Symptoms of Reactive Arthritis

Reactive arthritis is a type of arthritis that affects the joints, eyes, and urethra (the tube that carries urine from your bladder to the outside of your body). This type of arthritis is distinguishable because of the different areas of the body it affects. Reactive arthritis is sometimes called Reiter’s syndrome. 

It is a type of spondyloarthritis, an umbrella term for disorders linked by their symptoms and a specific gene marker called HLA-B27. These conditions are known for affecting the back, pelvis, neck, and some of the larger joints. They may also affect the eyes, skin, tendons, and entheses—the areas where the tendons and ligaments meet the bone.

Reactive arthritis tends to occur as a result of an infection somewhere else in the body. Common infectious causes might include Chlamydia trachomatis (transmitted during sexual activity) and Salmonella bacteria (which causes food poisoning). Keep reading to learn about the symptoms of this condition and when to see a healthcare provider.

Joint Symptoms 

The most common symptom of reactive arthritis is joint pain, typically of the lower extremities. Arthritis joint pain associated with this type of arthritis is either monoarthritis or asymmetric oligoarthritis.

Monoarthritis means that only one joint is affected by arthritis. Asymmetric oligoarthritis means that five or fewer joints might be affected on either side of the body.

While the large joints are most often affected by this condition, some people will have involvement in the small joints of their hands. Most will experience joint pain days or weeks after the primary infection. People with the condition initially present with arthritis symptoms in multiple joints, including the lower extremities, sacroiliac joints, and lumbar spine.

Joint pain with reactive arthritis is especially common in the morning, and people with the condition may also experience joint stiffness upon awakening. Affected joints are often warm, painful, and swollen.

Some people with reactive arthritis may have spine involvement. Axial (spine) involvement is common in people who are HLA-B27 positive.

Genital Tract Symptoms

The research on sexually-acquired reactive arthritis shows an incidence of 3.0% to 8.1%. Additional research shows up to 5% of genital chlamydial infections that become reactive arthritis will go undiagnosed, and half of these cases will proceed to chronic disease.

People who acquire reactive arthritis due to a chlamydial infection experience urinary tract and genital tract symptoms. In females, the genital tract includes the vulva, the vagina, the cervix, the uterus, the fallopian tubes, and the ovaries. In males, the genital tract includes the penis, scrotum, and testicles.

Females with urinary tract and genital tract symptoms may experience:

• Inflammation of the cervix, fallopian tubes (salpingitis), vulva, or vagina (vulvovaginitis)
• Urinary tract inflammation: usually one of the first symptoms to develop, but may not be experienced by females
• Dysuria: pain and burning with urination
• Vaginal discharge
• Bleeding between periods
• Deep dyspareunia (painful sexual intercourse) and/or bleeding after sexual intercourse
• Pelvic pain

Males with urinary tract and genital tract symptoms will experience:

• Urinary tract inflammation: quite common in males
• Pain or burning with urination and urinary frequency, but with negative urine cultures for infection
• Prostate gland inflammation (prostatitis)
• Small, shallow painless ulcers on the penis, forming plaque-like lesions and becoming chronic (long-term)
• Urethral discharge: abnormal pus-like or mucus-like discharge
• Testicular pain and swelling

Genital symptoms in males typically occur around 14 days before reactive arthritis develops.

Eye Symptoms

Many people with reactive arthritis will experience eye inflammation. This might include conjunctivitis that occurs early in the disease. Conjunctivitis is inflammation or infection of the conjunctiva (the transparent membrane that lines the eyelid and covers the white part of the eye).

Inflammation of the small blood vessels in the conjunctiva means they are much more visible, and the white part appears reddish or pink. It is possible for both eyes to be affected and for there to be swelling and discharge.

For some people, conjunctivitis is mild and painless, but for others, it might cause more severe symptoms like blepharospasm (uncontrolled eyelid twitching) and/or photophobia (light sensitivity). Additional symptoms of conjunctivitis include blurred vision and eye crusting, especially upon awakening in the morning.

Some people experience anterior uveitis or inflammation of the middle part of the eye, including the iris (the colored part of the eye) and the ciliary body (the adjacent tissue). Symptoms of anterior uveitis might include red, sore, and inflamed eyes, blurred vision, light sensitivity, or a small, irregular-shaped pupil.

Eye symptoms associated with reactive arthritis are treatable. They rarely cause permanent vision loss or scarring or affect the macula of the eye.

Other Symptoms

Additional symptoms of reactive arthritis are tendonitis and enthesitis, skin and nail symptoms, and gastrointestinal symptoms.

Two common features of reactive arthritis are tendonitis and enthesitis. These are associated with all types of spondyloarthritis. Tendonitis is a condition where the tissue that connects muscle to bone (the tendons) becomes inflamed.

Enthesitis is inflammation of the entheses, which are connective tissues attaching tendons, ligaments, or joint capsules to the bone. About 30% of people with this type of arthritis will experience enthesitis that presents as plantar fasciitis or Achilles’ tendonitis.

Some people with reactive arthritis will develop a skin condition called keratoderma blennorrhagica. Skin lesions from this condition are sometimes seen on the palms and soles, but they can spread to other areas, including the scrotum, scalp, and trunk. The lesions might resemble psoriasis lesions.

A second skin condition associated with reactive arthritis is balanitis circinata, characterized by inflammation and pain at the head of the penis. It affects up to 40% of men who have reactive arthritis.

Some people with reactive arthritis might experience nail involvement, including thickened nails, nail crumbling, and/or nail discoloration.

Gastrointestinal symptoms of reactive arthritis might include stomach pain and diarrhea. These symptoms might be related to bacterial causes, including Salmonella, Shigella, Yersinia, and Campylobacter bacteria that might cause a gastrointestinal infection that can trigger reactive arthritis.

When to See a Healthcare Provider

Call your healthcare provider if you experience symptoms of reactive arthritis, including joint pain and swelling, red and painful eyes, urinary or genital symptoms, or skin symptoms. Symptoms such as burning or painful urination or discharge from the vagina or penis need more immediate medical attention.

Your healthcare provider also needs to know if you have gastrointestinal symptoms, including diarrhea that is bloody or extremely painful.

You will likely see your primary care healthcare provider when you first experience symptoms. If they suspect an arthritis condition, they will refer you to a rheumatologist, a healthcare provider specializing in arthritis, for further evaluation and treatment. 

A Word From Verywell

Reactive arthritis is usually treated with antibiotics and medications, including corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), to manage symptoms. Severe cases of reactive arthritis can lead to joint damage and vision problems.

Recovery time will vary from person to person, but most people recover within a few months to a year. Some people with the condition may experience a relapse of symptoms after the initial treatment. Overall, the outlook for most people with reactive arthritis is positive.