10 Key Symptoms of Reactive Arthritis You Should Know

Reactive arthritis, also known as Reiter’s syndrome, is an inflammatory condition that develops in response to an infection in another part of the body. This type of arthritis typically affects the joints, eyes, and urinary tract, and usually occurs after a bacterial infection in the gastrointestinal or genitourinary system. Understanding the symptoms of reactive arthritis is crucial for early detection and proper medical care.

The condition most commonly affects men between the ages of 20 and 40, though it can occur in anyone. Symptoms typically appear one to four weeks after the initial infection and can range from mild to severe. While reactive arthritis often resolves on its own within several months, some people may experience chronic or recurring symptoms. Below, we explore the ten key symptoms that characterize this inflammatory condition.

1. Joint Pain and Swelling

Joint pain and swelling are the hallmark symptoms of reactive arthritis. The condition typically affects the joints asymmetrically, meaning it may affect joints on one side of the body more than the other. The most commonly affected areas include:

• Knees
• Ankles
• Feet, particularly the toes
• Lower back
• Heels

The pain is often described as a deep, aching sensation that worsens with movement and improves with rest. The affected joints may appear visibly swollen, feel warm to the touch, and exhibit redness. Morning stiffness is common, with joints feeling particularly stiff and painful upon waking. This stiffness typically lasts for more than 30 minutes and gradually improves with gentle movement throughout the day.

2. Inflammation of the Eyes (Conjunctivitis)

Eye inflammation is one of the classic features of reactive arthritis and occurs in approximately 30-60% of patients. Conjunctivitis, also called “pink eye,” is the most common eye manifestation. Symptoms include:

• Redness of the eyes
• Itching or burning sensation
• Increased tearing or watery discharge
• Light sensitivity (photophobia)
• Gritty feeling in the eyes

The eye inflammation in reactive arthritis can affect one or both eyes and may come and go. In some cases, more serious eye conditions such as uveitis or iritis may develop, which involve inflammation of the inner structures of the eye. These conditions require prompt medical attention to prevent potential vision complications.

3. Urinary Tract Symptoms

Inflammation of the urinary tract and reproductive organs is a characteristic feature of reactive arthritis, particularly when the condition is triggered by a sexually transmitted infection. Common urinary symptoms include:

• Painful urination (dysuria)
• Increased frequency and urgency of urination
• Burning sensation while urinating
• Discharge from the urethra
• Pelvic pain or discomfort

In men, inflammation of the prostate gland (prostatitis) may occur, causing additional pelvic pain and discomfort during urination or ejaculation. Women may experience inflammation of the cervix (cervicitis) or other reproductive organs. These symptoms can be confused with a urinary tract infection, making proper diagnosis essential.

4. Enthesitis (Inflammation Where Tendons Attach to Bone)

Enthesitis is a distinctive feature of reactive arthritis and other spondyloarthropathies. It refers to inflammation at the sites where tendons and ligaments attach to bones. The most commonly affected areas are:

• The Achilles tendon at the back of the heel
• The plantar fascia on the bottom of the foot
• Around the kneecap
• At the pelvis

This inflammation causes significant pain and tenderness at these specific sites. Heel pain from Achilles tendinitis or plantar fasciitis is particularly common and can make walking difficult and painful. The affected areas may be tender to touch and can become swollen. Unlike typical tendinitis from overuse, enthesitis in reactive arthritis is caused by the inflammatory process of the disease itself.

5. Lower Back Pain and Stiffness

Many people with reactive arthritis experience inflammation of the sacroiliac joints, which connect the lower spine to the pelvis. This condition, called sacroiliitis, produces characteristic symptoms:

• Deep, aching pain in the lower back and buttocks
• Stiffness that is worse in the morning and after periods of inactivity
• Pain that may radiate down one or both legs
• Discomfort that improves with movement and exercise
• Pain that worsens with prolonged sitting or standing

The lower back pain associated with reactive arthritis is inflammatory in nature, which distinguishes it from mechanical back pain. It typically improves with activity rather than rest, and is often accompanied by significant morning stiffness lasting more than 30 minutes. In some cases, the inflammation can extend to other areas of the spine.

6. Skin Changes and Rashes

Skin manifestations occur in approximately 10-30% of people with reactive arthritis. These dermatological symptoms can take several forms:

Keratoderma Blennorrhagicum: This is a distinctive skin condition that appears as crusty, scaling patches on the palms of the hands and soles of the feet. The lesions may resemble psoriasis and can sometimes appear on the scalp, trunk, or other areas of the body.

Circinate Balanitis: In uncircumcised men, this presents as painless, shallow ulcers or crusted lesions on the head of the penis. The lesions are typically circular or ring-shaped.

Mouth Ulcers: Small, usually painless ulcers may develop on the tongue, palate, or inside the cheeks. These oral lesions are often shallow and may go unnoticed by the patient.

These skin changes may appear and disappear throughout the course of the illness and can be one of the first signs that help distinguish reactive arthritis from other forms of arthritis.

7. Nail Changes

Changes to the fingernails and toenails are frequently observed in reactive arthritis, affecting up to 20% of patients. These nail abnormalities include:

• Thickening of the nails
• Yellow or brownish discoloration
• Crumbling or fragmentation of the nail
• Separation of the nail from the nail bed (onycholysis)
• Small depressions or pits in the nail surface
• Horizontal ridging

These nail changes can affect one or multiple nails and may resemble the nail changes seen in psoriatic arthritis or fungal nail infections. The toenails are more commonly affected than fingernails. The nail abnormalities may persist even after other symptoms of reactive arthritis have resolved.

8. Dactylitis (Sausage Digits)

Dactylitis is a characteristic finding in reactive arthritis where an entire finger or toe becomes uniformly swollen, resembling a sausage. This occurs due to inflammation of the tendons, joints, and soft tissues throughout the digit. Key features include:

• Diffuse swelling affecting the entire length of a finger or toe
• The affected digit appears uniformly enlarged
• Tenderness throughout the swollen area
• Difficulty bending the affected digit
• Redness or warmth over the swollen area

Dactylitis most commonly affects the toes but can also occur in the fingers. This “sausage digit” appearance is a helpful diagnostic clue that distinguishes reactive arthritis from other forms of arthritis such as rheumatoid arthritis, where swelling is typically limited to the joints themselves rather than the entire digit.

9. Fatigue and General Malaise

Systemic symptoms are common in reactive arthritis and can significantly impact quality of life. These include:

• Persistent fatigue that doesn’t improve with rest
• General feeling of being unwell (malaise)
• Lack of energy for daily activities
• Reduced stamina and endurance
• Difficulty concentrating or “brain fog”

The fatigue associated with reactive arthritis is often disproportionate to the level of physical activity and can be one of the most debilitating aspects of the condition. This overwhelming tiredness is thought to result from the body’s inflammatory response and the chronic pain associated with the condition. Many patients report that the fatigue is worse during disease flares and may improve as other symptoms resolve.

10. Fever and Weight Loss

In the acute phase of reactive arthritis, particularly shortly after the triggering infection, some individuals may experience constitutional symptoms such as:

• Low-grade fever, typically ranging from 99°F to 101°F (37.2°C to 38.3°C)
• Mild to moderate weight loss
• Night sweats
• Loss of appetite
• General feeling of illness

These systemic symptoms usually occur during the initial stages of the disease and tend to resolve as the condition progresses. The fever is typically mild and intermittent rather than high and constant. Unintentional weight loss may occur due to reduced appetite, the body’s inflammatory state, and the energy demands of fighting the condition. If fever is high or persistent, it’s important to seek medical evaluation to rule out other complications or infections.

What Causes Reactive Arthritis?

Reactive arthritis develops as an abnormal immune response to an infection in another part of the body. The body’s immune system reacts to the infection by attacking its own tissues, particularly in the joints, eyes, and urinary tract. The main causes and triggers include:

Gastrointestinal Infections: Bacterial infections of the digestive system are common triggers. The most frequently implicated bacteria include:

• Salmonella
• Shigella
• Yersinia
• Campylobacter

These infections typically result from consuming contaminated food or water and cause symptoms such as diarrhea, abdominal pain, and fever before the arthritis symptoms develop.

Sexually Transmitted Infections: Certain sexually transmitted bacteria can trigger reactive arthritis, most commonly:

• Chlamydia trachomatis
• Ureaplasma urealyticum

These infections may cause urethritis or cervicitis, and reactive arthritis symptoms typically appear weeks after the initial infection.

Genetic Predisposition: The HLA-B27 gene is found in approximately 50-80% of people with reactive arthritis, compared to only 6-8% of the general population. While having this gene doesn’t mean someone will definitely develop reactive arthritis, it does increase susceptibility. People with HLA-B27 who develop reactive arthritis also tend to have more severe and prolonged symptoms.

Other Risk Factors:

• Age: Most common in people between 20 and 40 years old
• Sex: Men are more likely to develop reactive arthritis from sexually transmitted infections, while gastrointestinal infections affect men and women equally
• Previous infections: Having had reactive arthritis before increases the risk of recurrence

Prevention of Reactive Arthritis

While reactive arthritis cannot always be prevented, you can reduce your risk by taking steps to avoid the infections that trigger it:

Food Safety Practices:

• Wash hands thoroughly before preparing or eating food
• Cook meat, poultry, and eggs to safe internal temperatures
• Avoid consuming unpasteurized dairy products
• Wash fruits and vegetables thoroughly before eating
• Prevent cross-contamination by using separate cutting boards for raw meat and other foods
• Refrigerate perishable foods promptly
• Avoid food from questionable sources, especially when traveling

Sexual Health Practices:

• Practice safe sex by using condoms consistently and correctly
• Limit the number of sexual partners
• Get regular screenings for sexually transmitted infections
• Seek prompt treatment if you suspect a sexually transmitted infection
• Ensure that sexual partners are tested and treated for STIs if necessary

General Hygiene:

• Wash hands frequently with soap and water, especially after using the bathroom and before eating
• Maintain good personal hygiene
• Avoid sharing personal items such as towels or eating utensils
• Stay up to date with vaccinations that can prevent certain infections

Early Treatment of Infections: If you develop a gastrointestinal or genitourinary infection, seek prompt medical attention and complete the full course of any prescribed antibiotics. Early and appropriate treatment of the initial infection may reduce the risk of developing reactive arthritis, though this is not guaranteed.

Frequently Asked Questions

How long does reactive arthritis last?

Most cases of reactive arthritis improve within 3 to 12 months, with many people experiencing complete resolution of symptoms. However, approximately 15-50% of patients may develop chronic or recurring symptoms that last beyond a year. Some individuals may experience periodic flares of symptoms even after the initial episode has resolved.

Is reactive arthritis contagious?

No, reactive arthritis itself is not contagious. However, the infections that trigger reactive arthritis (such as certain gastrointestinal or sexually transmitted infections) can be contagious. It’s important to practice good hygiene and safe practices to prevent spreading the underlying infection to others.

Can reactive arthritis come back?

Yes, reactive arthritis can recur, especially if you develop another triggering infection. Approximately 15-50% of people who have had reactive arthritis will experience a recurrence at some point. Those with the HLA-B27 gene are at higher risk for recurrent episodes and may experience more severe symptoms.

What is the difference between reactive arthritis and rheumatoid arthritis?

Reactive arthritis is triggered by an infection and typically affects joints asymmetrically (one side more than the other), while rheumatoid arthritis is an autoimmune disease that typically affects joints symmetrically (both sides equally). Reactive arthritis often involves the eyes and urinary tract, which is uncommon in rheumatoid arthritis. Additionally, reactive arthritis usually resolves on its own, while rheumatoid arthritis is a chronic, progressive condition.

Who is most at risk for developing reactive arthritis?

Reactive arthritis most commonly affects men between the ages of 20 and 40, particularly those who have the HLA-B27 gene. People who have had recent gastrointestinal infections or sexually transmitted infections are at increased risk. Those with a previous history of reactive arthritis are more likely to experience recurrence.

Should I see a doctor if I suspect reactive arthritis?

Yes, you should consult a healthcare provider if you experience joint pain and swelling, especially if it’s accompanied by eye inflammation or urinary symptoms, particularly following a recent infection. Early diagnosis and appropriate medical care can help manage symptoms more effectively and reduce the risk of complications. A doctor can perform necessary tests to confirm the diagnosis and rule out other conditions.

Can reactive arthritis cause permanent damage?

While most people recover completely from reactive arthritis, a small percentage may develop chronic arthritis or permanent joint damage, particularly if the condition is severe or prolonged. Some individuals may also develop chronic back problems if the spine is affected. Regular follow-up with a healthcare provider is important to monitor for any long-term complications.

Is the HLA-B27 test necessary for diagnosing reactive arthritis?

The HLA-B27 genetic test is not required for diagnosis but can support the diagnosis of reactive arthritis when combined with clinical symptoms and medical history. While 50-80% of people with reactive arthritis test positive for HLA-B27, testing negative doesn’t rule out the condition. Diagnosis is primarily based on symptoms, physical examination, and evidence of a recent triggering infection.

References:

• Mayo Clinic – Reactive Arthritis
• Johns Hopkins Arthritis Center – Reactive Arthritis
• Arthritis Foundation – Reactive Arthritis
• NHS – Reactive Arthritis
• National Institute of Arthritis and Musculoskeletal and Skin Diseases – Reactive Arthritis