Reactive arthritis

What is reactive arthritis?

Reactive arthritis is a condition that causes inflammation, pain and swelling of the joints. It usually develops after an infection, often in the bowel or genital areas. The infection causes activity in the immune system. The normal role of your body’s immune system is to fight off infections to keep you healthy. In some people this activity of the immune system causes joints to become inflamed, however the joints themselves are not actually infected. About one in 10 people with specific types of infections will get reactive arthritis.

For most people reactive arthritis disappears completely with time and causes no permanent joint problems.

What are the symptoms?

Reactive arthritis usually begins a few weeks after an infection. Symptoms can affect many parts of the body and commonly include:

• pain, swelling and stiffness of joints, often the knees and ankles
• pain and stiffness in the buttocks and back (also known as spondylitis, meaning inflammation of the spine)
• pain in tendons, such as at the back of the heel (tendons are the strong cords that attach muscles on to bones)
• rash on the palms of the hands or soles of the feet
• pain and redness in the eyes.

What causes it?

Only specific bacteria may result in reactive arthritis. The most common are:

• chlamydia bacteria, which are transmitted during sexual activity
• salmonella, shigella, yersinia or campylobacter bacteria, which cause food poisoning.

It is not known why some people who get these infections develop reactive arthritis and some do not. A certain gene called HLA-B27 is associated with reactive arthritis, especially inflammation of the spine. However this is a perfectly normal gene and there are many more people who have this gene and do not get reactive arthritis.

How is it diagnosed?

Your doctor will diagnose reactive arthritis from your symptoms and a physical examination. Your doctor may also order blood tests for inflammation, such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) tests. Blood tests may also help to rule out other types of arthritis.

What will happen to me?

For most people reactive arthritis disappears completely with time and causes no permanent joint problems. More than four out of five people with reactive arthritis will recover completely within three to 12 months. During this time you may find that your symptoms are worse some days and better other days. Most people need some form of treatment, usually medicines, while symptoms are present. About one in five people need long-term treatment as their arthritis does not improve or returns.

What treatments are there for reactive arthritis?

Your doctor will tailor your treatment to your symptoms and the severity of your condition. There is no way of predicting exactly which treatment will work best for you. Your doctor may need to trial several different treatments before finding the one that is right for you and may include medicines, such as:

• non-steroidal anti-inflammatory drugs (NSAIDs)
• disease-modifying anti-rheumatic drugs (DMARDs) for long-term arthritis
• antibiotics, which may be required to treat the original infection.

What can I do?

1. See your doctor for treatment and advice. Your doctor will help you get the right treatment to manage your symptoms. Your doctor may refer you to a rheumatologist, an arthritis specialist, if your condition is difficult to control.
2. Learn about reactive arthritis and play an active role in your treatment. Not all information you read or hear about is trustworthy so always talk to your doctor or healthcare team about treatments you are thinking about trying. Reliable sources of further information are also listed in the section below. Self management courses aim to help you develop skills to be actively involved in your healthcare. Contact your local Arthritis Office for details of these courses.
3. Learn ways to manage pain.
4. Live a healthy life. Stay physically active, eat a healthy diet, stop smoking and reduce stress to help your overall health and wellbeing.
5. Acknowledge your feelings and seek support. Having reactive arthritis can turn your everyday life upside down. As such it is natural to feel scared, frustrated, sad and sometimes angry. Be aware of these feelings and get help if they start affecting your daily life.

Websites:
Australian Rheumatology Association, American College of Rheumatology, Arthritis Foundation (US)