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Reactive Arthritis: Causes, Symptoms and Treatment

Reactive arthritis is a joint inflammation triggered by an infection elsewhere in the body. It commonly affects the knees, ankles, and toes and usually resolves within months.

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Things worth knowing about "Reactive Arthritis"

Reactive arthritis is a joint inflammation triggered by an infection elsewhere in the body. It commonly affects the knees, ankles, and toes and usually resolves within months.

What is Reactive Arthritis?

Reactive arthritis is an inflammatory joint condition that does not result from direct infection of the joint itself, but rather from an exaggerated immune response to a bacterial infection at another site in the body, most commonly in the gastrointestinal or urogenital tract. It was historically referred to as Reiter's syndrome, particularly when it presented with the classic triad of joint inflammation, eye inflammation, and urethritis (inflammation of the urethra).

Causes and Triggering Pathogens

Reactive arthritis is triggered by specific bacterial infections. The most common causative organisms include:

Chlamydia trachomatis (a sexually transmitted urogenital infection)
Salmonella, Shigella, Campylobacter, and Yersinia (foodborne gastrointestinal infections)
Clostridioides difficile (in clinical or hospital settings)

A significant genetic risk factor is the presence of the HLA-B27 antigen, which markedly increases both the likelihood of developing the condition and its potential severity. Approximately 60–80% of affected individuals carry this genetic marker.

Symptoms

Symptoms typically appear 1 to 4 weeks after the triggering infection. Common manifestations include:

Asymmetric arthritis of large joints, particularly the knees, ankles, toes, and subtalar joints
Enthesitis (inflammation at tendon insertion sites), most frequently at the heel
Conjunctivitis (inflammation of the conjunctiva) or uveitis (deeper eye inflammation)
Urethritis (urethral inflammation) or cervicitis
Skin manifestations such as keratoderma blenorrhagicum (hyperkeratotic skin lesions) or oral ulcerations
General symptoms including fatigue, fever, and weight loss

Diagnosis

There is no single definitive test for reactive arthritis. The diagnosis is primarily clinical and supported by the following investigations:

Blood tests: Elevated inflammatory markers (CRP, ESR) and HLA-B27 typing
Swabs or stool cultures: To identify the triggering pathogen
Joint aspiration: To rule out septic (infectious) arthritis
Imaging: X-ray or MRI to assess joint and tendon involvement

Treatment

General Measures

Treatment depends on the severity of the condition. Mild cases often resolve spontaneously within a few months without specific therapy.

Pharmacological Treatment

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are the first-line choice for pain relief and reduction of inflammation.
Corticosteroids (local injections or systemic) for severe inflammation.
Antibiotics: Indicated when an active infection is confirmed, particularly with Chlamydia trachomatis.
Disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine or methotrexate for chronic or persistent cases.

Physiotherapy

Targeted physiotherapy exercises help maintain joint function, improve mobility, and strengthen the surrounding muscles.

Prognosis and Outlook

The majority of patients recover fully within 3 to 12 months. However, approximately 15–20% of individuals, particularly those who are HLA-B27-positive, may develop a chronic course or progress to spondyloarthritis. Regular follow-up with a rheumatologist is recommended for monitoring and early intervention.

References

Hannu T. – Reactive arthritis. Best Practice & Research Clinical Rheumatology, 2011; 25(3): 347–357. PubMed PMID: 22100289.
Carter J.D., Hudson A.P. – Reactive Arthritis: Clinical Aspects and Medical Management. Rheumatic Disease Clinics of North America, 2009; 35(1): 21–44.
World Health Organization (WHO) – Sexually transmitted infections: Chlamydia trachomatis. WHO Fact Sheet, 2023.

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