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October 2016

Questions and Answers about

Reactive Arthritis

This publication contains general information

about reactive arthritis. It describes what

reactive arthritis is and how it develops. It

also explains how reactive arthritis is

diagnosed and treated. At the end is a list of

key words to help you understand the terms

used in this publication. If you have further

questions after reading this publication, you

may wish to discuss them with your doctor.

What Is Reactive Arthritis?

What Causes Reactive Arthritis?

Is Reactive Arthritis Contagious?

Who Gets Reactive Arthritis?

What Are the Symptoms of Reactive

Arthritis?

How Is Reactive Arthritis Diagnosed?

What Type of Doctor Treats Reactive

Arthritis?

How Is Reactive Arthritis Treated?

What Is the Prognosis for People

Who Have Reactive Arthritis?

What Research Is Being Conducted

on Reactive Arthritis?

Where Can People Find More

Information About Reactive Arthritis?

Key Words

What Is Reactive Arthritis?

Reactive arthritis is a form of arthritis, or joint

inflammation, that occurs as a “reaction” to

an infection elsewhere in the body.

Inflammation is a characteristic reaction of

tissues to injury or disease and is marked by

swelling, redness, heat, and pain. Besides

this joint inflammation, reactive arthritis is

associated with two other symptoms: redness

and inflammation of the eyes (conjunctivitis)

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and inflammation of the urinary tract

(urethritis). These symptoms may occur

alone, together, or not at all.

Reactive arthritis is a type of

"spondyloarthritis" a group of disorders that

can cause inflammation throughout the body,

especially in the spine. (Examples of other

disorders in this group include psoriatic

arthritis, ankylosing spondylitis, and the kind

of arthritis that sometimes accompanies

inflammatory bowel disease.)

In many patients, reactive arthritis is triggered

by an infection in the bladder, the urethra, or,

in women, the vagina (the urogenital tract)

that is often transmitted through sexual

contact. This form of the disorder is

sometimes called genitourinary or urogenital

reactive arthritis. Another form of reactive

arthritis is caused by an infection in the

intestinal tract from eating food or handling

substances that are contaminated with

bacteria. This form of arthritis is sometimes

called enteric or gastrointestinal reactive

arthritis.

The symptoms of reactive arthritis usually last

several months, although symptoms can

return or develop into a long-term disease in

a small percentage of people.

What Causes Reactive Arthritis?

Reactive arthritis typically begins within 2 to 4

weeks after infection. The bacterium most

often associated with reactive arthritis is

Chlamydia trachomatis, commonly known as

chlamydia (kla-MID-e-a). It is usually acquired

through sexual contact. Some evidence also

shows that respiratory infections with

Chlamydia pneumoniae may trigger reactive

arthritis.

Infections in the digestive tract that may

trigger reactive arthritis include Salmonella,

Shigella, Yersinia, and Campylobacter.

People may become infected with these

bacteria after eating or handling improperly

prepared food, such as meats that are not

stored at the proper temperature.

Doctors do not know exactly why some

people exposed to these bacteria develop

reactive arthritis and others do not, but they

have identified a genetic factor, human

leukocyte antigen (HLA) B27, that increases

a person’s chance of developing reactive

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arthritis. However, inheriting the HLA B27

gene does not necessarily mean you will get

reactive arthritis.

Is Reactive Arthritis Contagious?

Reactive arthritis is not contagious; that is, a

person with the disorder cannot pass the

arthritis on to someone else. However, the

bacteria that can trigger reactive arthritis can

be passed from person to person.

Who Gets Reactive Arthritis?

Overall, young adult men are most likely to

develop reactive arthritis. However, evidence

shows that although men are nine times more

likely than women to develop reactive arthritis

caused by sexually acquired infections,

women and men are equally likely to develop

reactive arthritis as a result of food-borne

infections. Women with reactive arthritis often

have milder symptoms than men.

What Are the Symptoms of

Reactive Arthritis?

Reactive arthritis most typically results in

inflammation of the urogenital tract, the joints,

and the eyes. Less common symptoms are

mouth ulcers and skin rashes. Any of these

symptoms may be so mild that patients do not

notice them. They usually come and go over

a period of several weeks to several months.

Joint Symptoms

Reactive arthritis typically involves pain and

swelling in the knees, ankles, and feet.

Wrists, fingers, and other joints are affected

less often. People with reactive arthritis

commonly develop inflammation of the

tendons (tendinitis) or at places where

tendons attach to the bone (ethesitis). In

many people with reactive arthritis, this

results in heel pain or irritation of the Achilles

tendon at the back of the ankle. Some people

with reactive arthritis also develop heel spurs,

which are bony growths in the heel that may

cause chronic (long-lasting) foot pain.

Approximately half of people with reactive

arthritis report low-back and buttock pain.

Reactive arthritis also can cause spondylitis

(inflammation of the vertebrae in the spinal

column) or sacroiliitis (inflammation of the

joints in the lower back that connect the spine

to the pelvis). People with reactive arthritis

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who have the HLA B27 gene are even more

likely to develop spondylitis and/or sacroiliitis.

Eye Involvement

Conjunctivitis, an inflammation of the mucous

membrane that covers the eyeball and eyelid,

develops in approximately half of people with

reactive arthritis. Some people may develop

uveitis, which is an inflammation of the inner

eye. Conjunctivitis and uveitis can cause

redness of the eyes, eye pain and irritation,

and blurred vision. Eye involvement typically

occurs early in the course of reactive arthritis,

and symptoms may come and go.

How Is Reactive Arthritis

Diagnosed?

Doctors sometimes find it difficult to diagnose

reactive arthritis because there is no specific

laboratory test to confirm that a person has it.

A doctor may order a blood test to detect the

genetic factor HLA B27, but even if the result

is positive, the presence of HLA B27 does not

always mean that a person has the disorder.

At the beginning of an examination, the

doctor will probably take a complete medical

history and note current symptoms as well as

any previous medical problems or infections.

Before and after seeing the doctor, it is

sometimes useful for the patient to keep a

record of the symptoms that occur, when they

occur, and how long they last. It is especially

important to report any flu-like symptoms,

such as fever, vomiting, or diarrhea, because

they may be evidence of a bacterial infection.

The doctor may use various blood tests

besides the HLA B27 test to help rule out

other conditions and confirm a suspected

diagnosis of reactive arthritis. For example,

the doctor may order rheumatoid factor or

antinuclear antibody tests (see “Key Words”).

Most people who have reactive arthritis will

have negative results on these tests. If a

patient’s test results are positive, he or she

may have some other form of arthritis (such

as rheumatoid arthritis) or another rheumatic

disease (such as lupus). Doctors also may

order a blood test to determine the

erythrocyte sedimentation rate (sed rate),

which is the rate at which red blood cells

settle to the bottom of a test tube of blood. A

high sed rate often indicates inflammation

somewhere in the body. Typically, people

with rheumatic diseases, including reactive

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arthritis, have an elevated sed rate.

The doctor also is likely to perform tests for

infections that might be associated with

reactive arthritis. Patients generally are

tested for a Chlamydia infection because

studies have shown that early treatment of

Chlamydia-induced reactive arthritis may

reduce the progression of the disease. The

doctor may look for bacterial infections by

testing cell samples taken from the patient’s

throat as well as the urethra in men or cervix

in women. Urine and stool samples also may

be tested. A sample of synovial fluid (the fluid

that lubricates the joints) may be removed

from the arthritic joint. Studies of synovial

fluid can help the doctor rule out infection in

the joint.

Doctors sometimes use x-rays to help

diagnose reactive arthritis and to rule out

other causes of arthritis. X-rays can detect

some of the symptoms of reactive arthritis,

including spondylitis, sacroiliitis, swelling of

soft tissues, damage to cartilage or bone

margins of the joint, and calcium deposits

where the tendon attaches to the bone.

What Type of Doctor Treats

Reactive Arthritis?

A person with reactive arthritis probably will

need to see several different types of doctors

because reactive arthritis affects different

parts of the body. However, it may be helpful

to the doctors and the patient for one doctor,

usually a rheumatologist (a doctor

specializing in arthritis), to manage the

complete treatment plan. This doctor can

coordinate treatments and monitor the side

effects from the various medicines the patient

may take. The following specialists treat

other features that affect different parts of the

body.

An ophthalmologist, who treats eye

disease.

A gynecologist, who treats genital

symptoms in women.

A urologist, who treats genital

symptoms in men and women.

A dermatologist, who treats skin

symptoms.

An orthopaedist, who performs

surgery on severely damaged joints.

A physiatrist, who supervises

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exercise regimens.

How Is Reactive Arthritis Treated?

Although there is no cure for reactive arthritis,

some treatments relieve symptoms of the

disorder. The doctor is likely to use one or

more of the following treatments.1

1All medicines can have side effects. Some

medicines and side effects are mentioned in

this publication. Some side effects may be

more severe than others. You should review

the package insert that comes with your

medicine and ask your health care provider

or pharmacist if you have any questions

about the possible side effects.

Nonsteroidal Anti-Inflammatory Drugs

(NSAIDs)

Aspirin, ibuprofen, naproxen, and naproxen

sodium are examples of NSAIDs.2 They are

often the first type of medication used. All

NSAIDs work similarly by blocking

substances called prostaglandins that

contribute to inflammation and pain. However,

each NSAID is a different chemical, and each

has a slightly different effect on the body.

Some NSAIDs are available over the counter,

while more than a dozen others, including a

subclass called COX-2 inhibitors, are

available only with a prescription. All NSAIDs

can have significant side effects, and for

unknown reasons, some people seem to

respond better to one NSAID than another.

Any person taking NSAIDs regularly should

be monitored by a doctor.

2 Warning: Side effects of NSAIDs include

stomach problems; skin rashes; high blood

pressure; fluid retention; and liver, kidney,

and heart problems. The longer a person

uses NSAIDs, the more likely he or she is to

have side effects, ranging from mild to

serious. Many other drugs cannot be taken

when a patient is being treated with NSAIDs,

because NSAIDs alter the way the body uses

or eliminates these other drugs. Check with

your health care provider or pharmacist

before you take NSAIDs. NSAIDs should only

be used at the lowest dose possible for the

shortest time needed.

Corticosteroid Injections

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For people with severe joint inflammation,

injections of corticosteroids directly into the

affected joint may reduce inflammation.

Doctors usually prescribe these injections

only after trying unsuccessfully to control

arthritis with NSAIDs.

Topical Corticosteroids

These corticosteroids come in a cream or

lotion and can be applied directly on the skin

lesions, such as ulcers, associated with

reactive arthritis. Topical corticosteroids

reduce inflammation and promote healing.

Antibiotics

The doctor may prescribe antibiotics to

eliminate the bacterial infection that triggered

reactive arthritis. The specific antibiotic

prescribed depends on the type of bacterial

infection present. It is important to follow

instructions about how much medicine to take

and for how long; otherwise the infection may

persist.

Immunosuppressive Medicines

A small percentage of patients with reactive

arthritis have severe symptoms that cannot

be controlled with any of the above

treatments. For these people, medicine that

suppresses the immune system, such as

sulfasalazine or methotrexate, may be

effective.

Exercise

Exercise, when introduced gradually, may

help maintain and improve joint function. In

particular, strengthening and range-of- motion

exercises can be effective. Strengthening

exercises build up the muscles around the

joint to better support it. Muscle-tightening

exercises that do not move any joints can be

done even when a person has inflammation

and pain. Range-of-motion exercises improve

movement and flexibility and reduce stiffness

in the affected joint. For patients with spine

pain or inflammation, exercises to stretch and

extend the back can be particularly helpful in

preventing long-term disability. Aquatic

exercise also may be helpful. Before

beginning an exercise program, patients

should talk to a health professional who can

recommend appropriate exercises.

What Is the Prognosis for People

Who Have Reactive Arthritis?

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Most people with reactive arthritis recover

fully from the initial flare of symptoms and are

able to return to regular activities a few

months after the first symptoms appear. In

such cases, the symptoms of arthritis may

last up to a year, although these are usually

very mild and do not interfere with daily

activities. Some people with reactive arthritis

will have chronic (long-term) arthritis, which

usually is mild. Studies show that between 15

and 50 percent of patients will develop

symptoms again sometime after the initial

flare has disappeared. It is possible that such

relapses may be caused by reinfection. Back

pain and arthritis are the symptoms that most

commonly reappear. A few patients will have

chronic, severe arthritis that is difficult to

control with treatment and may cause joint

damage.

What Research Is Being Conducted

on Reactive Arthritis?

Researchers continue to investigate the

causes of reactive arthritis and study

treatments for the condition. For example:

Researchers are trying to better

understand the relationship between

infection and reactive arthritis. In

particular, they are trying to determine

why an infection triggers arthritis and

why some people who develop

infections get reactive arthritis while

others do not. Scientists also are

studying why people with the genetic

factor HLA B27 are more at risk than

others.

Researchers are developing methods

to detect the location of the triggering

bacteria in the body. Some scientists

suspect that after the bacteria enter

the body, they are transported to the

joints, where they can remain in small

amounts indefinitely.

Researchers are testing combination

treatments for reactive arthritis. In

particular, they are testing the use of

antibiotics in combination with TNF

inhibitors and with other

immunosuppressant medicines, such

as methotrexate and sulfasalazine.

More information on research is available

from the following websites:

National Institutes of Health (NIH)

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Clinical Research Trials and You

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more about clinical trials, why they

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to the website will find information

about the basics of participating in a

clinical trial, first-hand stories from

clinical trial volunteers, explanations

from researchers, and links on how to

search for a trial or enroll in a

research-matching program.

ClinicalTrials.gov offers up-to-date

information for locating federally and

privately supported clinical trials for a

wide range of diseases and

conditions.

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that allows users to search a

repository of both intramural and

extramural NIH-funded research

projects from the past 25 years and

access publications (since 1985) and

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National Library of Medicine that lets

you search millions of journal citations

and abstracts in the fields of

medicine, nursing, dentistry,

veterinary medicine, the health care

system, and preclinical sciences.

Where Can People Find More

Information About Reactive

Arthritis?

National Institute of Arthritis and

Musculoskeletal and Skin Diseases

(NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS (877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: https://www.niams.nih.gov

If you need more information about available

resources in your language or another

language, please visit our website or contact

the NIAMS Information Clearinghouse at

NIAMSinfo@mail.nih.gov.

Other Resources

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American College of Rheumatology

Website: http://www.rheumatology.org

Arthritis Foundation

Website: http://www.arthritis.org

Spondylitis Association of America

Website: http://www.spondylitis.org

Key Words

Antibodies. Special proteins produced by

the body’s immune system that recognize and

help fight infectious agents, such as bacteria,

viruses, and other foreign substances that

invade the body.

Antinuclear antibodies. Antibodies that are

in the bloodstream of people who have

connective tissue diseases or certain

autoimmune disorders.

Arthritis. Literally means joint inflammation. It

is a general term for more than 100

conditions known as rheumatic diseases.

These diseases affect not only the joints but

also other parts of the body, including

important supporting structures such as

muscles, tendons, and ligaments, as well as

some internal organs.

Corticosteroids. Potent anti-inflammatory

hormones that are made naturally in the body

or synthetically (man-made) for use as drugs.

They are also called glucocorticoids. The

most commonly prescribed drug of this type is

prednisone.

Erythrocyte sedimentation rate. Also

referred to as the “sed” rate. A blood test that

signals the presence of inflammatory disease

by measuring the speed at which red blood

cells settle to the bottom of a test tube.

HLA B27. Human leukocyte antigen B27. A

genetic marker often—but not always—found

in the blood of patients with certain forms of

arthritis, such as reactive arthritis and

ankylosing spondylitis.

Immune system. The system that protects

the body from infections.

Range of motion. A measurement of the

extent to which a joint can go through all of its

normal movements.

Rheumatoid arthritis. A chronic

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inflammatory disease that causes pain,

stiffness, swelling, and loss of function in the

joints. The primary target of rheumatoid

arthritis is the synovium, or joint lining. This

tissue, which normally is smooth and shiny,

becomes inflamed, painful, and swollen. The

disease can also cause inflammation in the

blood vessels and the outer lining of the heart

and lungs.

Rheumatoid factor. A kind of antibody found

in the blood of many individuals who have

rheumatoid arthritis. Rheumatoid factor may

be found in many diseases besides

rheumatoid arthritis. However, some people

without health problems will also test positive

for rheumatoid factor.

Acknowledgments

The NIAMS gratefully acknowledges the

assistance of the following individuals in the

preparation of original versions of this

publication: Frank Arnett, M.D., University of

Texas Medical School, Houston, TX; Daniel

Clegg, M.D., University of Utah, Salt Lake

City, UT; Robert Inman, M.D., Toronto

Western Hospital and University of Toronto,

Ontario, Canada; John H. Klippel, M.D.,

Arthritis Foundation, Atlanta, GA; Barbara

Mittleman, M.D., NIAMS/NIH; Ralph

Schumacher, M.D., Department of Veterans

Affairs Medical Center, Philadelphia, PA;

and Bernadette Tyree, Ph.D., NIAMS/NIH.

The mission of the National Institute of

Arthritis and Musculoskeletal and Skin

Diseases (NIAMS), a part of the U.S.

Department of Health and Human Services’

National Institutes of Health (NIH), is to

support research into the causes, treatment,

and prevention of arthritis and

musculoskeletal and skin diseases; the

training of basic and clinical scientists to

carry out this research; and the dissemination

of information on research progress in these

diseases. The NIAMS Information

Clearinghouse is a public service sponsored

by the NIAMS that provides health

information and information sources.

Additional information can be found on the

NIAMS website at www.niams.nih.gov.

For Your Information

This publication contains information about

medications used to treat the health condition

discussed here. When this publication was

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developed, we included the most up-to-date

(accurate) information available.

Occasionally, new information on medication

is released.

For updates and for any questions about any

medications you are taking, please contact

U.S. Food and Drug Administration

Toll free: 888-INFO-FDA

(888-463-6332)

Website: http://www.fda.gov

For additional information on specific

medications, visit Drugs@FDA at

http://www.accessdata.fda.gov/scripts

/cder/daf/. Drugs@FDA is a searchable

catalog of FDA-approved drug products.

For updates and questions about statistics,

please contact

Centers for Disease Control and

Prevention, National Center for

Health Statistics

Toll free: 800-232-4636

Website: http://www.cdc.gov/nchs

This publication is not copyrighted. Readers

are encouraged to duplicate and distribute as

many copies as needed.

Additional copies of this publication are

available from:

National Institute of Arthritis and

Musculoskeletal and Skin

Diseases (NIAMS)

Information Clearinghouse

National Institutes of Health

1 AMS Circle

Bethesda, MD 20892-3675

Phone: 301-495-4484

Toll free: 877-22-NIAMS

(877-226-4267)

TTY: 301-565-2966

Fax: 301-718-6366

Email: NIAMSinfo@mail.nih.gov

Website: https://www.niams.nih.gov

NIH Publication No. 16–5039

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