What is reactive arthritis?

Reactive arthritis, also known as Reiter’s syndrome, is an inflammatory condition that occurs as a reaction to an infection elsewhere in the body, such as in the genitals, urinary or gastrointestinal system. Usually the infection occurs 2 to 4 weeks before the development of the arthritis.

What causes it?

Reactive arthritis may be triggered by a number of different bacterial infections. Most cases take one of two forms, urogenital or gastrointestinal.

In urogenital (genitourinary) reactive arthritis, or uroarthritis, the triggering infection originates in the penis, vagina, bladder or urethra.

If the infection is the result of something that you eat or handle, such as raw meat contaminated by bacteria, your condition is called gastrointestinal (enteric) reactive arthritis, or enteroarthritis.

One to 2 per cent of people involved in any food poisoning outbreak may develop a joint inflammation a few weeks later. Most people who get reactive arthritis were born with the HLA-B27 gene that makes them more likely to get this type of arthritis.

Who gets reactive arthritis?

Reactive arthritis is most common in men aged 20 to 40 years. Men are far more likely than women to develop reactive arthritis that has been triggered by a sexually transmitted infection (STI) such as chlamydia, or gonorrhoea, however, both men and women are equally likely to develop the condition as a result of food poisoning.

 What are the symptoms?

Joint inflammation
Pain and swelling, usually of the knees, ankles, or toes are often the first signs of reactive arthritis. Other joints, including fingers, wrists, elbows and joints at the base of the spine and tendons around joints such as the Achilles tendon can also become inflamed.

Urogenital tract symptoms
Reactive arthritis most typically results in inflammation of the urogenital tract, affecting the prostate or urethra in men and the urethra, uterus or vagina in women.

Men may experience a feeling of urgency to urinate and have a fluid discharge from the penis. Both men and women may experience a burning sensation during urination.

Eye inflammation
Conjunctivitis (inflamed mucous membrane that covers the eyeball and eyelid) may occur before, or at the onset of, arthritis. Symptoms include painful, irritated, red eyes and blurry vision.

How is it diagnosed?

Since there is no specific diagnosis for reactive arthritis, diagnosis is made primarily by excluding the presence of other disorders that have similar symptoms to this condition. Your doctor will use your medical history, current symptoms and the results of any evaluations such as blood tests to help with the diagnosis.

Treatment options

Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are used as first-line therapy to reduce joint pain and inflammation (redness and swelling) and should be taken regularly to achieve a good anti-inflammatory effect.

Corticosteroids
Severe joint inflammation not relieved by NSAIDs may be treated with corticosteroid injected directly into the affected joint. The injection is not usually particularly painful and the medication speedily relieves the joint pain by reducing inflammation. Low, well-spaced doses of injected corticosteroid are thought to produce little risk of significant side effects.

Antibiotics
Antibiotics may be prescribed to treat the bacterial infection that triggered the reactive arthritis. The specific antibiotic used will depend on the type of bacteria causing the infection. It is essential to complete the full course as prescribed by your doctor.

Disease modifying anti-rheumatic drugs (DMARDs)
In some cases, severe symptoms of arthritis that do not respond to NSAIDs or corticosteroids may be treated with a DMARD, such as sulfasalazine or methotrexate.

Side effects of medication

Every medicine can cause side effects. It is important to discuss with your doctor or pharmacist what these are, the likelihood of these happening and the possible results.

How long does reactive arthritis last?

The symptoms of reactive arthritis usually last 3 to 12 months, however, a small percentage of individuals may experience a recurrence of symptoms and development of a long term condition.

Original material provided by Arthritis New Zealand. Reviewed by everybody, July 2005.