Reactive Arthritis: Symptoms, Causes & Treatment Guide

What is Reactive Arthritis

Reactive Arthritis is a form of arthritis that can cause inflammation and pain in the joints, the skin, the eyes, the bladder, the genitals and the mucus membranes. Unlike ankylosing spondylitis, ReA does not normally affect the spine and the sacroiliac joints in a majority of cases. Reactive arthritis is thought to occur as a ‘reaction’ to an infection that started elsewhere in the body, generally in the genitourinary or gastrointestinal tract.

Reactive Arthritis Symptoms

Pain and stiffness: The knees and ankles and feet become the main areas where this condition produces its symptoms. The pain from your condition can spread to different parts of your body which include your heels and your lower back and your buttocks.

Eye inflammation: The eyes of people with reactive arthritis become red and develop painful inflammation which causes eye irritation. The symptoms could indicate that you have conjunctivitis which people also refer to as pink eye. The condition produces symptoms which include blurred vision.

Urinary issues: The need to urinate becomes more frequent. The process of doing it will create feelings of burning along with discomfort. The prostate gland and cervix experience inflammation as a condition which affects certain individuals.

The condition known as enthesitis occurs when inflammation affects the points where tendons and ligaments connect to bones. The heels and soles of the feet experience this condition most frequently.

Source: Inflammation Sites

The feet and hands experience swelling which causes them to resemble sausages.

Skin issues: The condition causes some patients to develop mouth sores and they also experience painless penis ulcers and they develop skin rashes on their hands and feet.

Low back pain: The pain becomes more severe during nighttime hours and when the day starts.

Causes of Reactive Arthritis

Reactive arthritis occurs after exposure / infection caused by certain types of bacteria. These include:

Chlamydia, a bacterium contracted during sexually activity, which causes either burning urination or watery discharge from the penis or vagina.
Bacteria such as Salmonella, Shigella, Yersinia or Campylobacter, which cause dysentery (diarrhea, abdominal pain, vomiting, fever). Exposure to these bacteria occurs after eating spoiled or contaminated food.

However, not everyone exposed to these bacteria will contract ReA. Those who go on to develop ReA tend to test positive for the HLA-B27 genetic marker, although other genetic factors may be involved. Thus, it is an interaction between an individual’s genetic make-up and the initial infection that causes reactive arthritis.

Reactive Arthritis Risk Factors

The following elements create conditions which lead to reactive arthritis:

The condition primarily affects adults who are between 20 and 40 years old.
The medical team performs sex assignment at birth. The risk of developing reactive arthritis from foodborne infections occurs with equal frequency in all people. The condition develops most frequently in people who were assigned male at birth following a sexually transmitted infection.
Genetics: The presence of HLA-B27 genetic marker makes a person more susceptible to develop the condition. The majority of people who carry this genetic marker will not develop reactive arthritis.
Infection: People with HIV face an elevated chance of developing reactive arthritis.

Reactive Arthritis Treatment

Although there is currently no known cure, there are treatments and medications available to reduce symptoms and manage the pain and inflammation caused by ReA.

Medications

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): The first treatment choice for NSAIDs includes indomethacin and ibuprofen and naproxen to decrease pain and swelling.
Corticosteroids: The treatment involves direct joint injection for severe joint inflammation and patients can also use creams for skin rashes and eye drops for eye inflammation and oral pills for their most severe cases.
Doctors prescribe antibiotics when bacterial infections remain active because these medications help eliminate the bacterial cause but they do not guarantee that the arthritis symptoms will disappear.
DMARDs (Disease-Modifying Antirheumatic Drugs): The treatment of choice when NSAIDs prove ineffective because these medications reduce immune system activity (sulfasalazine and methotrexate serve as examples).

Other Therapies

Physical Therapy: Essential for improving joint flexibility, muscle strength, and function through range-of-motion and strengthening exercises.
Eye Care: Eye drops (steroid or other) for conjunctivitis or iritis require ophthalmologist involvement.
People who want to manage their pain should use relaxation methods together with physical exercise and learn how to handle their regular tasks.

Treatment Approach

The doctors start by identifying and treating any existing infection which might be causing the condition.
The treatment approach focuses on controlling joint and skin and eye inflammation together with pain management.
Specialists: A rheumatologist handles arthritis treatment while ophthalmologists and dermatologists provide care for eye and skin conditions.

Disease Course / Prognosis

ReA usually develops 2-4 weeks after the infection. A tendency exists for more severe and long-term disease in patients who do test positive for HLA-B27 as well as those who have a family history of the disease.

Reactive Arthritis typically follows a limited course, where symptoms subsiding in 3-12 months. However, the condition has a tendency to recur. About 15-20% of people with ReA develop a chronic, and sometimes severe, arthritis or spondylitis.