Reactive arthritis

Reactive arthritis | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Muscle, bone and joints Conditions Reactive arthritis Reactive arthritis About reactive arthritis Symptoms of reactive arthritis Causes of reactive arthritis Treating reactive arthritis About reactive arthritis Reactive arthritis, formerly known as Reiters syndrome, is a condition that causes inflammation (redness and swelling) in various places in the body. It usually develops following an infection, and in most cases clears up in a few months withoutcausing long-term problems. The three most common placesaffected by reactive arthritisare: the joints ( arthritis ), which can causepain, stiffness and swelling the eyes ( conjunctivitis ), which can causeeye pain and redness the urethra(non-gonococcal urethritis), which can cause pain when urinating (the urethrais the tube that carries urine out of the body) However,most people will not experience all of these problems. Read more about the symptoms of reactive arthritis . What causes reactive arthritis? Reactive arthritis usually develops within four weeks of an infection, typically after a sexually transmitted infection (STI)such as chlamydia, or an infection of the bowel. For reasons that are still unclear, the immune system (the bodys defence against infection) appears to malfunction in response to the infection and starts attacking healthy tissue, causing it to become inflamed. Read more about the causes of reactive arthritis . Seeking medical advice Seeyour GP ifyou haveswollen and painful joints, especially if you have recently hadsymptoms of an infection such as diarrhoea or pain when passing urine. There is no single test for reactive arthritis, although blood and urine tests, genital swabsand X-rays may be used to check forinfection and rule out other causes of your symptoms. Your GP will also want to know about your recent medical history,such as whether you may have recently had abowel infection or an STI. How reactive arthritis is treated There is currently no cure for reactive arthritis, but most people get better in around six months. Meanwhile, treatment can help to relieve symptoms such as pain and stiffness. Symptoms canoften be controlled using non-steroidal anti-inflammatory drugs (NSAIDs) and painkillers such as ibuprofen . Severe symptomsmayrequire more powerful steroid medication ( corticosteroids ) or disease-modifying anti-rheumatic drugs (DMARDs). Read more about treating reactive arthritis . Who is affected Reactive arthritis can occur at any age, but it most commonly affects young adults aged 20-40. Men are generally affected more than woman particularly in cases linked to STIs, which are estimated to be about 10 times more common in men. People who have a certain gene called HLA-B27, which is found in around one in every 10 people in theUK,are about thought to be around 50 times more likely to develop reactive arthritis than those who dont have this gene. Preventing reactive arthritis The most effective way to reduce your risk of reactive arthritis is to avoid the STIs andbowel infections that most commonlycause the condition. The most effective way of preventing STIs is to always use a barrier method of contraception , such as a condom , during sex with a new partner. Read adviceon contraception and sexual health . Symptoms of reactive arthritis The symptoms of reactive arthritis usually develop within four weeks of an infection. In most cases, reactive arthritis follows a sexually transmitted infection (STI)such as chlamydia, or abowel infection such as food poisoning . The three parts of the body most commonly affected by reactive arthritisare the: joints andtendons urinary system eyes However, most people wont experience problems inall of these areas. Joints and tendons Reactive arthritis usually involves inflammation of the joints ( arthritis ) and tendons, which can cause: joint pain, tenderness and swelling  usually in weight-bearing joints such as your knees, feet and ankles lower back and buttock pain swelling of your fingers and toes joint stiffness  particularly in the morning See your GP if you have any swollen and painful joints, especially if you have recently had diarrhoea or problems passing urine. The urinary system Reactive arthritis can sometimes alsoinvolve inflammation of the urethra (non-gonococcal urethritis), which is the tube that carries urine out of the body. Symptoms of urethritis caninclude: pain or a burning sensation when you pee urinating more often than usual having a sudden urge topee a discharge of fluid from the penis or vagina blood in your urine (less commonly) The eyes Reactive arthritis may occasionallyinvolve inflammation of the eyes ( conjunctivitis ). Symptoms of conjunctivitis caninclude: red eyes watery eyes eye pain swollen eye lids In rare cases, a type ofuveitis called iritis can develop.Iritis can cause the eyes to becomepainful, red and sensitive to light.See your doctor or an eye specialist as soon as possible if you have these symptoms. Other symptoms Reactive arthritis can also cause symptoms, including: feeling unusually tired ahightemperature(fever) weight loss mouth ulcers painless whitepatchesinside your mouth a rash thick and crumbly nails abdominal (tummy) pain bouts ofdiarrhoea Causes of reactive arthritis Its not known exactly what causes reactive arthritis, but its thought to be the result of the immune system reacting to an infection. The immune system Your immune system is your bodys defence against illness and infection. When it senses a virus or bacteria, itsends antibodies and cells to fight the infection. This causes tissues to swell, known as inflammation, which makesit harder for theinfection to spread. In cases of reactive arthritis, something goes wrong with the immune system and it causes inflammation in parts of the body that were not infected, often after the infection has already passed. Infection The two most common types of infection linked to reactive arthritis are: sexually transmitted infections (STIs) such as chlamydia or gonorrhoea , although many casesoccur afternon-gonococcal urethritis infections of thebowel and digestive system (gastrointestinal infections)  usuallycaused by either campylobacter or salmonella bacteria, both of which can cause food poisoning Genetic factors Research has shown that people with a specific gene known as HLA-B27 have a significantlyincreased chance of developing reactive arthritis, as well as related conditions such as ankylosing spondylitis (a type of arthritis that affects the spine) . In the UK, its estimated thataround1 in every 10 people have the HLA-B27 gene. Around3out of every4 cases of reactive arthritis develop in people with the gene. People withthe HLA-B27 gene also tend to have more severe and longer-lasting symptoms, with a greater risk of their symptoms recurring. Exactly how the gene contributes to the development of reactive arthritis is unclear. Treating reactive arthritis Theres no cure for reactive arthritis, but the condition is usually temporary and treatment can help to relieve your symptoms. Most people will make a full recovery in about six months, although around one in five cases lasts a year or more, and a small number of people experience long-term joint problems. There is also a risk you could develop the condition again after another infection. Self-care In the initial stages of reactive arthritis, its recommendedthat you get plenty of rest and avoid using affected joints. As your symptoms improve, you should begin a gradual programme of exercisedesigned to strengthen affected muscles and improve the range of movement in your affected joints. Your GP or specialist may recommend a suitable exercise programme for your arthritis . Alternatively, you may be referred to a physiotherapist for physical therapy. You might also find ice packs and heat pads useful in reducing joint pain and swelling, although these should not be directly placed on yourskin. Antibiotics Antibiotics may not help to treat reactive arthritis itself, but they are sometimes prescribed if you have an ongoing infection particularly if you have asexually transmitted infection (STI). Your recent sexual partner(s) may also need treatment. Non-steroidal anti-inflammatory drugs (NSAIDs) Non-steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen ,are the main medication used for reactive arthritis, as they can help to reduce inflammation and relieve pain. However, taking a regular dose of a NSAID on a long-term basis can increase your risk of problems such as stomach ulcers . If you are at an increased risk of developing stomach ulcers, your GP may recommend an additional medication known as a proton pump inhibitor (PPI), which can protect your stomach by reducing the production of stomach acid. Rarely, long-term use of NSAIDscan also slightly increase your risk of having a heart attack or stroke . Read more about the side effects of NSAIDs . Steroid medication Steroid medication ( corticosteroids ) may be recommended if your symptoms dont respond to NSAIDs, or youre unable to use NSAIDs. Steroids work by blocking the effects of many of the chemicals the body uses to trigger inflammation. A corticosteroid called prednisolone is usually the preferred choice. Prednisolone can be given as an injection into a joint or as a tablet. Eye drops are also available if you have inflamed eyes ( conjunctivitis ). Around1 in 20 people who take prednisolone will experience changes in their mental state, such as depression or hallucinations. Contact your GP as soon as possible if you notice any changes in your thoughts or behaviour. Other side effects can include weight gain, acne , stomach ulcers and osteoporosis ,although these should improve as your dose is decreased. Read more about the side effects of corticosteroids . Disease-modifying anti-rheumatic drugs (DMARDs) If your symptoms persist despite treatment with NSAIDs and/or corticosteroids, you may be prescribed a medication known as a disease-modifying anti-rheumatic drug (DMARD). Like corticosteroids, DMARDs work byblocking the effects of some of the chemicals your immune system uses to trigger inflammation. It can take a few months before you notice a DMARD working, so its important to keep taking medication even if you dont see immediate results. A DMARD called sulfasalazine is usually the preferred option. Common side effects of sulfasalazine include feeling sick, loss of appetite and headaches , although these usually improve once your body gets used to the medication. DMARDs may alsocause changes inyour blood or liver, so its important to have regular bloodtests while taking these medicines. Source: MSK Expert Panel - Opens in new browser window Last updated: 20 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Arthritis Other health sites The Pain Toolkit Pain Concern Versus Arthritis: reactive arthritis NHS inform About NHS inform Editorial policy Contact us Webchat Give feedback about NHS inform Info for Me tool Terms and conditions Privacy and cookies policy Freedom of information (FOI) Accessibility Other languages and formats  2023 NHS 24  v1.1.1.17852