Reactive Arthritis (Formerly Reiter's Syndrome)

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Jerry R. Balentine, DO, FACEP
    Jerry R. Balentine, DO, FACEP

    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

What is the treatment for reactive arthritis?

Treatment of reactive arthritis is based on where it has become manifest in the body. For joint inflammation, patients are generally initially treated with nonsteroidal anti-inflammatory drugs (NSAIDs). These medications include aspirin, indomethacin (Indocin), tolmetin (Tolectin), sulindac (Clinoril), piroxicam (Feldene), and others. Among their potential side effects are gastrointestinal irritation, including ulceration and bleeding. They should be taken with food to minimize this risk. Corticosteroids, such as prednisone, can be helpful to reduce inflammation and are used in the short-term treatment of inflammation in reactive arthritis. They can be given by mouth or by local injection into the joint. They are also used to decrease tendon inflammation in some forms of tendinitis.

Antibiotics may be prescribed if one still has the infection that triggered reactive arthritis.

Sulfasalazine (Azulfidine) has been shown to be effective in some patients with persistent reactive arthritis. Potential side effects of this sulfa-based medication include sulfa rash reaction and suppression of the bone marrow. Therefore, blood counts are monitored when Azulfidine is used long-term.

For the aggressive inflammation of chronic joint inflammation in reactive arthritis, medications that suppress the immune system, including the DMARD methotrexate (Rheumatrex, Trexall), are used. Methotrexate can be given orally by injection. It is given on a weekly basis and requires regular monitoring of blood counts and blood liver tests because of potential toxicity to the bone marrow and liver.

Tumor necrosis factor blockers (TNF): The cell protein TNF acts as an inflammatory agent in rheumatoid arthritis. There is some evidence that TNF blockers can also be helpful in reactive arthritis.

Reactive arthritis has been reported in association with HIV infection (AIDS virus). In this context, immune-suppression medicine is generally avoided because of the potential for worsening the HIV disease.

Eye inflammation can be alleviated with anti-inflammatory drops. Some patients with severe iritis require local injections of cortisone to prevent damaging inflammation to the eye, which can lead to blindness.

The inflammation around the penis can be helped by cortisone creams (such as Topicort). When bacteria are discovered in the bowel or urine, antibiotics specific for those bacteria are given.

Exercise has shown to help people with arthritis. You should have a physical therapist show you specific exercises for your joints.

Medically Reviewed by a Doctor on 6/7/2017

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