Overview

Reactive arthritis is a condition that causes redness and swelling (inflammation) in various joints in the body, especially the knees, feet, toes, hips and ankles.

It usually develops after you've had an infection, particularly a sexually transmitted infection or food poisoning.

In most cases, it clears up within a few months and causes no long-term problems.

Men and women of any age can get it, but it's more common in men, and people aged between 20 and 40.

Symptoms of reactive arthritis

The most common symptom of reactive arthritis is pain, stiffness and swelling in the joints and tendons, most commonly the knees, feet, toes, hips and ankles.

In some people it can also affect the:

• genital tract - causing pain when peeing, or discharge from the penis or vagina
• eyes - causing eye pain, redness, sticky discharge, conjunctivitus and, rarely, inflammation of the eye (iritis)

See an eye specialist or go to A & E as soon as possible if one of your eyes becomes very painful and the vision becomes misty.

This could be a symptom of iritis - and the sooner you get treatment, the more successful it is likely to be.

Most people will not get all the above symptoms.  They can come on suddenly but usually start to develop a few days after you get an infection somewhere else in your body.

Causes of reactive arthritis

Typically, reactive arthritis is caused by a sexually transmitted infection (STI), such as chlamydia, or an infection of the bowel, such as food poisoning.

You may also develop reactive arthritis if you, or someone close to you, has recently had glandular fever or slapped cheek syndrome.

The body's immune system seems to overreact to the infection and starts attacking healthy tissue, causing it to become inflamed.  But the exact reason for this is unknown.

People who have a gene called HLA-B27 are much more likely to develop reactive arthritis than those who don't, but it's unclear why.

When to see your GP

If you have symptoms of reactive arthritis, you should see your GP, especially if you have recently had symptoms of an infection – such as  diarrhoea, or pain when peeing.

There's no single test for reactive arthritis, although blood and urine tests, genital swabs, ultrasound scans and X-rays may be used to check for infection and rule out other causes of your symptoms.

Your GP will also want to know about your recent medical history, such as whether you may have recently had a bowel infection or an STI.

If you think you might have an STI, you can also visit a local genitourinary medicine (GUM) clinic or other sexual health service. These clinics can often see you straight away, without a GP referral.

Find sexual health services in your area.

If your GP thinks you have reactive arthritis, they may refer you to an arthritis specialist (rheumatologist). They may also refer you to an eye specialist (ophthalmologist) if you have problems with your eyes.

Treatment for reactive arthritis

Treatment usually focuses on:

• using antibiotics to clear any STI that may have triggered the reactive arthritis
• using painkillers such as ibuprofen to releive joint pain and stiffness
• managing any severe or ongoing arthritis, usually using medications such as steroids or disease-modifying anti-rheumatic drugs (DMARDs)

Most people start returning to normal activities after 3 to 6 months.  Symptoms don't usually last loner than 12 months.

Symptoms

The symptoms of reactive arthritis usually develop shortly after you get an infection, such as a sexually transmitted infection or bowel infection.

The main, and sometimes only, symptom of reactive arthritis is pain, stiffness and swelling in the joints and tendons.

It can also affect the:

• genital tract
• eyes

However, not everyone will get symptoms in these areas.

You should see your GP as soon as possible if you have any of these symptoms, especially if you have recently had diarrhoea or problems peeing.

Joint symptoms

Reactive arthritis usually involves inflammation of the joints, but it's most common in the knees, feet, toes, hips and ankles.

Symptoms include:

• pain, tenderness and swelling in your joints
• pain and tenderness in some tendons, especially at the heels
• pain in your lower back and buttocks
• sausage-like swelling of your fingers and toes
• joint stiffness - particularly in the morning

Genital tracts symptoms

Sometimes, you can also have symptoms of a urinary tract infection.  These include:

• needing to pee suddenly, or more often than usual
• pain or burning sensation when peeing
• smelly or cloudy pee
• blood in your pee
• pain in your lower tummy
• feeling tired and unwell

Eye symptoms

Occasionally, you may get inflammation of the eyes (conjunctivitis or, rarely, iritis).

Symptoms can include:

• red eyes
• watery eyes
• eye pain
• swollen eyelids
• sensitivity to light

See an eye specialist or go to A & E as soon as possible if one of your eyes becomes very painful and the vision becomes misty.

This could be a symptom of iritis - and the sooner you get treatment, the more succesful it is likely yo be.

Other symptoms

Reactive arthritis can also cause:

• flu-like symptoms
• a high temperature (fever)
• weight loss
• mouth ulcers
• a scaly rash on the hands or feet

Treatment

Reactive arthritis is usually temporary, but treatment can help to relieve your symptoms and clear any underlying infection.

Most people will make a full recovery within a year, but a small number of people experience long-term joint problems.

Treatment usually focuses on:

• clearing the original infection that triggered the reactive arthritis - usually antibiotics in the case of sexually transmitted infections (STIs)
• relieving symptoms such as pain and stiffness - usually using painkillers such as ibupofen
• managing severe or ongoing reactive arthritis - usually using medications such as steroids or disease-modifying anti-rheumatic drugs (DMARDs)

Antibiotics

Antibiotics will not treat reactive arthritis itself but are sometimes prescribed if you have an ongoing infection - particularly if you have an STI.  Your recent sexual partner(s) may also need treatment.

Non- steroidal anti-inflammatory drugs

Anti-inflammatory painkillers (NSAIDs), such as ibuprofen, can be taken to reduce inflammation and relieve pain.

Steroid medication

If you have severe inflammation, or you can't take NSAIDs or they didn't work for you, you may be prescribed steroid medication to reduce inflammation.

Steroids may be given as tablets if several of your joints are affected. If only one or two joints are affected, steroids may be injected directly into the affected joint or tendon.

Disease-modifying anti-rheumatic drugs (DMARDs)

If your symptoms don't get better after a few weeks with other treatment or are very severe, you may be prescribed a DMARD, which also work by reducing inflammation. They may be prescribed on their own but can also be prescribed in combination with steroids or NSAIDs, or with both.

The most commonly used DMARDs are methotrexate and sulfasalazine.

It can take a few months before you notice a DMARD is working, so it's important to keep taking it even if you don't see immediate results.

Common side effects of methotrexate and sulfasalazine include feeling sick, diarrhoea, loss of appetite and headaches, although these usually improve once your body gets used to the medication.

DMARDs may also cause changes in your blood or liver, so it's important to have regular blood tests while taking these medicines.

Other drugs

If your reactive arthritis is very severe, even stronger drugs, known as biologics, may be prescribed.

These have to be given regularly by injection and may increase your risk of getting infections.

Self-care

There are also things you can do yourself to relieve your symptoms.

When you first start getting symptoms of reactive arthritis, you should try to get plenty of rest and avoid using the affected joints.

As your symptoms improve, you should begin to do exercises to stretch and strengthen the affected muscles, and improve the range of movement in your affected joints.

Your GP or specialist may recommend exercises for your arthritis. Alternatively, you may be referred for physiotherapy.

You might also find ice packs and heat pads useful in reducing joint pain and swelling. Wrap them in a clean towel before putting them against your skin.

Place the pack against the affected area for up to 20 minutes.

Splints, heel pads and shoe inserts (insoles) may also help.

How to stop reactive arthritis coming back

There is a risk you could develop reactive arthritis again if you get another infection. The best way to avoid this is by protecting yourself against STIs and bowel infections.

The most effective way of preventing STIs is to always use a barrier method of contraception, such as a condom, during sex with a new partner.

Read advice about STIs, contraception and sexual health.

Ensuring good standards of hygiene when preparing and storing food can help to prevent bowel infections. Read about food safety and preventing food poisoning.