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Reactive Arthritis

Reactive arthritis refers to pain, stiffness, redness or swelling in a joint resulting from a previous infection. It most often occurs in the joints of the lower limbs (knees, ankles, toes), but can also occur in the upper limbs. Problems may be in the joints only or involve other body systems such as the eyes, skin muscles or tendons.

FAQs

What are early signs of reactive arthritis?

If you have reactive arthritis you will probably develop the warning signs within a few weeks after you've had an infection. The infection may have been food poisoning or another illness of the intestine. It could also have been chlamydia, which is a disease passed on by an infected person during sex. (Note that while the triggering infection may be communicable, reactive arthritis itself cannot be passed from one person to another.)|

Signs include stiffness, pain and swelling in a joint that seems to have come on for no reason. The area may also be red and hot. Pain and stiffness may be worse in the morning. Usually only a single joint is involved at the onset but more joints can be affected over time.

Most often the inflammation occurs in the lower limbs (knees, ankles, toes). You may also have lower back pain resulting from involvement of the sacroiliac joints - the joints at the base of the spine where the spine joins the pelvis. Ongoing joint problems may result in stiff joints and weak muscles and it could become difficult to fully straighten the joints.

Problems may develop with other body systems such as your tendons, skin and eyes. Some people have pain in the heel where the Achilles tendon attaches to the bone, or underneath the foot where the tendons supporting the arch of the foot attach to the heel. The eyes may feel sore or sensitive to sunlight. Sores may appear in the mouth or on the genitals. These may be painful or painless. (Inflammation from reactive arthritis in any of these areas used to be called Reiter’s syndrome).

How is reactive arthritis diagnosed?

Establishing the correct diagnosis is important, so if your doctor thinks you have reactive arthritis, he or she may ask questions about the symptoms, other medical conditions, recent travel, illnesses, and contact with people who may have had infections. Because there is a usually a lag time of several days to weeks between the infection that is the underlying cause of the arthritis and the onset of inflammation, a person might not connect the two events and so not think of mentioning the previous infection. Your doctor may also perform a physical examination, and order x-rays and other tests to find out what has caused the arthritis.

Diagnosis may be difficult: there is no specific test to confirm reactive arthritis. Your doctor will probably perform a physical examination and order other tests such as x-rays and blood tests. One test called an ESR (erythrocyte sedimentation rate) measures the level of inflammation in the blood. The erythrocyte sedimentation rate (ESR) is often high in people with reactive arthritis. If you have reactive arthritis, you may also have anemia, a blood condition that can cause you to look pale, and feel weak, sleepy and dizzy.

Other tests your doctor may perform include tests of your stool (feces), or the fluids and tissues of your urethra or joints. About half of patients with reactive arthritis have a positive test for HLA-B27, a genetic marker that is common in people with forms of inflammatory arthritis called spondyloarthropathies, a group of diseases that includes reactive arthritis. This suggests a possible genetic predisposition to these forms of inflammatory arthritis, but the presence of the gene is not specifically diagnostic for reactive arthritis.

What are the risk factors for reactive arthritis?

Certain types of bacteria cause reactive arthritis. If you have reactive arthritis, one of these types of bacteria may have already made you sick. The bacteria that cause reactive arthritis are some of those that cause food poisoning with subsequent diarrhea. They include: Salmonella, Shigella, Campylobacter and Yersinia.

Sexually transmitted infections such as chlamydia can also lead to reactive arthritis. After the bacteria causes you to get sick they can travel through your body to other areas, where they then cause inflammation. Reactive arthritis cannot be passed from one person to another.

How common is reactive arthritis?

Anyone who is susceptible to developing food poisoning can also develop reactive arthritis. However, reactive arthritis usually affects people between the ages of 20 and 50.

Not every person who gets an infection that can cause reactive arthritis will also develop the disease. Some people may have a genetic predisposition and therefore a higher risk of developing reactive arthritis. Just as we inherit our hair colour and blood type from our parents, we also inherit our tissue type. The tissue typing system is the Human Lymphocyte Antigen (HLA) system. One of the tissue types, HLA-B27, is found in only a small percentage of the broad population. Approximately 6% to 7% of the Caucasian population has HLA-B27; it is even more rare to find HLA-B27 in people of African descent. Having the HLA-B27 tissue type seems to increase a person's risk of developing reactive arthritis after a bacterial infection, and may also increase the risk that reactive arthritis will not quickly resolve. Approximately 50% of reactive arthritis patients are HLA-B27 positive.

Treatment

A reactive arthritis diagnosis is typically made or confirmed by a rheumatologist. They will work with you to develop a disease treatment plan, in an effort to get the inflammation under control and slow or stop the progression of the disease. For a person diagnosed with reactive arthritis, the rheumatologist is the leader of your health-care team.

Medications

Arthritis medications are designed to control disease, slow its progression, and to help manage pain. There is a wide range of options – with new ones coming on the horizon – so understanding all possible treatments is not easy.

These medications can be very complex, so you are encouraged to ask for in-depth explanations from your health care team – including pharmacists, who are an excellent source of information.

To explore this area of treatment, the Arthritis Society has developed a comprehensive expert guide that delivers detailed information on medications used to treat arthritis.

EXPLORE: Arthritis Medications – A Reference Guide

The optimal treatment is what is best in each individual case – so speak with your doctor and/or pharmacist about what kind of medications are most appropriate for you.

Surgery 

Joint surgery is rarely required for people with reactive arthritis.

Therapies

These healthcare professions have advanced training from a university and are registered to practice by their provincial/territorial association.

A physiotherapist (PT) can develop an individualized program designed to help you increase your strength, flexibility, range-of-motion, and general mobility and exercise tolerance through a wide variety of therapeutic treatments and strategies. These include exercise prescription, physical interventions, and relaxation, in addition to advising you on other techniques for reducing pain and increasing your overall quality of life. PTs can also refer you to other health professionals and community services for further measures that will help you adapt to your changing circumstances.

An occupational therapist (OT) trained in arthritis management can analyze everything you do in a day and develop a program to help you protect your joints and minimize fatigue. If necessary, your OT can help you redesign your home or workplace to make it easier for you to work or simply get around. They can also make or recommend a number of different splints, braces, orthopedic shoes and other aids that can help reduce your pain and increase your mobility and functionality. Their goal is to prepare you, using assistive devices and adaptive strategies, to reclaim as much of your former life as possible.

Self-Management

In many cases, reactive arthritis goes away on its own within a few weeks, but  some cases may take up to four months before they  resolve. However, given treatment most people with reactive arthritis manage well as the joint pain and swelling resolve. The initial stages of the disease can be accompanied by severe joint pains, and it is important to determine with the rheumatologist which medications are best to control the symptoms. Occasionally a steroid injection into a swollen joint (like a knee) can provide some relief.

As the initial phase of joint pain begins to resolve it is important to gradually increase your exercise and stretching.

Physical activity

Physical activity is any activity that uses your muscles and increases your heart rate. Physical activity strengthens the muscles and connective tissues around your joints, helping support muscles around joints that have been weakened by arthritis. Participating in a properly designed exercise program is a great way to help alleviate the discomfort caused by arthritis. So are all those activities that you do as a part of everyday life – such as vacuuming the house, walking to work, even gardening. These kinds of activities can be very beneficial for your joints, and can help you maintain and improve your mobility.

Exercise

Muscles and the other tissues that hold joints together weaken when they aren't moved enough, so the joint loses its shape and function. Moderate stretching exercises will help relieve pain and keep the muscles and tendons around the affected joint more flexible and strong. Low-impact exercises like swimming, walking, water aerobics and stationary bicycling can all reduce pain while maintaining your strength and flexibility. Always consult your doctor before beginning an exercise program.

There are different types of exercises you can do to decrease pain and stiffness:

  • Flexibility exercises, including stretches and range of motion exercises, improve flexibility and can reduce pain and stiffness and help keep your joints moving. Range of motion refers to the amount your joints can move in certain directions. Stretches elongate muscles and are best done when muscles are already warmed up. Ideally, you should complete range of motion exercises every day even on days when your joints are sore. For some ideas about stretches, check out our “Simple Stretches” video.
  • Strengthening exercises maintain or increase muscle tone and protect your joints. These exercises include weight training done with “free” weights, your own body weight or weight machines.
  • Endurance exercises strengthen your heart, give you energy, control your weight and help improve your overall health. These include walking, swimming and cycling including stationary bikes. It is best to avoid high-impact exercises like contact sports.

For more information about arthritis, physical activity and exercise, visit our Exercise & Motion page.

Protect your joints

While it’s important to keep your joints moving, it’s also important to avoid situations that put excessive stress or strain on your joints, as that can increase your risk of injury and make your joints deteriorate faster. Avoiding joint stress will also lead to less pain and help your joints work better, longer.

Techniques to protect your joints include:

  • Pace yourself: alternate heavy or repeated tasks with lighter tasks. Taking a break reduces stress on painful joints and conserves energy by allowing weakened muscles to rest.
  • Keep joints aligned: Positioning joints wisely promotes proper alignment and decreases excess stress. For example, squatting and kneeling may put extra stress on your hips or knees. When lifting or carrying heavy items, keep items at waist height and avoid carrying them up and down stairs.
  • See a therapist: Talking to your doctor about seeing a physiotherapist who can customize your exercise program, or an occupational therapist who can advise you on assistive devices and adaptations for your home or workplace.
  • Use assistive devices: Using appropriate tools and devices not only makes tasks easier, it helps to conserve your energy. Raise seat levels to decrease stress on hip and knee joints. Use a reacher to pick up items from the ground. Use a cane or walker to decrease stress on hip and knee joints.

For more information about protecting your joints, visit our Active Joint Protection page.

Heat & Cold

Taking a warm shower and using warm packs are great ways to help reduce pain and stiffness. Always use a protective barrier, such as a towel, between the warm pack and the skin. Heat is ideal for:

  • Relieving pain
  • Relieving muscle spasms and tightness
  • Enhancing range of motion

IMPORTANT: Do not use heat on an already inflamed joint, as it can make symptoms worse.

Using a commercial cold pack or a homemade one (from crushed ice, ice cubes or a bag of frozen vegetables) can be helpful to help provide short-term relief from inflammation. Always use a protective barrier, such as a towel, between the cold pack and the skin. Cold is ideal for:

  • Swelling
  • Decreasing pain
  • Constricting blood flow to an inflamed joint

For more information about using heat or cold, visit our Pain Management page.

Eating well

There is no conclusive evidence to suggest that what you eat can make arthritis either better or worse.  Reactive arthritis is accompanied by significant pain and swelling in the joints, and the role of diet in the early phase of the disease has not be studied systematically.

However, being overweight can put excess strain on your joints. To work normally, your body needs food to supply energy, vitamins and minerals. Healthy eating will help you manage your weight and give you the energy to complete your daily activities, as well as promote a strong immune system, and bone and tissue health.

Three ways to improve your nutrition include:

  • Reduce fat intake: A healthy diet should include a small amount of unsaturated fats and limited amounts of saturated and trans fat. Choosing the right amount and types of fats help you achieve and maintain a healthy body weight.
  • Reduce sugar intake: Sugar contains “empty” calories and has no nutritional value. This includes syrup as well as white, brown, cane and raw sugar. Limit or avoid adding sugar to drinks and cereals. Although artificial sweeteners contain fewer calories, it is best to get used to food being less sweet. Use dried, unsweetened fruit like raisins, cherries or dates to sweeten cereals since they provide vitamins, minerals and fibre.
  • Eat more vegetables and fruit: Vegetables and fruit should make up the largest component of your diet. Keep in mind that the sweetest fruits have high sugar content so best not to overdo it. Try to have at least one vegetable or fruit at every meal and while snacking. Besides being an excellent source of energy, vegetables and fruit boost your fibre intake, which helps with digestion and weight management. They are also loaded with antioxidants, which help boost the immune system and may help maintain healthy cartilage.

If you plan to change your diet, talk with your doctor and a dietician to develop the best program for your needs and lifestyle. For more information about eating well, visit our Arthritis and Nutrition page.

Relaxation and coping skills

Developing good relaxation and coping skills can help you maintain balance in your life, giving you a greater feeling of control over your arthritis and a more positive outlook. Relaxing the muscles around a sore joint reduces pain. There are many ways to relax. Try deep breathing exercises. Listen to music or relaxation tapes. Imagine or visualize a pleasant and restful activity, such as lying on a beach. The abrupt onset of joint pain and swelling in reactive arthritis can be discouraging and emotionally draining. It is important to remember that the long-term outlook for most patients with reactive arthritis is very favourable.

For more information about relaxation and coping skills, visit our Pain Management page.

What Now

Living well with arthritis

There is a lot you can do to take control and actively manage your arthritis. Below we have listed a few resources to help you learn more about actively managing your arthritis to live better.

Flourish

To find health & wellness advice, self-management tips, inspirational stories, and much more.

Explore Flourish

Online Learning

Our online courses are jam-packed with helpful tips and information.  Each course is devoted to a specific issue or symptom linked to arthritis.

Discover Arthritis Courses

Workshops and Webinars

Learn about upcoming educational events and webinars.

Find Workshops and Webinars

Navigating Through Arthritis

Learn about information and services available.

Navigate through arthritis

Contributor(s)

This information was last updated September 2017, with expert advice from:

Dr. Rob Inman, MD
Senior Scientist, Krembil Research Institute, University Health Network
Professor of Immunology, Faculty of Medicine, University of Toronto

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