Reactive Arthritis (Reiter's Syndrome)

What is reactive arthritis (Reiter’s syndrome)?

Reactive arthritis (Reiter’s syndrome) is a rare, temporary form of inflammatory arthritis that’s triggered by a bacterial infection. It causes pain and stiffness in your joints, especially in your lower body. It can also cause symptoms in other body tissues, like your eyes and skin, as well as whole-body symptoms like fatigue. But unlike most types of arthritis, it’s not a lifelong condition, and it usually lasts for less than a year.

Reactive arthritis happens when an infection in your urinary tract, genitals, digestive system or throat triggers an unusual reaction from your immune system. Your immune system normally generates inflammation to fight infections. But with Reiter’s syndrome, your immune system sends inflammation to places in your body where the infection never was. It’s as if it’s not convinced that the battle is over.

What are the symptoms of reactive arthritis?

The most common reactive arthritis symptoms are joint pain and stiffness, especially in your:

• Lower back.
• Knees.
• Ankles.
• Feet.

But you may also have a variety of other symptoms, including:

• Eye pain with swelling and redness.
• Gastrointestinal symptoms, like stomach pain and diarrhea.
• Needing to pee more frequently and pain when you pee.
• Inflammatory skin rashes and mouth sores.
• Achilles tendinitis and heel pain.
• Joint swelling, especially in your fingers and toes (sausage fingers).
• Flu-like symptoms, like fever, fatigue and body aches.

What is the ‘triad’ of reactive arthritis symptoms?

The classic triad of reactive arthritis symptoms is:

• Arthritis (joint inflammation).
• Conjunctivitis (eye inflammation).
• Urethritis (inflammation in your pee passageway).

This triad makes for a quick way to recognize Reiter’s syndrome. But most people won’t have all of these symptoms at the same time. Different symptoms may come and go. You may never have the full triad, and you may also have other symptoms not listed in the classic triad.

What is the cause of Reiter’s syndrome?

Reactive arthritis starts with a bacterial infection. It’s usually a:

• Urinary tract infection (UTI).
• Sexually transmitted infection (STI).
• Gastrointestinal infection (such as food poisoning).
• Throat infection (sore throat).

Some of the specific bacteria that can trigger it include:

• Chlamydia.
• Gonorrhea.
• Salmonella.
• Shigella.
• Campylobacter.
• Yersinia.
• Mycoplasma.
• C. difficile.
• Streptococcus.

Reiter’s syndrome begins several days to weeks after the original infection ends, and only in a small percentage of people. It appears that the infection triggers an autoimmune response. This means your immune system overcorrects and begins to target healthy parts of your own body with inflammation. Fortunately, unlike most autoimmune diseases, reactive arthritis is usually a temporary condition.

Reactive arthritis belongs to a group of inflammatory arthritis conditions called spondyloarthritis. Most of these are autoimmune diseases. Scientists aren’t sure why some people get autoimmune diseases and others don’t. You don’t have to have a severe infection to trigger reactive arthritis. One possible factor is a gene called HLA-B27. Many people who get spondyloarthritis and Reiter’s syndrome have it.

Who gets Reiter’s syndrome?

Anyone can get reactive arthritis, but you’re more likely to get it if:

• You’re under 40 and were assigned male at birth.
• You have HIV.
• You have another autoimmune disease.
• You have the HLA-B27 gene.

How is reactive arthritis diagnosed?

If you've recently developed symptoms of arthritis, your healthcare provider will want to see them and hear about them. Certain combinations of symptoms will suggest reactive arthritis. They’ll particularly want to know if you’ve recently recovered from an infection that might have triggered Reiter’s syndrome.

You might have a variety of tests to help make the diagnosis, including:

• X-rays.
• Computed tomography (CT) scan.
• Magnetic resonance imaging (MRI).
• Joint aspiration (arthrocentesis).
• Throat culture.
• Urinalysis.
• Blood tests.

How do you calm Reiter’s syndrome?

Treatment for reactive arthritis may include:

• Antibiotics. Depending on the infection that started it, and whether it’s still active, sometimes, a course of antibiotics, like doxycycline and rifampin, can stop or shorten reactive arthritis.
• NSAIDs. Your provider might prescribe a temporary high dose of a potent nonsteroidal anti-inflammatory drug (NSAID), like indomethacin. After reducing your symptoms, they’ll reduce your dose.
• DMARDs. Disease-modifying anti-rheumatic drugs (DMARDs) like sulfasalazine treat inflammatory arthritis by suppressing some of your immune system’s activity. They can help if NSAIDs aren’t working.
• Corticosteroids. While most people with Reiter’s syndrome don’t benefit from oral steroids, these powerful anti-inflammatory drugs can be useful in topical creams or as an injection into a joint.

Can reactive arthritis be cured?

Reiter’s syndrome is usually self-limited, meaning it will clear up on its own in time (in three to 12 months). In the meantime, treatment can often repress symptoms and may help them to go away quicker. But reactive arthritis is an autoimmune disorder, and no autoimmune disorder is really curable. This means it’s always possible for symptoms to return — for example, if you get another infection.

In a small percentage of people, Reiter’s syndrome seems to trigger a more serious and lasting form of spondyloarthritis. They develop long-term joint inflammation that can do real damage over time. It’s unclear whether this is chronic reactive arthritis or whether, in this case, you’ve developed a different disease. One autoimmune disease can trigger another, and many people have more than one.

How should I take care of myself while living with Reiter’s syndrome?

Even though it’s likely to be temporary, reactive arthritis can have a major impact on your day-to-day life while it lasts. Although many people have mild symptoms that come and go, others struggle with severe fatigue and discomfort. You might need to adjust your daily schedule or how you work during this time.

Your healthcare provider might recommend:

• Physical therapy. A physical therapist can suggest ways to gently exercise the muscles and tendons that support your sore joints. This can help reduce stiffness and strain on your joints.
• Orthotics. An occupational therapist can suggest ways to support the joints you use a lot or modify the way you use them. You might benefit from wearing a brace, splint or shoe insert.
• Hot/cold therapy. Ice packs and heat packs can help relieve soreness in different ways. Your provider might suggest ice for your sore joints and heat for your stiff muscles, for example.
• Power naps. Chronic fatigue can wear you down, but long periods of bed rest won’t help your sore joints or stiff muscles. Instead, try taking short naps and moving around in between.