Reactive Arthritis

Reactive Arthritis (previously referred to as Reiter’s syndrome) is a group of symptoms consisting of arthritis (inflammation of the joints), urethritis (inflammation of the urethra), conjunctivitis (inflammation of the lining of the eye), and lesions of the skin and mucous membranes.

The exact cause of Reactive Arthritis is unknown, but it likely caused by an interaction between a genetic factor (HLA-B27) and trigger by some environmental factor (such as an infection). It develops most commonly in men before the age of 40.

Symptoms

Frequently the symptoms began several days or weeks after an identifiable infection, usually that of the gastrointestinal tract (ie. Salmonella, Yersinia, Campylobacter) or sexually transmitted infection (Chlamydia or Gonorrhea).

The symptoms of urethritis usually appear within days or weeks of the infection followed by a low-grade fever, conjunctivitis, and arthritis developing over the next several weeks.

Genitourinary symptoms –

  • urinary urgency, hesitancy or burning
  • urethral discharge
  • penis pain
  • incontinence
  • genital lesions (male)
  • small, painless ulcers in the mouth, tongue, and glans penis

Ophthalmologic symptoms –

  • redness of the eye
  • discharge from the eye
  • burning eye pain
  • blurring of vision

Arthritis – The arthritis may be mild or severe with involvement being asymmetric and in more than one joint.

  • joint pain in the large joints (hip pain, knee pain, and ankle pain are common)
  • low back pain
  • heel pain
  • Achilles tendon pain
  • skin lesions on the palms and soles that may resemble psoriasis
  • arthritis

Diagnosis

The diagnosis is based on symptoms, exam findings, laboratory testing, and sometimes X-ray. All the symptoms do not need to be present at the same time which may delay diagnosis.

Tests that may be performed include:

  • Joint X-rays (knees, Sacroiliac joints, etc)
  • Urinalysis
  • HLA-B27 antigen
  • Blood test (Sedimentation Rate, CRP)

Treatment

The goal of treatment for reactive arthritis includes alleviation of present symptoms and treat the underlying infectious cause.

In general, the conjunctivitis and skin lesions associated with the syndrome do not require treatment, and will resolve on their own. The underlying infection should be treated with antibiotics, although this has not been shown to affect the course of the arthritis.

The arthritis is treated with nonsteroidal anti-inflammatory medications (NSAIDS) and pain relievers. Local administration of corticosteroids may help relieve the symptoms associated with persistent inflammation in one joint. In more severe, prolonged cases not responding to NSAIDs or joint injection stronger immunosuppressive agents such as sulfasalazine, methotrexate, or biological agents (such a TNF inhibitors) may be helpful.

Prognosis

With appropriate treatment Reactive arthritis frequently resolves within 3 to 4 months, but up to one-half of individuals will experience recurrences of the arthritis or other symptoms over a period of several years.