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Reactive arthritis is an uncommon inflammatory condition, occurring in just 1 in 1,000 adults worldwide. Unlike other forms of arthritis, reactive arthritis is short term, with most people recovering within six months. Whilst there is no cure, treating the symptoms of reactive arthritis can help to relieve the pain and discomfort associated with the condition.
What is reactive arthritis?
Reactive arthritis is a non-contagious inflammatory medical condition that affects the joints, resulting in pain, stiffness and swelling. This type of arthritis, known previously as Reiter’s syndrome, is described as reactive as it occurs in response to an infection elsewhere in the body.
The infection usually originates in the intestine or the urinary tract. Reactive arthritis is a spondyloarthritis (SpA), which distinguishes it from some other types of arthritis, as it causes inflammation in the entheses. Entheses are the areas in the joints in which ligaments and tendons fuse with bones. As reactive arthritis is responsive, it typically only affects the individual for less than a year, although in some cases it can endure for a longer period of time.
What is non-reactive arthritis?
Non-reactive forms of arthritis are those forms which do not develop due to infection but typically occur due to the natural wear and tear at the joints. Natural wear and tear may also be sped up by injury or illness.
An example of non-reactive arthritis is osteoarthritis. This is a chronic condition, where cartilage at the joints is worn away over time, causing bones to rub against each other. Unlike reactive arthritis, it is completely irreversible, though there are many methods available to help reduce pain.
What is the most common cause of reactive arthritis?
Reactive arthritis, sometimes called postinfectious arthritis, is triggered by bacterial infections in other parts of the body. The infection needn’t be severe to trigger the onset of reactive arthritis, and may even be asymptomatic.
One of the most common causes of reactive arthritis is chlamydia, a sexually transmitted infection, though the processes that cause the infection to lead to the onset of the condition are not fully understood.
It is thought that reactive arthritis behaves in the same way as other autoimmune diseases, in that it is unable to distinguish between foreign cells and native cells, thus attacking healthy tissue and cells. Infection is carried from its origin, through the blood, and is released into the tissue surrounding the joints.
As the typical immune response is to defend the body from foreign cells, reactive arthritis is an autoimmune response to infection.
Another infection which is commonly associated with the onset of reactive arthritis is salmonella, which is contracted when eating food that has been contaminated with the bacteria, forming an infection in the gut. Other food transmitted infections that are known to cause reactive arthritis are shigella, campylobacter and yersinia.
However, whilst bacterial infections are cited as a trigger for reactive arthritis, many people who have the aforementioned infections will not suffer from reactive arthritis. It is thought that some people are genetically predisposed to the condition, specifically those with the human leukocyte antigen (HLA-B27), which is an instrumental protein associated with how likely one might be to develop specific diseases.
Between 7% and 10% of people in the UK carry the gene; nevertheless, most individuals with the human leukocyte protein who contract the listed bacterial infections are not affected by reactive arthritis.
This has led many researchers to believe that other factors are more heavily involved. It is important to note, however, that those with HLA-B27 might be more likely to develop chronic reactive arthritis, should they develop reactive arthritis.
Signs and symptoms of reactive arthritis
Symptoms of reactive arthritis are known to affect three main parts of the body: the joints and tendons, the urinary system, and the eyes. They are usually noticed within two to four weeks of the individual contracting one of the bacterial infections listed above.
Symptoms include, but are not limited to:
- Pain in the joints, particularly in the ankle joints, knees and feet.
- Stiffness in the joints, which is often worse at the start of the day.
- Swollen joints, especially fingers and toes.
- Pain in the lower back (read more about different types of pain).
- Spinal inflammation.
- Heel growths.
- Eye pain caused by conjunctivitis.
- Red eyes.
- Swelling of the eyelids.
- Sensitivity to light.
- Blurred vision.
- Inflammation of the urethra, which can cause pain and difficulty urinating, such as a burning sensation.
- More frequent urination.
- A sudden need to urinate.
- Inflammation of the prostate gland.
- Penile/vaginal discharge.
- Inflammation of the fallopian tubes.
- Inflammation of the cervix.
- Inflammation of the vulva.
- Blood in the urine.
Many of the urinary tract symptoms are symptoms of sexually transmitted infections and may not mean that the individual has developed reactive arthritis.
Other symptoms may include, but are not limited to:
- Unexpected fatigue.
- A rash on the skin.
- Abdominal pain.
- Mouth ulcers.
- Unexpected weight loss.
- Weakened nails.
Who is more at risk of reactive arthritis?
Reactive arthritis is more dominant in particular age groups and sexes, dependent on their exposure to different infections. Those between the ages of 20 to 40 years old are more susceptible to reactive arthritis. It is unknown why, but it is thought that people between those ages are more likely to be exposed to sexually transmitted infections and gut infections.
Additionally, people who are sexually active are more likely to trigger reactive arthritis. However, men are more likely than women to trigger reactive arthritis from a sexually transmitted infection.
When it comes to infections that are transmitted through food, both men and women are equally as likely to trigger reactive arthritis. Reactive arthritis can also occur in children, though children often recover quickly from symptoms.
What is the difference between reactive arthritis and rheumatoid arthritis?
In contrast to reactive arthritis, which is a short-term condition, rheumatoid arthritis is long term. The cause of rheumatoid arthritis is unknown, though it functions in the same way that reactive arthritis does – as an autoimmune condition. The immune systems of those with rheumatoid arthritis send out antibodies which attack the tissue around joints.
The cells around the joint become inflamed and let off chemicals that affect the bones, cartilage, tendons and ligaments in the vicinity. Unlike reactive arthritis, which eventually goes away, rheumatoid arthritis can have a crippling effect on the body if it is left untreated, with joints wearing away altogether.
Whilst reactive arthritis is usually a response to infection, there are other factors involved in developing rheumatoid arthritis.
These can include:
- Smoking. Smoking is believed to heighten the risk of developing rheumatoid arthritis. Smoking increases inflammatory proteins in the body, which are linked to rheumatoid arthritis. Additionally, smoking can trigger your body to produce anti-CCP antibodies which can cause severe symptoms of rheumatoid arthritis.
- Hormones. Women are more susceptible to suffering from rheumatoid arthritis due to its link with oestrogen. Whilst studies on this are limited and inconclusive, childbirth has been identified as a trigger, as well as periods of stress.
- Obesity. People who are overweight are identified as being at higher risk of developing rheumatoid arthritis, and also experience more pain due to swelling being located in weight-bearing joints such as knees and ankles.
- Genetics. Studies have shown that rheumatoid arthritis can be passed down through families, representing somewhere between 50% and 60% of the risk.
Rheumatoid arthritis also has a low level of occurrence, with about 1% of the population in the UK suffering from the condition.
How is reactive arthritis diagnosed?
In any instance where reactive arthritis is suspected, the first point of call should be visiting your GP.
It is best to prepare for your visit by ensuring you have the following:
- A clear description of your symptoms.
- A record of when they started.
- Any known recent or current infections.
Reactive arthritis is predominantly diagnosed based on the display of symptoms, as there is no one test that gives a clear and conclusive diagnosis. This can mean that the process of diagnosing rheumatoid arthritis can be long and arduous, and could even be misdiagnosed.
However, there are tests that can give some indication of the presence of reactive arthritis. These tests look for signs of infection, inflammation, antibodies that are commonly linked to arthritis generally, and of course, signs of the presence of the gene associated with arthritis.
- Tests for inflammation may include looking at the ESR (erythrocyte sedimentation rate). This analyses the length of time it takes for the individual’s blood to sink to the bottom of the tube. Heavier blood, with a faster falling rate, indicates the levels of inflammation present.
- It is commonplace for genital swabs to be taken to assess whether chlamydia or any other sexually transmitted infection is present. Whilst the patient is awaiting test results, they should refrain from sexual activity, and if the tests are positive, the patient will be asked to contact any recent sexual partners, and/or their current sexual partner should be tested for the infection.
- Tests for other bacteria that are known to trigger reactive arthritis may be done as well, through urine and stool samples. Tests for gut infections have a chance of coming back with a negative result as they may have cleared prior to the onset of symptoms of reactive arthritis.
- A gene test may be taken to ascertain whether the individual has the human leukocyte antibodies which may cause reactive arthritis.
- X-rays can be useful when it comes to examining joints. X-rays can help to identify swelling and joint damage.
Physical examination plays an important role in diagnosing reactive arthritis, as doctors can examine factors such as muscle strength, reflexes, warmth, redness and swelling. They can also look at other parts of your body, such as your eyes.
How is reactive arthritis treated?
Many people who suffer from reactive arthritis are relieved from their symptoms within a year, and at least half of people diagnosed only have symptoms for up to six months.
The best way of treating the pain is to try and treat any bacterial infection that may have triggered it. This is usually done through administering antibiotics, although chlamydia is facing the modern threat of resistance to antibiotics.
Other treatments include:
- Administering anti-inflammatory drugs, such as NSAIDs, which can reduce the inflammation of joints, tendons and ligaments.
- Administering steroidal injections (corticosteroids) directly into the joints, which can numb the pain and reduce inflammation. Steroids can also be used to relieve eye irritation.
- Rest. Specialists will recommend that adequate rest is taken to allow the swelling to decrease.
- Physiotherapy. Physiotherapy is a tool used to reduce the levels of stiffness, immobility and pain experienced by those with reactive arthritis. You can read more about pain management by visiting our knowledge base.
- Immunosuppression. As the arthritis is triggered by an autoimmune response to infection, medicines that suppress the immune response may be administered. This may include drugs such as methotrexate or sulfasalazine.
Whilst treatments can be helpful, they are not usually needed in the long term, as reactive arthritis goes away within a year. However, up to 50% of people who have suffered from reactive arthritis will experience a brief resurgence of the disease at some point, and a few people experience long-term joint damage and chronic pain.
Some people choose to follow more holistic forms of treatment, such as following an anti-inflammatory diet, to speed up their recovery time. This typically involves removing things such as sugars, processed meats, gluten and alcohol from their diet.
Additionally, many foods are known to have natural anti-inflammatory properties, such as fatty fish, green tea, nuts and leafy greens. Following an anti-inflammatory diet is seen as a way to help manage and reduce symptoms, rather than a cure.
What help is available to individuals with reactive arthritis?
Many arthritis charities and organisations offer free advice helplines for those suffering from many different types of arthritis.
The following links may also be useful: