Home

Diseases & condition

Medical Condition

Reactive Arthritis

Last updated: March 2025

Reactive Arthritis (Reiter's syndrome): Causes, Symptoms, Diagnosis and Treatment Options

Article Highlights

Reactive arthritis (Reiter's syndrome) is a type of inflammatory arthritis that occurs as a reaction to an infection in another part of the body. It can cause joint pain, swelling and stiffness, often affecting the knees, ankles, and feet. Symptoms of reactive arthritis can extend to the eyes and skins which can be serious. Treatments of reactive arthritis depends on reducing inflammation and addressing the underlying cause. This guide explores the causes, symptoms, and treatment options available for managing reactive arthritis.

In this article, you'll learn


  1. Topic Overview
  2. What is Reactive Arthritis
  3. Causes of Reactive Arthritis
  4. Risk factors of Reactive Arthritis
  5. Pathophysiology of Reactive Arthritis
  6. Symptoms of Reactive Arthritis
  7. Diagnostic Investigations
  8. Treatment of Reactive Arthritis
  9. Complications of Reactive Arthritis
  10. Preventions of Reactive Arthritis


What is Reactive Arthritis?

Reactive arthritis, also known as Reiter's syndrome, is a temporary form of arthritis triggered by infections, primarily from the genitourinary tract or gastrointestinal infections. It typically causes pain and stiffness in the lower body joints, along with potential symptoms in the eyes and skin, and can lead to systemic fatigue. Unlike most arthritis types,it usually resolves in less than a year.

This condition arises when infections in areas like the urinary tract or throat provoke an inappropriate immune response, causing inflammation in joints where no infection exists. Most commonly, a sexually transmitted infection or bacterial infection in the intestines triggers development of reactive arthritis.
Reactive arthritis is classified as an autoimmune disease and often presents in larger joints, such as the knees and ankles. It was historically associated with a triad of symptoms: arthritis,conjunctivitis, and urethritis.While it can affect anyone, it is most common in men aged 20 to 40.


Incidence of Reactive Arthritis

Reactive arthritis primarily affects young men, typically between the ages of 20 and 40. Although it was previously thought to be uncommon, According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS),men develop reactive arthritis more often than women. The average age of onset is around 30 years old, and men often experience more severe joint pain compared to women


Risk factors of Reactive Arthritis

  • Having an infection from sexual contact
  • Having an illness from contaminated food
  • Being male under 40
  • Having HIV
  • Having another autoimmune disease.
  • A genetic factor (presence of the HLA-B27 gene)

Causes of Reactive Arthritis

The cause of reactive arthritis is still unknown, but research suggests that the disease is caused, in part, by a genetic predisposition. However, Reiter`s syndrome may be caused by bacterial infections, often following infections in the intestines, genitals, or urinary tract. They are;

  • Genetic Predisposition account for about 75% of individual with the HLA-B27 genetic marker.
  • Sexually Transmitted Infections (STIs) caused by Chlamydia trachomatis and Gonorrhea.
  • Gastrointestinal Infections triggered by bacteria such as Salmonella, Shigella, Campylobacter, and Yersinia.

Other Bacteria cause includes;
  • Escherichia coli
  • Mycoplasma
  • Streptococcus
  • Shigella
  • Campylobacter
  • Clostridium difficile.

Reactive arthritis is not contagious; however, the bacteria responsible for the condition can be transmitted through sexual contact or contaminated food. Not everyone exposed to these bacteria will develop reactive arthritis. Reiter`s syndrome can arise from various types of infections, including:

  • Urinary Tract Infections (UTIs)
  • Sexually Transmitted Infections (STIs)
  • Gastrointestinal Infections (like food poisoning)
  • Throat Infections (such as a sore throat)


Pathophysiology of Reactive Arthritis

Reactive arthritis is an immune-mediated condition triggered by infections, particularly those involving Chlamydia trachomatis or enteric bacteria. Bacterial fragments stimulate T lymphocytes, which then attack synovial tissues through molecular mimicry. Impaired anti-bacterial cytokine responses contribute to prolonged inflammation, though the precise mechanisms remain unclear.

The HLA-B27 genetic marker is present in 30% to 50% of cases, with higher prevalence in severe instances. It is believed to facilitate reactive arthritis by altering immune tolerance, increasing TNF-α production, and delaying bacterial clearance.



Signs & Symptoms of Reactive Arthritis

Reactive arthritis presents with a range of symptoms affecting the musculoskeletal system, urinary tract, eyes, and skin. These symptoms can develop after an infection and vary in severity.

Musculoskeletal Symptoms

  • Joint pain and swelling, primarily in the knees, ankles, and sacroiliac joints
  • Inflammation of tendons, leading to heel pain or thickened fingers
  • Heel spurs, causing chronic pain
  • Spondylitis - Inflammation of the spine
  • Sacroiliitis - Inflammation of the lower back joints

Urinary Tract Symptoms In Men

  • Increased urinary output
  • Burning sensation during urination
  • Penile discharge
  • Prostatitis (inflammation of the prostate gland)

Urinary Tract Symptoms In Women

  • Cervicitis
  • Urethritis,causing a burning sensation during urination
  • Salpingitis - inflammation of the fallopian tubes
  • Vulvovaginitis - inflammation of the vulva and vagina

Eye Symptoms

  • Red, painful, and irritated eyes
  • Blurry vision
  • Uveitis - inflammation of the inner eye
  • Conjunctivitis - inflammation of the mucous membrane covering the eye and eyelid

Skin and Mucosal Symptoms

  • Skin rashes, including keratoderma blennorrhagica - small pustules on the soles of the feet
  • Mouth sores, which may accompany other symptoms

Diagnostic Test & Investigations

Diagnosing reactive arthritis involves a combination of medical history, physical examination, and various tests to rule out other conditions and identify potential infections that may have triggered the disease.

  • History taking
  • Physical examination
  • Erythrocyte Sedimentation Rate (ESR)
  • C-Reactive Protein (CRP)
  • White Blood Cell (WBC) and Red Blood Cell (RBC) Counts
  • Serology and Cultures
  • HLA-B27 Genetic Test
  • Tuberculin Skin Test and HIV Screening
  • X-Rays
  • Magnetic Resonance Imaging (MRI)
  • Computed Tomography (CT) Scans
  • Arthrocentesis - Joint Aspiration
  • Urinalysis and Stool Samples

You may also like: Everything you need to know about

Treatment of Reactive Arthritis

Treatment for reactive arthritis focuses on addressing symptoms, reducing inflammation, and managing the underlying infection that may have triggered the condition. Treatment may also include:

  • Antibiotics such as doxycycline and rifampin to treat the infection
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) indomethacin to reduce inflammation
  • Corticosteroids to reduce inflammation
  • Immunosuppressive medicines such as methotrexate to control inflammation
  • Disease-modifying anti-rheumatic drugs (DMARDs) like sulfasalazine treat inflammatory arthritis by suppressing some of your immune system’s activity
  • Rest to ease pain and inflammation
  • Exercise to strengthen muscles and improve joint function

Nursing Management of Reactive Arthritis

The following are the measures to put in place in the care of patient's with Reactive Arthritis

  • Ensure adequate bed rest in the acute disease
  • Treat inflammation with anti - inflammatory drugs
  • Intra arthritis steroid injection in severe position
  • Inform physiotherapist when necessary
  • Look out for any complications and treat as they arise
  • Treat female partners and their male counterparts to avoid pelvic inflammatory disease in females

Complications of Reactive Arthritis


Differential Diagnosis

Conditions that also mimic reactive arthritis;

  • Psoriatic Arthritis
  • Lichen Planus
  • Rheumatic fever
  • Ankylosing spondylitis
  • Rheumatoid arthritis
  • Lupus Erythematosus
  • Behcet's Disease
  • Atopic Dermatitis
  • Gonococcal arthritis
  • Gouty arthritis
  • Septic arthritis
  • Secondary syphilis

Preventions of Reactive Arthritis

Preventing reactive arthritis involves reducing the risk of infections that can trigger the condition. While not all cases can be prevented, certain measures can significantly lower the likelihood of developing reactive arthritis.

  • Safe sexual practices
  • Proper food handling
  • Regular handwashing with soap and water, especially before eating and after using the restroom, can help prevent infections that may lead to reactive arthritis.
  • Healthy diet - a balanced diet rich in vitamins, minerals, and antioxidants supports immune function and overall health.
  • Regular exercise - engage in regular physical activity to boost immune function
  • Seeking medical attention for urinary tract
  • Completing prescribed antibiotic courses can help prevent complications.