Reactive arthritis

This is a type of arthritis, also known as ‘Reiter’s Syndrome’ which occurs as a response to a gastrointestinal infection, e.g. food poisoning or a sexually transmitted infection (STI), e.g. chlamydia.

It causes inflammation in the joints of the body in a similar way to other forms of arthritis such as rheumatoid arthritis, gout and septic arthritis.

But the difference between this and these other conditions is that reactive arthritis develops due to an infection in another part of the body whereas these diseases are caused by an infection in the joints.

For most sufferers this disease fluctuates over a period of 6 months before clearing up altogether. During this time, people affected with reactive arthritis experience highs and lows but fortunately, it then disappears.

A small percentage of people are unlucky in that they develop chronic reactive arthritis which requires long term treatment.

Reactive arthritis is discussed as follows in this section:

• Who is most likely to develop reactive arthritis?
• How does reactive arthritis occur?
• Causes of reactive arthritis
• Symptoms of reactive arthritis
• Diagnosis of reactive arthritis
• Tests for reactive arthritis
• Treatment for reactive arthritis
• Managing reactive arthritis

Who is most likely to develop reactive arthritis?

This arthritis is no respecter of age or gender. It affects both men and women although the ratio depends upon the type of reactive arthritis.

More men than women develop reactive arthritis coupled with a sexually transmitted infection (STI).

Equal numbers of men and women develop reactive arthritis coupled with an abdominal infection.

About 90% of men are affected by reactive arthritis. This applies to all forms of this disease.

(Source: NHS Choices/reactive arthritis)

This is a little known form of arthritis which mainly affects younger people although children can also be affected. There are only 30 to 40 new cases of reactive arthritis every year.

How does reactive arthritis occur?

This form of arthritis develops following an infection in another part of the body – hence the name ‘reactive arthritis’. Examples of this include a gastrointestinal illness such as Campylobacter food poisoning or as a reaction to a sexually transmitted disease.

This is an autoimmune condition with symptoms which classify it as a form of arthritis.

Causes of reactive arthritis

It is a complex condition which is difficult to find an exact cause. In this respect it is similar to several other forms of arthritis which are equally difficult to find the causes of.

It has been suggested that reactive arthritis develops as due to an overactive response by the immune system or the presence of antigens (substance which triggers antibodies) in the joints.

But more research is needed to determine the causes of reactive arthritis.

There are a couple of theories which are:

• Reaction to an infection
• Genetics

Reaction to an infection

The immune system becomes overstimulated when dealing with an infection, for example Chlamydia which then causes pain and inflammation in the joints, eyes and urethra (tube which expels urine out of the body).

Another sexually transmitted infection (STI) is gonorrhoea. This and chlamydia are the two disease most commonly linked to reactive arthritis.

Stomach infections such as salmonella and campylobacter are amongst those usually connected to reactive arthritis.

Viral infections such as chickenpox, hepatitis A/B and C and HIV are also likely to cause this condition but this tends to be rare.

Genetics

There are people with the gene HLA-B27 who are at increased risk of developing reactive arthritis. Plus it places them at greater risk of other similar conditions such as ankylosing spondylitis.

Most cases of reactive arthritis occur in people who have this gene. They have worse symptoms and an increased chance of a relapse compared to people without this gene.

Further research is continuing into the HLA-B27 gene.

Symptoms of reactive arthritis

This condition affects three areas of the body which are:

• Joints and muscles
• Eyes
• Urinary system

But there are several other symptoms which occur less often. These include:

• Mouth ulcers
• Mild fever
• Skin rash over the hands and feet
• Fatigue
• Thick, brittle nails
• Diarrhoea: this usually precedes the arthritis

The important thing to remember is that not everyone gets all of these symptoms. You may only develop some of these and this varies from one person to the next.

Joints and muscles

These are the symptoms we associate with arthritis. An inflammation develops in the joints, usually those in the lower half of the body such as the hips and knees.

But other joints can be affected which include the lower back, wrists, elbows, fingers, toes and the base of the heel (Achilles tendon).

These joints become swollen and inflamed which occurs after a period of stiffness.

Eyes

This inflammation takes the form of conjunctivitis which causes the eyes to become red and swollen. Uveitis and/or iritis can also occur.

The eyes become itchy and swollen and tend to water. Eye pain is another symptom.

Urinary system

By this we mean the urethra: the tube which passes urine from the bladder and out of the body. Both men and women have a urethra although this is shorter in women.

The urethra is one of three areas of the body affected by reactive arthritis. It causes a painful burning sensation and a constant need to urinate. There may be blood present in the urine and a discharge may occur from the vagina (women) or the penis (men).

The first indication that you have reactive arthritis is a swelling in the knees, ankles or toes. This is then followed by some or most of the other symptoms.

Diagnosis of reactive arthritis

It is important that you see your GP as soon as notice these symptoms. The main reason for this is that any inflammation of the joints can be a sign of rheumatoid arthritis, gout or several other forms of arthritis.

These can lead to a long term disability if left untreated so seek treatment as soon as possible.

The main difference between reactive arthritis and these other types of arthritis is that of a link to an earlier infection. Reactive arthritis is as the name says: it develops as a response to a previous infection such as salmonella food poisoning.

Your GP will ask you about your medical history and if anyone in your family suffers or has suffered from reactive arthritis. He/she will also ask you if you have experienced a stomach infection such as food poisoning or a sexually transmitted disease, e.g. chlamydia.

This is followed by tests. There is no single test for reactive arthritis; rather a combination of tests which are designed to rule out other similar forms of arthritis.

Tests for reactive arthritis

These will be carried out by your GP or if necessary, a specialist such as a rheumatologist.

Your GP will have examined you first, followed a discussion about your symptoms. This is then followed by blood tests, swabs and/or a sample of faeces (known as a ‘stool sample’).

In addition to these you may have a small sample of fluid removed from one of your joints to check for signs of inflammation.

Blood tests

These are used to detect the presence of antibodies or other substances which cause arthritis. They also check the amount of inflammation in your body.

Swabs

This is a painless test in which swabs are taken from the vagina or penis to assess for signs of an infection or inflammation.

Stool sample

A small sample of faeces is analysed under a microscope to check for infection.

These are standard tests performed for a variety of medical conditions which include arthritis.

Treatment for reactive arthritis

This depends upon the extent of your condition. Treatment takes the form of a three pronged attack which includes:

• Strong painkillers such as non-steroidal anti-inflammatory drugs (NSAID’s) to reduce any pain, stiffness and swelling.
• Antibiotics to treat the original infection
• Corticosteroids to treat chronic arthritis

You may have to alter certain aspects of your lifestyle such as stopping smoking, watching your weight, eating healthily and taking exercise.

Examples of painkillers include Ibuprofen and Diclofenac. These are useful for mild to moderate forms of reactive arthritis. Severe forms may require steroid treatment, e.g. injections as well.

Antibiotics are prescribed to treat an eye infection (drops), sexually transmitted infection (STI) or an abdominal infection. Steroid drops are an option in severe eye infections.

Heel pads, shoe pads and wrist splints can help along with ice and heat packs to reduce any swelling. Make sure that you get plenty of rest but balance this with exercise as it is important to keep your joints moving.

For more information about these forms of treatment visit our treatment for arthritis section.

Managing reactive arthritis

The use of the word ‘managing’ means controlling the symptoms of your condition on a daily basis. It includes a few ‘self help’ actions which should not impact too much on your day to day routine.

It is usually chronic forms of arthritis which require people to make adjustments to their way of life to enable them to function as normally as possible.

If you have mild or a moderate form of this condition then you will be concerned with maintaining a balance between exercise and bed rest. Expect periods where you will be tired and rest as much as you can when that happens.

But do not forget to remain as active as you can. This means taking exercise such as walking or swimming. Your GP can advise you about suitable forms of exercise.

Another good option is to visit a physiotherapist as he/she will show you ways of moving your joints without putting any strain on them. He or she will also give you exercises to try out at home.

Having reactive arthritis means that you are greater risk of food poisoning and sexually transmitted diseases as these were the initial trigger for your condition. So take extra care when handling food and use a barrier method of contraception during sex.

Find out more about self help in our living with arthritis section.