Reactive Arthritis

By | June 8, 2022

Inflammation that has not healed can spread to the body and lead to complications as a result. One such secondary reaction is reactive arthritis and its special form, Reiter’s syndrome.

What is reactive arthritis?

Reactive arthritis is inflammation of the joints as a result of another inflammation in the body, e.g. B. Airways, intestines, urinary tract or genitals. For what is cardiovascular diseases, please visit

Reactive arthritis usually develops a few weeks after infection. A trigger can often no longer be determined (often salmonella or sexually transmitted diseases such as chlamydia or gonorrhea).

Reactive arthritis is associated with characteristic symptoms: joint pain/swelling and warmth in the shoulder, elbow, knee or hip.

In the case of Reiter’s syndrome (also Reiter’s triad), a special form of reactive arthritis, one suffers from joint problems as well as conjunctivitis and urethritis.


Both reactive arthritis and Reiter’s syndrome are caused by a previous bacterial infection (intestines, urinary tract, genitals).

On the one hand, both can occur if an infection is not treated or not completely treated. Then bacterial residues remain in the body, which are recognized and fought by the immune system.

On the other hand, the immune system can also react to endogenous antigens if these resemble the structures of the bacteria (molecular mimicry). Joint inflammation can also occur when the bacteria are no longer present. In this case, doctors speak of non-septic arthritis. The antigen HLA-B27, which triggers the immune response, can be detected in the body of affected patients.

Symptoms, Ailments & Signs

Characteristic signs of reactive arthritis are swelling, redness and pain associated with joint inflammation, which occurs about two to four weeks after an infection of the respiratory tract, the urinary and genital organs or the intestine. Hip, knee or ankle joints are usually affected, occasionally joint inflammation also develops in the wrists, elbows or shoulders.

The inflammation of a finger or toe joint, known as “sausage fingers”, is also typical. As a rule, the symptoms only occur on one side of the body and are limited to one joint, only very rarely do several joints swell at the same time: successive inflammations of different joints can occur. Spinal or pelvic involvement is characterized by back pain that radiates to the buttocks and worsens at night.

Other symptoms that can occur are scaly skin changes, particularly on the palms of the hands and soles of the feet, and painful blue-red nodules (erythema nodosa) occasionally form on the ankles and lower legs. Inflammation of the eyes associated with reactive arthritis is noticeable through redness, burning, pain and increased sensitivity to light, visual disturbances are also possible.

The conjunctiva as well as the cornea or iris can be affected. In men, there is occasionally inflammation of the glans with pustules and redness. Slight fever and a general feeling of illness are often given as non-specific signs.

Diagnosis & History

If reactive arthritis or Reiter’s syndrome is suspected, a doctor will use various examinations and tests to confirm the diagnosis of reactive arthritis.

In the anamnesis, he first asks about complaints. He then examines the patient physically and takes blood, possibly also a urine or stool sample. If, in addition to reactive arthritis, eye and urethral inflammation occurs at the same time, this is an indication of Reiter’s syndrome.

A blood test can be used to determine whether there are other signs of reactive arthritis or Reiter’s syndrome:

  • Detection of the antigen HLA-B27 in the blood
  • Inflammatory markers present
  • no rheumatoid factors detectable

In addition to the blood test, the diagnosis of reactive arthritis can be confirmed by further tests:

  • urine test
  • stool examination
  • Swab of the urethra
  • joint puncture
  • X-ray examination
  • ultrasound examination
  • scintigraphy

If left untreated, both reactive arthritis and Reiter’s syndrome can become severe. In most cases, reactive arthritis clears up within a year. In more severe cases – especially when several joints are affected and there is also Reiter’s syndrome – healing can take a long time. As a complication, the inflammation can impair joint function or destroy tissue. If the eye is affected, vision can decrease.


Complications can occur when existing inflammation spreads to other parts of the body as part of reactive arthritis. Joint inflammation can affect the entire joint and permanently impair or even destroy joint function. Any conjunctivitis that may be present can spread to adjacent eye structures and thereby impair vision.

Depending on the type of underlying inflammation, these “transitional processes” can occur anywhere in the body, triggering serious complications. Reiter’s syndrome is a special form of reactive arthritis that, in addition to joint problems, leads to conjunctivitis and urethritis. Both forms cause severe pain, restricted mobility and permanent joint damage as they progress.

Because of the symptoms, some patients develop mental illnesses such as depression and anxiety. The trigger itself can also cause symptoms and long-term effects. In the treatment of reactive arthritis, antibiotics and rheumatic drugs are the main triggers for complications. Diclofena, ibuprofen and similar preparations can, for example, cause gastrointestinal problems, headaches, muscle and body aches, skin irritation and kidney or liver damage. Alternative treatment methods such as cold applications and physiotherapy are relatively free of complications, apart from minor frostbite or temporary muscle pain.

When should you go to the doctor?

This type of arthritis should always be treated by a doctor. Self-healing cannot occur here, so that the affected person always needs medical treatment to prevent further complications and symptoms. The life expectancy of those affected is limited by this arthritis in some cases. A doctor should be consulted if the patient suffers from inflammation of the joints or severe infections of the respiratory tract. These symptoms usually appear suddenly. Swelling in the joints can also indicate this disease.

Those affected suffer from very severe back pain and are therefore significantly restricted in their everyday life. The inflammation can also affect the eyes, so that those affected are very sensitive to light and can also have visual disturbances. Furthermore, fever or, in general, a permanent feeling of illness often indicates this type of arthritis and must be examined by a doctor. The diagnosis of this arthritis can be made by the general practitioner. However, further treatment depends heavily on the exact symptoms and their severity and is usually carried out by a specialist.

Treatment & Therapy

As with other inflammatory diseases, the treatment of reactive arthritis and Reiter’s syndrome involves pain relief and healing of the inflammation. As a rule, non-steroidal rheumatic drugs such as ibuprofen, acetylsalicylic acid or diclofenac are prescribed.

If inflammation is detected in the body, antibiotics are administered. In the case of a sexually transmitted disease, the partner is also treated. In the case of reactive arthritis, however, there are often no longer any inflammatory parameters, and then antibiotics are not needed. In this case, cold applications to relieve pain and physiotherapy to maintain or restore joint mobility are very helpful against joint pain.

If several joints are affected or if the inflammation has spread, cortisone is administered to avoid consequential damage. An eye infection must be treated quickly because of the risk of visual impairment.


The best way to prevent reactive arthritis is to protect yourself from infections of the gut, urinary tract, and genitals that are the cause of reactive arthritis. It is therefore important to adhere to hygiene rules in the household:

  • clean hands and clean cookware when cooking
  • Be careful with raw meat and raw eggs
  • wash fruit


Condoms help prevent sexually transmitted diseases. Reactive arthritis is considered cured after six months of therapy. However, the risk of recurrence is very high. After successful therapy, it is important to monitor the further course of the disease over time during follow-up care. In up to 50 percent of those affected, the joint inflammation or other disease-related symptoms recur after a few years.

The mean relapse-related course of the disease is 3 years. Rarely, disease progressions of up to 15 years are possible. Inflammation of the joints that occurs as a result of recurrence must then be treated quickly in order to avoid permanent joint damage or changes. During follow-up care, the inflammatory markers should therefore be determined regularly – at least every six months – by taking a blood sample.

Depending on the medical findings, X-rays and ultrasound examinations must also be carried out. Joint damage in the early stages can thus be detected and treated in good time. In order to minimize the risk of recurrence, sexual contacts should only be entered into with “medically assured” persons during the three-year period of the relapse-related course.

In addition to the high risk of recurrence, chronic arthralgia, arthritis or tendon problems can manifest themselves in up to 40 percent of those affected. Physiotherapeutic measures are the focus of aftercare. Movement exercises and regular endurance sports can maintain or even improve joint mobility and muscles. In addition, the drug therapy is regularly continued during follow-up care.

You can do that yourself

As part of self-help, any inflammation that has been suffered should always be completely cured. The organism is not fully resilient if an existing disease is not completely healed.

A healthy lifestyle and diet are important to support the healing process. The food intake should be balanced and rich in vitamins so that the immune system can mobilize sufficient defenses in the event of an illness. The intake of harmful substances such as alcohol and nicotine should be avoided as a matter of principle. Being overweight should be avoided and sufficient daily exercise should also take place. Getting fresh air regularly is just as helpful as exercising. Sufficient sleep and good sleep hygiene also help the body to stay healthy or to promote the healing process in the case of existing diseases.

People with reactive arthritis should refrain from heavy physical exertion. As soon as the body sends signals of fatigue, these must be taken into account. Rest and protection are necessary so that regeneration can take place. A restructuring of everyday life can help many people to improve their overall well-being. Care should be taken to ensure that tasks and obligations to be fulfilled are redistributed to the people in the immediate vicinity as soon as the person concerned can no longer adequately perform them.

Reactive Arthritis