Reactive arthritis, formerly referred to as Reiter's syndrome, is a form of arthritis that affects the joints, eyes, urethra (the tube that carries urine from the bladder to the outside of the body), and skin.
The disease is recognized by various symptoms in different organs of the body that may or may not appear at the same time. It may come on quickly and severely or more slowly, with sudden remissions or recurrences.
Reactive arthritis primarily affects sexually active males between the ages of 20 and 40. Those with HIV (human immunodeficiency virus) are at a particularly high risk.
What Are the Symptoms of Reactive Arthritis?
Symptoms
The signs and symptoms of reactive arthritis generally start 1 to 4 weeks after exposure to a triggering infection. They might include:
Pain and stiffness. The joint pain associated with reactive arthritis most commonly occurs in the knees, ankles and feet. Pain may also occur in the heels, low back or buttocks.
Eye inflammation. Many people who have reactive arthritis also develop eye inflammation (conjunctivitis).
Urinary problems. Increased frequency and discomfort during urination may occur, as can inflammation of the prostate gland or cervix.
Inflammation of tendons and ligaments where they attach to bone (enthesitis). This happens most often in the heels and the sole of the feet.
Swollen toes or fingers. In some cases, toes or fingers might become so swollen that they look like sausages.
Skin problems. Reactive arthritis can affect skin in a variety of ways, including mouth sores and a rash on the soles of the feet and palms of the hands.
Low back pain. The pain tends to be worse at night or in the morning.
Inflammation sites
Inflammation often affects these sites in people with reactive arthritis.
Treatment
The goal of treatment is to manage your symptoms and treat an infection that could still be present.
Medications
If your reactive arthritis was triggered by a bacterial infection, your doctor might prescribe an antibiotic if there is evidence of persistent infection. Which antibiotic you take depends on the bacteria that are present.
Signs and symptoms of reactive arthritis may be eased with:
Nonsteroidal anti-inflammatory drugs (NSAIDs). Prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin (Indocin), can relieve the inflammation and pain of reactive arthritis.
Steroids. A steroid injection into affected joints can reduce inflammation and allow you to return to your usual activity level. Steroid eye drops may be used for eye symptoms, and steroid creams might be used for skin rashes.
Rheumatoid arthritis drugs. Limited evidence suggests that medications such as sulfasalazine (Azulfidine), methotrexate (Trexall) or etanercept (Enbrel) can relieve pain and stiffness for some people with reactive arthritis.
Physical therapy
A physical therapist can provide you with targeted exercises for your joints and muscles. Strengthening exercises increase the joint's support by developing the muscles around the affected joints. Range-of-motion exercises can increase your joints' flexibility and reduce stiffness.
Diagnosis
During the physical exam, your doctor is likely to check your joints for swelling, warmth and tenderness, and test range of motion in your spine and affected joints. Your doctor might also check your eyes for inflammation and your skin for rashes.
Blood tests
Your doctor might recommend that a sample of your blood be tested for:
Evidence of past or current infection
Signs of inflammation
Antibodies associated with other types of arthritis
A genetic marker linked to reactive arthritis
Joint fluid tests
Your doctor might use a needle to withdraw a sample of fluid from within an affected joint. This fluid will be tested for:
White blood cell count. An increased number of white blood cells might indicate inflammation or an infection.
Infections. Bacteria in your joint fluid might indicate septic arthritis, which can result in severe joint damage.
Crystals. Uric acid crystals in your joint fluid might indicate gout. This very painful type of arthritis often affects the big toe.
Imaging tests
X-rays of your low back, pelvis and joints can indicate whether you have any of the characteristic signs of reactive arthritis. X-rays can also rule out other types of arthritis.
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