Reactive arthritis is an inflammatory condition that causes pain, stiffness, and sometimes swelling in the joints. It usually occurs as a reaction to an infection and normally goes away on its own within a few months without causing ongoing problems.
What causes reactive arthritis?
Reactive arthritis is inflammation in the joints caused by an infection somewhere else in the body, usually the urinary system or bowel. For reasons that are still unclear, the immune system (the body's defence against infection) appears to overreact in response to the infection and starts attacking healthy tissue in the joints, causing them to become inflamed.
Who is affected by reactive arthritis?
- People born with the HLA-B27 gene are more likely to get reactive arthritis.
- People who have been exposed to a sexually transmitted infection (STI) such as chlamydia or gonorrhoea. In men, the STI usually has symptoms. In women, the STI may have no symptoms but they can still develop reactive arthritis.
- People who have been exposed to food poisoning caused by campylobacter, salmonella or shigella
- Reactive arthritis is most common in men aged 20 to 40 years.
What are the symptoms of reactive arthritis?
The first sign of a problem is often when your joints, especially your knees, ankles or toes, start to swell and become painful shortly after you’ve had an infection. The three most common places affected by reactive arthritis are the joints, the urinary system, and the eyes. However, most people will not experience all of these problems.
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.
Urinary tract symptoms
Reactive arthritis will typically result in inflammation of the urethra in men, and the vagina, urethra and uterus 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.
Redness and inflammation of the eye tissue, known as conjunctivitis, may occur before or at the same time as the joint pain. Symptoms include painful, irritated, red eyes and blurry vision.
How is reactive arthritis diagnosed?
Diagnosis is largely based on whether you had symptoms of infection before the appearance of joint pain. Your doctor may order a test for the HLA-B27 gene.
What is the treatment for reactive arthritis?
Treatment will depend on what stage the condition is at:
- 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.
- Non-steroidal anti-inflammatory drugs (NSAIDS) can be used to reduce joint pain and inflammation.
- They should be taken regularly to achieve a good anti-inflammatory effect.
- Your doctor will advise on which one would be most suitable for you.
- 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.
- In some cases, severe symptoms of arthritis that do not respond to NSAIDs or corticosteroids may be treated with a DMARD (disease-modifying antirheumatic drugs), such as sulfasalazine or methotrexate.
How long does reactive arthritis last?
The symptoms usually last 3-12 months, however, a small percentage of individuals may have a recurrence of symptoms and develop a long-term condition.
Self care – how can I look after myself?
In the early stages of reactive arthritis, it's recommended that you get plenty of rest and avoid using affected joints. As your symptoms improve, you will slowly need to start exercises to strengthen affected muscles and improve the range of movement in your affected joints.
Your doctor or specialist may recommend a suitable exercise programme for your arthritis, or may refer you to a physiotherapist. You may also find ice packs and heat pads useful in reducing joint pain and swelling. Do not place these directly on your skin.
If you would like to talk to someone about reactive arthritis you can call one of the Arthritis Educators at Arthritis New Zealand. Just ask for them when you call 0800 663 463.
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Questions and answers about reactive arthritis National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), USA