Reactive Arthritis

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KEY POINTS

• Reactive arthritis causes swelling and irritation in one or more joints.
• It is most often caused by a bacterial infection.
• Reactive arthritis can be treated with medicine, physical therapy, braces, ice, or heat.

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What is reactive arthritis?

Reactive arthritis is swelling and irritation of joints in the fingers, toes, knees, ankles, and low back. Other parts of the body, such as the eyes and the urinary tract, may also get irritated and painful.

What is the cause?

Reactive arthritis is an immune system reaction to bacterial infection in your body. The immune system is your body’s defense against infection. You have a higher risk of getting reactive arthritis if you have:

• An infection in your intestines such as food poisoning
• A sexually transmitted infection such as chlamydia
• Certain genes inherited from your parents. Genes are inside each cell of your body and are passed from parents to children. They contain the information that tells your body how to develop and work.
• HIV/AIDS

Men between the ages of 20 and 50 are most likely to develop reactive arthritis.

What are the symptoms?

The symptoms usually begin within a few weeks after you have an infection. They can affect many different parts of the body. They may be so mild that you do not notice them.

Symptoms may include:

• Pain and swelling in the knees, ankles, heels, fingers, and toes
• Eye redness, pain, and irritation or blurred vision
• Increased need to urinate, pain or discomfort when you urinate, or discharge from the urethra (the tube that drains urine from the bladder)
• Fever and chills
• Low back pain

Women may have pain in the belly or pelvic area, vaginal discharge, or pain with sex.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Your healthcare provider will ask about your diet and if you practice safe sex. Tests may include:

• Blood and urine tests
• X-rays
• Tests of fluid from the throat, urethra (opening at the penis), cervix (opening of the uterus into the vagina), or a swollen joint
• Tests of a bowel movement sample

How is it treated?

There is no cure for reactive arthritis, but treatment can help relieve symptoms. Your healthcare provider may recommend:

• Medicine
  • Acetaminophen may help with pain but will not reduce inflammation. Nonsteroidal anti-inflammatory medicines (NSAIDs), such as aspirin, ibuprofen, and naproxen, help both pain and inflammation. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.
    • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
    • Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don't take more than 3000 milligrams (mg) in 24 hours. To make sure you don’t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.
  • Your provider may prescribe antibiotics if you have a bacterial infection.
  • If symptoms do not improve with antibiotics and pain medicine, your provider may recommend:
    • Steroid medicine to decrease pain and swelling. It can be given as a pill, cream or ointment, or shot. Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.
  • Disease-modifying antirheumatic drugs (DMARDs) slow down or stop damage to the joints. They can help lessen pain and inflammation in the joints. DMARDs may increase your risk of infection or other serious side effects. Your healthcare provider will check you regularly to see how these medicines are working and watch for any side effects.

Exercise

Exercise may help. However, too much exercise too soon or not warming up enough may make arthritis worse.

• Range-of-motion exercises are gentle stretching exercises that help you move each joint as far as possible. Examples include low-speed bike riding, tai chi, and yoga. Range-of-motion exercises help you keep or improve your flexibility and relieve stiffness.
• Strengthening exercise, such as weight training, makes muscles and tendons stronger. Strong muscles and tendons support joints better. You will be able to move more easily and with less pain.

Talk with your healthcare provider before you start an exercise program. Your provider may refer you to a physical therapist to design a program that is right for you.

Other treatments

• Your healthcare provider may recommend physical or occupational therapy to treat pain and help you have better use of your joints.
• Your provider may suggest using heat or cold therapy, depending on your symptoms.
• Sometimes it may help to use a splint or brace to rest a joint and protect it from injury.
• Transcutaneous electrical nerve stimulation (TENS) may relieve some types of arthritis pain. TENS directs mild electric pulses through the skin to nerves in the painful area.
• Acupuncture and massage are other possible treatments.

Most people recover fully within 2 to 6 months after symptoms start. For some people, symptoms come and go over several months, gradually getting better. You may continue to have symptoms that come and go for the rest of your life, but usually the symptoms are mild.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Take a warm bath or apply heat directly to the painful joints with a heating pad or hot towel. Do not fall asleep on the heating pad.
• Rest your joints when they are warm, swollen, or painful.
• Take care of your health. Try to get at least 7 to 9 hours of sleep each night. If you smoke, try to quit. If you want to drink alcohol, ask your healthcare provider how much is safe for you to drink. Learn ways to manage stress. Exercise according to your healthcare provider's instructions.
• Ask your provider:
  • How and when you will get your test results
  • How long it will take to recover
  • If there are activities you should avoid and when you can return to your normal activities
  • How to take care of yourself at home
  • What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent reactive arthritis?

To help prevent reactive arthritis caused by food poisoning:

• Make sure you cook all foods well, especially, especially beef, chicken, turkey, pork, seafood, and eggs. Pork should be heated to an internal temperature of at least 160°F (71°C). For whole chickens and turkeys a temperature of 180°F (82°C) is recommended for thigh meat and 170°F (77°C) for breast meat.
• Wash your hands and clean any dishes or utensils before you prepare, cook, serve, or eat food. Keep kitchen counters and other food preparation surfaces clean. Replace used dishcloths and kitchen towels with clean ones often.
• Wash your hands after you go to the bathroom or touch animals, especially pets such as birds, turtles, or other reptiles.
• If you take care of young children, wash your hands often and dispose of diapers carefully so that bacteria can't spread to other surfaces or people.
• When you travel to places where you are not sure of the safety of the water, drink bottled water. Avoid ice from local water and foods that have been washed with local water, unless the water has been boiled.

To help prevent reactive arthritis caused by sexually transmitted infections:

• Use latex or polyurethane condoms during foreplay and every time you have vaginal, oral, or anal sex.
• Have just 1 sexual partner who is not sexually active with anyone else.