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Reactive Arthritis (Reiter's Syndrome)

What is reactive arthritis?

Reactive arthritis, also known as Reiter's syndrome, is a type of arthritis that occurs as a reaction to an infection somewhere in the body. Most infections that cause the disease originate in the genitourinary tract (the bladder, urethra, penis, or vagina) and are spread through sexual intercourse, a form of the disease called genitourinary Reiter's syndrome, or urogenital Reiter's syndrome. Other infections that can cause reactive arthritis include gastrointestinal infections due to eating contaminated food or handling contaminated substances, a form of the disease called gastrointestinal Reiter's syndrome, or enteric Reiter's syndrome.

Who is affected by reactive arthritis?

Reactive arthritis is characterized by inflamed joints and affects mostly young men, between the ages of 20 and 40. Although researchers are not sure why some people develop reactive arthritis in response to certain infections, a genetic factor (presence of the HLA-B27 gene) seems to increase the risk.

What causes reactive arthritis?

Reactive arthritis, or Reiter's syndrome, is usually preceded by an infection caused by bacteria, such as Chlamydia trachomatis (a sexually transmitted disease) or salmonella (a bacteria that can contaminate foods). It is important to note that the disease reactive arthritis itself is not contagious, but, rather, the bacteria that causes it. About 80 percent of people with the tendency to develop this disease have a special gene marker called HLA-B27.

What are the symptoms of reactive arthritis?

Reactive arthritis may cause arthritic symptoms, such as joint pain and inflammation, as well as urinary tract symptoms and conjunctivitis (eye infection). The following are the most common symptoms of reactive arthritis. Any of these symptoms may occur alone, together, or not at all. Symptoms typically last three to 12 months, but may develop into chronic disease in a small percentage of people. However, each individual may experience symptoms differently. Symptoms may include:

Arthritis symptoms

  • Joint pain and inflammation that often affect the knees, feet, and ankles

  • Inflammation of the tendon that is attached to the bone (called enthesopathy), which may cause heel pain or the shortening and thickening of the fingers

  • Heel spurs, which are bony growths in the heel that can cause chronic pain

  • Spondylitis (inflammation of the spine)

  • Sacroiliitis (inflammation of the lower back joints)

Urinary tract symptoms

Men:

  • Increased urinary output

  • Burning sensation during urination

  • Discharge from penis

  • Inflamed prostate gland (prostatitis)

Women:

  • Inflamed cervix

  • Inflamed urethra, causing a burning sensation during urination

  • Inflamed fallopian tubes (salpingitis)

  • Inflamed vulva and vagina (vulvovaginitis)

Eye symptoms

  • Red eyes

  • Painful and irritated eyes

  • Blurry vision

  • Inflamed mucous membrane that covers the eyeball and eyelid (conjunctivitis)

  • Inflammation of the inner eye (uveitis)

The symptoms of reactive arthritis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is reactive arthritis diagnosed?

Diagnosis of reactive arthritis may be difficult, because there are no specific laboratory tests that can confirm it. However, diagnosis may be confirmed based on a personal medical history and reported symptoms. Certain blood tests may be performed to rule out other conditions, such as rheumatoid arthritis and lupus. Other diagnostic tests may include:

  • Erythrocyte sedimentation rate (ESR or sed rate). A measurement of how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood's proteins clump together and become heavier than normal. Thus, when measured, they fall and settle faster at the bottom of the test tube. Generally, the faster the blood cells fall, the more severe the inflammation. (People with reactive arthritis often have an increased ESR.)

  • Tests for certain infections that are often associated with reactive arthritis, including testing for chlamydia

  • Arthrocentesis (also called joint aspiration). This test obtains a sample of synovial fluid in the joint for examination by inserting a thin, hollow needle into the joint and removing the fluid with a syringe.

  • Urine and stool samples

  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film; to check for spondylitis, sacroiliitis, swelling or damage to the joint.

Treatment for reactive arthritis

Specific treatment for reactive arthritis will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance for specific medications, procedures, and therapies

  • Expectation for the course of the condition

  • Your opinion or preference

Treatment usually includes antibiotics to treat the infection that is causing the reactive arthritis symptoms. Treatment may also include:

  • Nonsteroidal anti-inflammatory medications

  • Corticosteroids to reduce inflammation

  • Immunosuppressive medications, such as methotrexate to suppress inflammation

  • Rest to reduce pain and inflammation

  • Exercise to strengthen muscles and improve joint function