Reactive Arthritis

Reactive arthritis is an inflammatory disease that occurs in reaction to infections by certain bacteria particularly involving the genitourinary or gastrointestinal system. The most common infections include the sexually transmitted infection Chlamydia trachomatis, and bowel infections like Campylobacter, Salmonella, Shigella and Yersinia.

Arthritis may present several weeks after the infection. Once called Reiter’s syndrome, reactive arthritis is a “spondyloarthropathy.” Reactive arthritis often affects men between 20 and 50 and symptoms can last for days or become a chronic condition.

What Are the Signs/Symptoms?

Reactive arthritis symptoms include pain and swelling in knees, ankles, or heels; severe swelling of toes or fingers; and persistent lower back pain that tends to be more severe at night or in the morning. It may cause irritating, red eyes, burning during urination, or a rash on the palms or soles of the feet. To diagnose reactive arthritis, a rheumatologist may look for these symptoms as well as signs of the original infection. It is important to remember that most people with these very common infections don’t get reactive arthritis. People who test positive for the HLA-B27 gene may be at higher risk for severe or chronic arthritis, but those who test negative may get reactive arthritis too. People with weakened immune systems from HIV or AIDS may also develop reactive arthritis.

What Are Common Treatments?

Effective treatments are available for reactive arthritis. It is treated according to how far the disease has progressed. In the early, acute stage, nonsteroidal anti-inflammatory drugs (NSAIDs) treat inflammation. These include ibuprofen, naproxen, diclofenac, indomethacin, celecoxib, amongst others. Dose and side effects of NSAIDs may vary from person to person. Later-stage, or chronic reactive arthritis, may be treated with disease-modifying antirheumatic drugs (DMARDs) like sulfasalazine, or methotrexate. Patients with severe joint inflammation may need corticosteroid injections, or even biologics like etanercept or adalimumab.

Living with Reactive Arthritis

Early diagnosis and treatment of reactive arthritis is key. Patients who notice arthritis symptoms about a month after a bacterial infection should see a doctor right away to get a diagnosis. Sometimes, reactive arthritis symptoms go away or are effectively treated with NSAIDs. Chronic or severe disease occurs in some people, but there are treatments available. These medications may have side effects, so patients should talk with their doctors about the risks and benefits of these treatments.

Updated February 2023 by Bhakti Shah, MD, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

This patient fact sheet is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.