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  • Writer's pictureDr. Chris Phillips

Understanding Reactive Arthritis: Causes, Symptoms, and Management



Reactive arthritis, also known as Reiter's syndrome, is a type of inflammatory arthritis that develops in response to an infection in another part of the body, commonly the intestines, genitals, or urinary tract. 


This disease can cause inflammation in the joints, eyes, and urinary tract, and while it can be a debilitating condition, understanding its causes, symptoms, and management can help those affected manage their symptoms effectively.

In this article with support from the National Institutes of Health, we will discuss the causes, symptoms and management of this disease. 


What is Reactive Arthritis?

Reactive arthritis is a form of spondyloarthritis, a group of disorders that cause inflammatory joint disease. It typically occurs as a reaction to an infection, often a bacterial infection, but the arthritis itself is not infectious. The most common bacteria associated with reactive arthritis are Chlamydia, Salmonella, Shigella, Yersinia, and Campylobacter.


Causes of Reactive Arthritis

The exact cause of reactive arthritis is not fully understood, but it is known to be triggered by an infection. The condition usually develops within one to four weeks after the initial infection. Genetic factors also play a significant role, with the HLA-B27 gene being strongly associated with a higher risk of developing reactive arthritis. Not everyone with the HLA-B27 gene will develop the condition, but the presence of this gene increases susceptibility.


Symptoms of Reactive Arthritis

The symptoms of reactive arthritis can vary but commonly include:

  1. Joint Pain and Swelling: The most affected joints are usually the knees, ankles, and feet. The pain and swelling can be asymmetric, affecting one side of the body more than the other.

  2. Inflammation of the Eyes (Conjunctivitis or Uveitis): Eye symptoms can range from redness and irritation to pain and blurred vision.

  3. Urinary Problems: These can include pain or burning during urination and an increased frequency of urination, often due to urethritis.

  4. Enthesitis: Inflammation where tendons and ligaments attach to the bone, commonly affecting the Achilles tendon.

  5. Skin Problems: Some people may develop skin rashes or sores, particularly on the palms of the hands and soles of the feet.

  6. Gastrointestinal Symptoms: Abdominal pain and diarrhea can be associated with the initial infection that triggered the arthritis.


Diagnosis of Reactive Arthritis

Diagnosing reactive arthritis can be challenging as there is no specific test for it. Doctors rely on a combination of medical history, physical examination, and laboratory tests to make a diagnosis. Key diagnostic steps include:

  • Medical History: Assessing recent infections, particularly gastrointestinal or genitourinary infections.

  • Physical Examination: Evaluating symptoms such as joint pain, swelling, and other signs of inflammation.

  • Laboratory Tests: Blood tests to detect markers of inflammation (elevated ESR and CRP levels), presence of the HLA-B27 gene, and tests for infections.

  • Imaging: X-rays or MRI scans may be used to examine joint damage or inflammation.


Management and Treatment

There is no cure for reactive arthritis, but the condition can be managed effectively with a combination of treatments aimed at alleviating symptoms and controlling inflammation. Management strategies include:

  1. Medications:

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These are the first line of treatment to reduce pain and inflammation.

  • Corticosteroids: Used to control severe inflammation, either orally or via injections directly into the affected joints.

  • Disease-Modifying Antirheumatic Drugs (DMARDs): In cases where symptoms persist or are severe, medications such as sulfasalazine or methotrexate may be prescribed.

  • Antibiotics: If a bacterial infection is still present, appropriate antibiotics are used to eradicate the infection.

  1. Physical Therapy: Regular physical therapy can help maintain joint function, improve range of motion, and strengthen muscles around the affected joints.

  2. Lifestyle Modifications:

  • Exercise: Regular low-impact exercises such as swimming or cycling can help keep joints flexible and reduce stiffness.

  • Healthy Diet: A balanced diet can support overall health and reduce inflammation. Anti-inflammatory foods such as fatty fish, leafy greens, and berries may be beneficial.

  • Weight Management: Maintaining a healthy weight can reduce stress on the joints, particularly the weight-bearing joints like knees and ankles.

  1. Supportive Treatments: Using orthotic devices or splints can help support affected joints and reduce pain during daily activities.


Prognosis

The prognosis for reactive arthritis varies. In many cases, symptoms improve within a few months to a year. However, some people may experience recurrent episodes or develop chronic arthritis. Early diagnosis and appropriate treatment are crucial for managing symptoms and improving quality of life.


Conclusion

Reactive arthritis is a complex condition triggered by an infection that can cause significant discomfort and impact daily life. Understanding its causes, symptoms, and management options is essential for those affected. Through a combination of medications, physical therapy, and lifestyle changes, individuals with reactive arthritis can manage their symptoms effectively and maintain a good quality of life. 


If you suspect you have reactive arthritis and are seeking a rheumatologist, we are accepting new patients and would love to see you. Whether you are already diagnosed or suspect you have a rheumatic disease, send our office your physician’s referral and then call us at 270-408-6100 to schedule an appointment. Please note: A physician's referral is required for all new patients.

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