Reactive arthritis

Last updated: July 20, 2023

Summarytoggle arrow icon

Reactive arthritis (formerly known as Reiter syndrome) is a postinfectious autoimmune condition that is most commonly preceded by bacterial infection of the gastrointestinal or urinary tract. It is categorized as a seronegative spondyloarthropathy and is associated with HLA-B27. Reactive arthritis often affects young adults and manifests with musculoskeletal and/or extraarticular symptoms. The classic triad of arthritis, conjunctivitis, and urethritis is only seen in about one-third of patients. The diagnosis is based on clinical features such as patient history and physical examination and may be supported by laboratory or imaging findings, although there are no specific confirmatory tests for reactive arthritis. Reactive arthritis usually resolves spontaneously within 6–12 months; treatment during this acute phase is primarily supportive (e.g., NSAIDs for arthritis). Underlying infections should be identified and treated. A small proportion of patients develop severe or chronic arthritis; for these individuals, systemic corticosteroids or disease-modifying antirheumatic drugs (DMARDs) may be required.

Epidemiologytoggle arrow icon

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Postinfectious autoimmune disorder [4]

She Cherishes Cooking Yummy Salmon: Shigella, Chlamydia, Campylobacter, Yersinia, and Salmonella are the most common causes for reactive arthritis.

Clinical featurestoggle arrow icon

Classic triad of reactive arthritis (seen in approximately one-third of affected individuals): “can't see (conjunctivitis), can't pee (urethritis), can't climb a tree (arthritis)”. [8]

Diagnosticstoggle arrow icon


Laboratory studies [1][6]

As with other seronegative arthropathies, there is an association between reactive arthritis and HLA-B27 (approximately 50–80% of HLA-B27 tests are positive in patients with reactive arthritis); however, HLA-B27 testing is not required to diagnose reactive arthritis and does not change the management of the condition. [1][6]

Genitourinary chlamydia infection is frequently asymptomatic; have a low threshold for testing for chlamydia in patients with reactive arthritis. [1]

Imaging [1][10]

Additional studies

Aortic regurgitation can be fatal if missed; request an echocardiogram if there are any concerning clinical features. [7]

Treatmenttoggle arrow icon


Supportive therapy


Extraarticular manifestations [6][15]

Treatment should be overseen by the relevant specialist.

Management of underlying infections [6][11]

Differential diagnosestoggle arrow icon

Infection-associated arthritis [20]

Differential diagnoses of infection-associated arthritis [9][21]
Condition Reactive arthritis Septic arthritis Lyme disease [22] Syphilitic arthritis
Nongonococcal Gonococcal (disseminated gonococcal infection) [23]
Causative pathogen
Risk factors
  • Frequent outdoor activities (e.g., hunters, farmers, hikers)
  • Acute
  • Acute
  • Variable [25]
  • Progressive
  • Progressive
Clinical features
Distribution pattern
  • Oligoarthritis
    • Asymmetrical
    • Migratory
    • Lower body (especially knee)

Non-infectious arthritis [20]

The differential diagnoses listed here are not exhaustive.

Prognosistoggle arrow icon

  • Resolves spontaneously within a year
  • High rate of recurrence

Referencestoggle arrow icon

  1. Pujalte GG, Albano-Aluquin SA. Differential Diagnosis of Polyarticular Arthritis. Am Fam Physician. 2015; 92 (1): p.35-41.
  2. Alexander SA, Kim E, Mandhadi R. Approaching Reactive Arthritis Associated With Poor Prognostic Factors: A Case Report and Literature Review. Cureus. 2021; 13 (2): p.e13555.doi: 10.7759/cureus.13555 . | Open in Read by QxMD
  3. Diagnostic approach to polyarticular joint pain. Updated: September 15, 2003. Accessed: March 16, 2017.
  4. Lyme disease and the orthopaedic implications of Lyme arthritis. Updated: February 1, 2011. Accessed: March 16, 2017.
  5. Vidaurrazaga MM, Perlman DC. A case of purulent gonococcal arthritis. IDCases. 2020; 19: p.e00662.doi: 10.1016/j.idcr.2019.e00662 . | Open in Read by QxMD
  6. Ruan XC, Lim JH, Tey HL. Acute Inflammatory Polyarthritis: A Rare Presentation of Secondary Syphilis. Ann Acad Med Singapore. 2017; 46 (2): p.72-73.
  7. Ghanem KG. Chapter 46: Disseminated Gonococcal Infection. In: Imboden JB, Hellmann DB, Stone JH, eds.$Current Diagnosis & Treatment in Rheumatology, Third Edition. Third Edition, ed. McGraw-Hill Education / Medical; 2013.
  8. Walls R, Hockberger R, Gausche-Hill M. Rosen's Emergency Medicine. Elsevier Health Sciences ; 2018
  9. Selmi C, Gershwin ME. Diagnosis and classification of reactive arthritis. Autoimmun Rev. 2014; 13 (4-5): p.546-549.doi: 10.1016/j.autrev.2014.01.005 . | Open in Read by QxMD
  10. Adizie T, Moots RJ, Hodkinson B, French N, Adebajo AO. Inflammatory arthritis in HIV positive patients: A practical guide. BMC Infect Dis. 2016; 16 (1).doi: 10.1186/s12879-016-1389-2 . | Open in Read by QxMD
  11. Fox C, Walker-Bone K. Evolving spectrum of HIV-associated rheumatic syndromes. Best Pract Res Clin Rheumatol. 2015; 29 (2): p.244-58.doi: 10.1016/j.berh.2015.04.019 . | Open in Read by QxMD
  12. Cusick MF, Libbey JE, Fujinami RS. Molecular mimicry as a mechanism of autoimmune disease. Clin Rev Allergy Immunol. 2012; 42 (1): p.102-11.doi: 10.1007/s12016-011-8294-7 . | Open in Read by QxMD
  13. Maman E, Bickels J, Ephros M, et al. Musculoskeletal Manifestations of Cat Scratch Disease. Clinical Infectious Diseases. 2007; 45 (12): p.1535-1540.doi: 10.1086/523587 . | Open in Read by QxMD
  14. Schmitt SK. Reactive Arthritis. Infect Dis Clin North Am. 2017; 31 (2): p.265-277.doi: 10.1016/j.idc.2017.01.002 . | Open in Read by QxMD
  15. Brown LE, Forfia P, Flynn JA. Aortic insufficiency in a patient with reactive arthritis: case report and review of the literature. HSS J. 2011; 7 (2): p.187-9.doi: 10.1007/s11420-010-9184-x . | Open in Read by QxMD
  16. Sonia Szamocki, Clarissa Martyn-Hemphill, James S.A. Green. Reactive arthritis: can't see, can't pee, can't climb a tree. Trends Urol Men's Health. 2016; 7 (1): p.17-20.doi: 10.1002/tre.501 . | Open in Read by QxMD
  17. Jacobson JA, Roberts CC, Bencardino JT, et al. ACR Appropriateness Criteria ® Chronic Extremity Joint Pain—Suspected Inflammatory Arthritis. J Am Coll Radiol. 2017; 14 (5): p.S81-S89.doi: 10.1016/j.jacr.2017.02.006 . | Open in Read by QxMD
  18. Bentaleb I, Abdelghani KB, Rostom S, Amine B, Laatar A, Bahiri R. Reactive Arthritis: Update. Curr Clin Micro Rpt. 2020; 7 (4): p.124-132.doi: 10.1007/s40588-020-00152-6 . | Open in Read by QxMD
  19. Lucchino B, Spinelli FR, Perricone C, Valesini G, Di Franco M. Reactive arthritis: current treatment challenges and future perspectives. Clin Exp Rheumatol. 2019; 37 (6): p.1065-1076.
  20. Freedberg DE, Kim LS, Yang Y-X. The Risks and Benefits of Long-term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association. Gastroenterology. 2017; 152 (4): p.706-715.doi: 10.1053/j.gastro.2017.01.031 . | Open in Read by QxMD
  21. Barber CE, Kim J, Inman RD, Esdaile JM, James MT. Antibiotics for Treatment of Reactive Arthritis: A Systematic Review and Metaanalysis. J Rheumatol. 2013; 40 (6): p.916-928.doi: 10.3899/jrheum.121192 . | Open in Read by QxMD
  22. Carlin E, Ziza J, Keat A, Janier M. 2014 European Guideline on the management of sexually acquired reactive arthritis. Int J STD AIDS. 2014; 25 (13): p.901-912.doi: 10.1177/0956462414540617 . | Open in Read by QxMD
  23. Petris CK, Almony A. Ophthalmic manifestations of rheumatologic disease: diagnosis and management. Mo Med. ; 109 (1): p.53-8.
  24. Meier K, Schloegl A, Poddubnyy D, Ghoreschi K. Skin manifestations in spondyloarthritis. Ther Adv Musculoskelet Dis. 2020; 12: p.1759720X20975915.doi: 10.1177/1759720X20975915 . | Open in Read by QxMD
  25. Braun J, Krüger K, Manger B, Schneider M, Specker C, Trappe HJ. Cardiovascular Comorbidity in Inflammatory Rheumatological Conditions. Dtsch Arztebl Int. 2017.doi: 10.3238/arztebl.2017.0197 . | Open in Read by QxMD
  26. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR. Recommendations and Reports. 2021; 70 (4): p.1-187.doi: 10.15585/mmwr.rr7004a1 . | Open in Read by QxMD

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