint pain and swelling, most commonly in the knees, ankles, and feet. Previously known as Reiter’s syndrome, this condition involves an autoimmune response where the body mistakenly attacks healthy tissues in the joints, eyes, skin, and urinary tract.

According to the NHS, reactive arthritis symptoms typically emerge 1-4 weeks after the triggering infection has occurred or resolved. The condition predominantly affects men between the ages of 20 and 50, though women and people of all ages can develop reactive arthritis. Research indicates that approximately 1–3% of people exposed to triggering bacteria develop this condition, making it relatively uncommon but significant for those affected.

What Causes Reactive Arthritis?

Reactive arthritis stems from specific bacterial infections that activate an abnormal autoimmune response in genetically susceptible individuals. The most common triggers include Chlamydia trachomatis, a sexually transmitted infection that represents the leading cause in many countries, and gastrointestinal bacteria such as Salmonella, Shigella, Yersinia, and Campylobacter.

When exploring reactive arthritis causes, genetics plays a crucial role. The HLA-B27 gene significantly increases your risk of developing reactive arthritis following exposure to triggering bacteria. The inflammatory process occurs through molecular mimicry, where activated immune cells, particularly T lymphocytes, mistakenly attack the body’s own tissues after exposure to bacterial antigens. This explains why reactive arthritis symptoms can persist long after the original infection has cleared, sometimes lasting months or occasionally developing into chronic arthritis.

Symptoms of Reactive Arthritis

Recognising reactive arthritis symptoms early can help you seek appropriate medical care and begin effective treatment. The condition typically affects multiple body systems, creating a distinctive pattern of inflammation:

Joint-Related Symptoms:
• Pain and swelling in knees, ankles, heels, and feet
• Lower back and buttock pain, often worse at night
• Swelling of fingers or toes (dactylitis)
• Heel pain and Achilles tendon inflammation
• Morning stiffness lasting over an hour

Eye and Skin Symptoms:
• Conjunctivitis causing red, irritated eyes with sticky or watery discharge
• Eye sensitivity to light (photophobia)
• Mouth ulcers and painless sores
• Scaly rashes on the palms and soles (keratoderma blennorrhagica)
• Psoriasis-like skin lesions

Urogenital Symptoms:
• Burning sensation during urination
• Increased urination frequency
• Urethral discharge
• Pelvic pain in women

Diagnostic and Imaging Tests for Reactive Arthritis

Diagnosing reactive arthritis requires a comprehensive approach combining clinical assessment with specific laboratory and imaging tests. These will help your doctor confirm the condition and rule out other forms of arthritis, like rheumatoid arthritis, lupus, or chronic arthritis:

Essential Blood Tests:
• CBC test to assess overall health and detect signs of inflammation or infection
• ESR test to assess inflammation levels
• C-reactive protein test indicating acute inflammatory activity
• HLA-B27 test (Human Leukocyte Antigen B27) to assess genetic predisposition
• Rheumatoid Factor (RF) Test and Anti-CCP Test to exclude rheumatoid arthritis

Infection Screening:
• Urinalysis (such as Urine Routine Test (Urine R/M Test)) to detect urogenital inflammation or infection
• Stool cultures (such as the Culture & Sensitivity - Aerobic Bacteria Stool Test), identifying gastrointestinal bacterial triggers
• Sexually transmitted infection testing (such as Chlamydia trachomatis DNA detection by real-time PCR, including urine or vaginal swab samples), particularly for Chlamydia trachomatis
• Throat swabs may be performed when a streptococcal infection is suspected

Advanced Imaging Studies:
• X-rays of affected joints and spine to assess inflammation and damage
• MRI scan provides detailed visualization of joint inflammation, synovitis, and early cartilage changes
• CT scans are occasionally used to evaluate spinal involvement or complex joint changes.
• Ultrasound to assess joint inflammation and tendon involvement

How Is Reactive Arthritis Diagnosed?

The diagnostic process for reactive arthritis follows a systematic approach that combines clinical evaluation with laboratory confirmation:

1. Detailed Medical History Review: Your doctor will explore recent infections, particularly gastrointestinal illnesses, food poisoning episodes, or sexually transmitted infections occurring 1-4 weeks before joint symptoms began.
2. Comprehensive Physical Examination: Clinical assessment focuses on identifying characteristic inflammation patterns, particularly asymmetrical involvement of large joints, like knees and ankles, along with evaluation of eye involvement and urogenital symptoms.
3. Laboratory Test Analysis: Blood work identifies inflammatory markers through CBC test results and elevated ESR and CRP levels, and screens for HLA-B27 genetic predisposition that increases reactive arthritis risk.
4. Infection Source Investigation: Testing determines triggering infections through urinalysis, stool cultures, and comprehensive STI screening to confirm bacterial aetiology and guide targeted treatment.
5. Advanced Imaging Assessment: X-rays or MRI scans reveal characteristic inflammatory changes in the joints and spine while excluding other arthritis diagnoses through detailed tissue visualization.
6. Symptom Pattern Recognition: Diagnosis relies on identifying the inflammatory arthritis, eye inflammation, and urogenital symptoms.
7. Differential Diagnosis Exclusion: Your doctor systematically rules out alternative conditions such as rheumatoid arthritis, lupus, or septic arthritis through comprehensive testing and clinical evaluation.

Treatment Options for Reactive Arthritis

Effective treatment approaches vary based on symptom severity, affected body systems, and individual patient factors:

• Control inflammation and pain using NSAIDs first, and corticosteroids when symptoms are more severe.
• Treat any underlying infection with appropriate antibiotics, especially in cases related to chlamydia or other identifiable bacteria.
• Use long-term disease-modifying antirheumatic drugs (DMARDs) or biologics if symptoms persist or become chronic.
• Incorporate supportive therapies, including physical and occupational therapy, to maintain mobility and daily function.
• Ensure regular monitoring and follow-up to adjust therapy, track progress, and prevent long-term complications.

Medications for Reactive Arthritis

Medication selection for reactive arthritis depends on symptom severity and affected body systems:

Anti-Inflammatory Medications:
• NSAIDs (ibuprofen, naproxen, and indomethacin) reduce joint pain and inflammation.
• Corticosteroid injections provide rapid relief for severely swollen joints.
• Systemic corticosteroids are used for widespread inflammation unresponsive to NSAIDs.
• Topical preparations for localized skin or eye involvement

Targeted Therapies:
• Antibiotics specifically chosen based on identified bacterial triggers
• Sulfasalazine may be prescribed in chronic cases to reduce inflammation and prevent long-term joint damage
• Biologic agents such as etanercept or infliximab for severe, treatment-resistant cases

Lifestyle Changes for Managing Reactive Arthritis

Implementing supportive lifestyle modifications enhances medical treatment effectiveness and improves your overall quality of life:

Joint Protection Strategies:
• Use assistive devices and ergonomic modifications to reduce joint stress.
• Practice proper body mechanics during daily activities
• Alternate periods of activity with adequate rest to prevent symptom flares
• Apply heat therapy for morning stiffness and cold therapy for acute inflammation.

Exercise and Physical Activity:
• Engage in low-impact activities like swimming, walking, and tai chi.
• Perform range-of-motion exercises to maintain joint flexibility
• Strengthen supporting muscles through targeted resistance training
• Work with physiotherapists to develop personalized exercise programs

General Health Management:
• Maintain a healthy body weight to reduce stress on weight-bearing joints
• Follow a balanced, anti-inflammatory diet rich in omega-3 fatty acids
• Ensure adequate sleep and stress management to support immune function
• Avoid smoking and excessive alcohol consumption, which can worsen inflammation

Prognosis for Reactive Arthritis

The outlook for reactive arthritis varies significantly among individuals, but most people experience gradual improvement over time. Most patients experience significant symptom improvement within 3–5 months, though some may experience intermittent flares. Early diagnosis and appropriate reactive arthritis treatment significantly improve outcomes and reduce the risk of developing chronic arthritis. Factors influencing prognosis include genetic predisposition (HLA-B27 status), prompt treatment initiation, and adherence to prescribed therapy.

Can Reactive Arthritis Be Prevented?

While you cannot completely prevent reactive arthritis, you can significantly reduce your risk by avoiding triggering infections. Practice safe sex to prevent sexually transmitted infections like chlamydia, maintain proper food hygiene to avoid gastrointestinal infections, and seek prompt treatment for any bacterial infections.

If you carry the HLA-B27 gene, discuss prevention strategies with your doctor, particularly if you have a family history of reactive arthritis or other inflammatory conditions.

Conclusion

Understanding reactive arthritis empowers you to recognise symptoms early and seek appropriate medical care when needed. This inflammatory condition, while challenging, responds well to comprehensive treatment that addresses both the underlying immune response and symptom management. The key to successful management lies in early recognition, accurate diagnosis through appropriate testing, and adherence to your prescribed reactive arthritis treatment plan.

At Metropolis Healthcare, we understand the importance of accurate diagnostic testing in managing conditions like reactive arthritis. Our comprehensive portfolio of over 4,000 tests includes essential blood work, like the CBC test, inflammatory markers, and genetic testing that support precise diagnosis. With our extensive network of 220+ laboratories and home sample collection services across 10,000+ touchpoints in India, accessing the diagnostic tests you need has never been more convenient.

FAQs

What is the most common cause of reactive arthritis?

Chlamydia trachomatis, a sexually transmitted infection, represents the leading cause of reactive arthritis, followed by gastrointestinal bacteria like Salmonella and Shigella.

How long does reactive arthritis last?

Reactive arthritis usually lasts between 6 and 12 months, depending on severity and the individual’s immune response. However, some may have intermittent flares or develop chronic arthritis requiring ongoing management.

Is reactive arthritis curable?

While there's no cure, reactive arthritis treatment effectively manages symptoms and prevents complications, with most patients achieving significant improvement over time.

Can reactive arthritis go away on its own?

Some mild cases may resolve without treatment, but medical intervention typically speeds recovery and prevents potential complications, like chronic arthritis.

References

• https://www.ncbi.nlm.nih.gov/books/NBK499831/#article-28255.s11
• https://www.nhs.uk/conditions/reactive-arthritis/
• https://my.clevelandclinic.org/health/diseases/reactive-arthritis-reiters-syndrome
• https://rheumatology.org/patients/reactive-arthritis
• https://medlineplus.gov/ency/article/000440.htm