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    Reactive arthritis

    Reiter syndrome; Post-infectious arthritis

    Reactive arthritis is a group of conditions that may involve the joints, urethra, and eyes. These areas become swollen and inflamed. It is often in response to infections.

    Causes

    The exact cause of reactive arthritis is unknown. It occurs most often in men younger than age 40. It may follow an infection in the urethra after unprotected sex. It can also follow an intestinal infection (such as food poisoning).

    Certain genes may make you more likely to get this condition.

    The disorder is rare in young children, but it may occur in teenagers.

    Symptoms

    Urinary symptomswill appear within days or weeks of an infection. These symptoms may include:

    • Burning when urinating
    • Fluid leaking from the urethra (discharge)
    • Problems starting or continuing a urine stream
    • Needing to urinate more often than normal

    A lowfever, along with eye discharge, burning, or redness (conjunctivitis or "pink eye") can develop over the next several weeks.

    Joint pain and stiffness also begins during this time period. The arthritis may be mild or severe. Arthritis symptoms may include:

    • Heel pain or pain in the Achilles tendon
    • Pain in the hip, knee, ankle, and low back
    • Pain that only one side of the body or more than one joint

    Symptoms may include skin sores on the palms and soles of the feet that look like psoriasis. There may also be small, painless ulcers in the mouth, tongue, and penis.

    Exams and Tests

    Your health care provider will diagnose the condition based on your symptoms. A physical exam may show signs of conjunctivitis or skin sores. Symptoms may not all appear at the same time so there may be a delay in getting a diagnosis.

    You may have the following tests:

    • HLA-B27 antigen
    • Joint x-rays
    • Sed rate (ESR)
    • Urinalysis

    Treatment

    The goal of treatment is to relieve symptoms and treat the infection that is causing this condition.

    Eye problems and skin sores do not need to be treated most of the time. They will go away on their own.

    Your doctor will prescribe antibiotics if you have an infection. Nonsteroidal anti-inflammatory drugs (NSAIDS) and pain relievers may help with joint pain. If a joint is very swollen for a long period of time, your health care provider may inject a corticosteroid medicine into the joint.

    Physical therapy can help you relieve pain. It can also help you move better and maintain muscle strength. Rarely, people with a severe case of the disease may need medication to suppress the immune system.

    Outlook (Prognosis)

    Reactive arthritis may go away in a few weeks, but it can last for a few months. Symptoms may return over a period of years in up to half of the people who have this condition.

    Rarely, the condition can lead to abnormal heart rhythm or problems with the aortic heart valve.

    When to Contact a Medical Professional

    See your health care provider if you develop symptoms of this condition.

    Prevention

    Avoid infections that can bring on reactive arthritis by practicing safe sex and avoiding things that can cause food poisoning.

    References

    Hill JS. Reactive arthritis and undifferentiated spondyloarthritis. In: Firestein GS, Budd RC, Gabriel SE, et al, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 76.

    Carter JD, Hudson AP. Reactive arthritis: clinical aspects and medical management. Infect Dis Clin North Am. 2009;35(1).

    Inman RD. The spondyloarthropathies. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 273.

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            Review Date: 4/20/2013

            Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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