by Nicole Evans M.D.

Created on: January 08, 2010

Reactive arthritis is an aptly named inflammatory arthritis that occurs in reaction to an infection originating elsewhere in the body.  Reactive arthritis is thus autoimmune in etiology.  Some physician’s may still refer to this autoimmune arthritis by the older name, Reiter's Syndrome.

The symptoms of reactive arthritis appear following one of several types of infection. Common infections include sexually transmitted diseases and a diarrheal illness known as infectious gastroenteritis.  Common bacteria that cause a form of gastroenteritis most frequently associated with reactive arthritis include Shigella, Salmonella, Yersinia, Campylobacter, and Clositridium difficile.

The most common sexually transmitted disease (STD) causing reactive arthritis is Chlamydia trachomatis. In fact, an easy way students remember the symptoms and cause of reactive arthritis is by the saying "can't see, can't pee, can't climb a tree". This refers to Chlamydial infection of the conjunctiva of the eyes and urethral tract, and the resulting reactive arthritis. Of course, in children it is much more common to develop a reactive arthritis following a bout of infectious diarrhea.

A history of prior Chlamydia infection or diarrheal illness, in combination with some or all of the specific symptoms described below will strongly suggest the diagnosis of reactive arthritis.  The common presenting symptoms of reactive arthritis include:

-Arthritis (joint pain and inflammation) involving only a few joints.

-Lower limb joints (especially knees and ankles) are involved more often than upper extremity joints such as elbows, wrists and hands.

-Inflammation is commonly noted at the insertion site of the Achilles tendon or plantar fascia along the bottom of the feet, causing tenderness and swelling.

-Additional symptoms of reactive arthritis may be present that don't involve joints at all.  These symptoms can include painless ulcers in the mouth or on the penis, a thick scaly rash occuring on the soles of the feet or palms of the hand, inflammation or infection of the urinary or genital systems, constitutional symptoms such as fever, weight loss, and/or malaise.

The symptoms of reactive arthritis develop one to two weeks after sexual exposure resulting in an STD.  With gastroenteritis, the symptoms appear within the timespan of the actual foodborne diarrheal infection. However, the symptoms of reactive arthritis can, unfortunately, last for several months.

Because of the autoimmune nature of this illness, treatment is focused on relieving the symptoms of reactive arthritis.  Most cases will resolve on their own within 6 months, although half of these individuals will have a recurrence of the next several years. Rarely, reactive arthritis can become a persistent condition.

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