Did I Just Get Reactive Arthritis From Chlamydia?

Chlamydia is one of the most prevalent sexually transmitted diseases (STDs) in the United States. It can produce an array of serious side effects, such as pelvic inflammatory disease (PID), infertility and, in some cases, arthritis.

Reactive arthritis, formerly known as Reiter syndrome, is a rare form of autoimmune disease that occurs in response to a bacterial infection somewhere in the body—usually the urinary or gastrointestinal tract. Most cases stem from chlamydia, or from salmonella, a bacteria that causes food poisoning. Other bacteria that can trigger reactive arthritis include Campylobacter, shigella and Yersinia.

"Reactive arthritis is an inflammatory response to bacteria that can cause symptoms like pain and swelling in the joints, persistent lower back pain, swelling in extremities like the fingers and toes, and other uncomfortable symptoms," said Mahmud Kara, M.D., founder and CEO of KaraMD, a supplements manufacturer in Cleveland.

The condition isn't contagious and often resolves with the original infection. However, Kara and other health experts stress early detection and treatment are key to diminishing chronic disease risks or complications.

What causes reactive arthritis?

Kara explained that inflammation is one way the immune system works to defend the body against threats such as bacteria, viruses and toxins. When deployed appropriately, inflammation can help eliminate harmful substances and accelerate recovery. Sometimes, the immune system becomes confused, however. It mistakes healthy cells for harmful ones and proceeds to attack them—a phenomenon known as autoimmunity.

With reactive arthritis, it appears the immune system mistakes cells in the synovium (joint lining) for harmful bacteria, according to Dalit Ashany, M.D., a rheumatologist at the Hospital for Special Services in New York City.

Why this happens is uncertain. However, she explained that some research indicates cells within the joint synovium may resemble ones found in infectious organisms, such as those associated with chlamydia. This is a phenomenon known as "molecular mimicry."

Reactive arthritis is different from septic arthritis, in which the triggering bacteria are found within the joints. And unlike rheumatoid arthritis or adult-onset Still's disease (AOSD), it affects four or fewer joints, rather than the entire body.

Signs and symptoms of reactive arthritis

Reactive arthritis affects everyone differently, and its course can be inconsistent, even among people exposed to the same triggering organisms at the same time, according to Elliot Rosenstein, M.D., one of the directors of the Institute for Rheumatic & Autoimmune Disease at Overlook Medical Center in Summit, New Jersey.

Generally, symptoms arise within a few weeks after the initial infection, said Tarek Kteleh, M.D., a rheumatologist with Rheumatology of Central Indiana based in Muncie, Indiana. These symptoms affect multiple body parts, most prominently the lower extremities and urinary tract.

"One of the reactive arthritis criteria is a triad which they have a lot of the time," he added. "We in medicine call it, 'the patient cannot see, cannot pee and cannot climb the tree.'"

Specifically, symptoms usually include one or more of the following, according to these health experts and Mayo Clinic:

• Conjunctivitis (pink eye). The eyes can become inflamed and red. Rarely, deeper layers of the eye can be affected, which can interfere with vision and cause eye pain and light sensitivity.
• Heart inflammation. Rarely, the disease can affect the heart, causing issues such as an abnormal heart rhythm, aortic valve insufficiency and chest pain.
• Inflammation of sites where tendons and ligaments attach to the bone. Termed enthesitis or enthesopathy, this usually occurs in the plantar fascia.
• Joint inflammation and pain. Usually, reactive arthritis affects joints in the lower extremities, including the knees, ankles and feet. Some people have pain in the heels, low back or buttocks, as well.
• "Sausage digits." Individual fingers and toes can swell and resemble sausages.
• Skin problems. About 15 percent of people develop skin issues such as rashes that resemble psoriasis, typically on the penis, palms of the hands or soles of the feet. Shallow ulcers (usually painless) can occur on the mouth or genitals. On the genitals, these ulcerations are generally on the glans or shaft of the penis, or at the mouth of the urethra.
• Urinary issues. These can resemble a urinary tract infection and include increased frequency, difficulty or discomfort while urinating, cloudy urine, and blood in the urine. Other manifestations include inflammation of the prostate gland, bladder, urethra or cervix.

These symptoms might not all appear at once. They may dissipate or disappear for weeks or months, then worsen or re-emerge. However, unlike most types of arthritis, reactive arthritis tends to be self-limited. No one knows why, Kteleh said, but one theory is that the immune system self-corrects after the instigating infection is gone.

Most people have notable symptoms for three to five months, according to Ashany, and the disease typically resolves completely within a year.

However, about 15 percent to 50 percent of people who recover from reactive arthritis develop symptoms again, according to Cleveland Clinic. Any subsequent episodes could indicate new bacterial infections. About 15 percent to 20 percent of people develop chronic arthritis, Ashany noted, and some develop characteristics of related diseases, such as psoriatic arthritis, ankylosing spondylitis or arthritis associated with inflammatory bowel disease (IBD).

In rare cases, other serious complications, such as permanent damage to the urethra, can occur, according to Kteleh and Ashany.

Carriers of the HLA B27 genetic variant are at higher risk for relapses and chronic disease, added Kanika Monga, M.D., a rheumatologist with Houston Methodist Academic Institute in Texas.

Risk factors for reactive arthritis

Reactive arthritis is most prevalent in men between ages 30 and 50, though women get it, too. The condition affects about 5 in 100,000 people in the U.S.

"It is not entirely certain why some people develop reactive arthritis and others exposed to the same potential triggers do not," Rosenstein said.

There may be a genetic component, he added. The genetic variation HLA B27 seems to interact with the organisms that trigger the disease in such as way as to "potentiate" inflammation. About 30 percent to 50 percent of people with reactive arthritis have this genetic variant.

Some research suggests men are nine times more likely to develop the disease through an STD/STI, while all people are equally or more likely to get it through spoiled food, according to Cleveland Clinic and Mayo Clinic.

"This may be because the male urethra (the tube that carries urine out of the body) is much more likely to get infected during sexual intercourse," Monga noted. "The urethra in males is both a part of their reproductive tract (used for ejaculation) and urinary tract whereas for females it is only a part of their urinary tract."

More recent studies, including a 2017 review published in Clinical Rheumatology, have challenged the disparity, indicating a similar incidence rate in men and women. It is possible, Ashany and the study authors said, that females may be vastly underdiagnosed.

According to experts, that may be partly because certain STDs/STIs are more likely to be asymptomatic, and thus go undiagnosed, in women.

"An infection can spread without initially being aware that an infection is present in the first place," Kara said. "Early treatment is crucial in preventing reactive arthritis."

Prevention of reactive arthritis

"The best way to reduce the risk of getting reactive arthritis is to avoid getting the inciting infection in the first place," Ashany said.

You can't change your genetic makeup, but you can practice safer sex and food-handling habits to protect yourself from reactive arthritis and the bacteria responsible for it.

To prevent STDs (like chlamydia) and STIs, practicing safer sex and using barrier methods, like condoms, is a good place to start, according to experts. They recommend frequent and regular STI testing, particularly if you're at high risk or notice any potential symptoms.

"When it comes to food-related bacteria like salmonella, make sure you frequently wash your hands while cooking, keep your food area clean and sanitized, store your food at the proper temperatures, etcetera," Kara said. "Here as well, in the event of a confirmed infection, early treatment is very important."

Diagnosis

Diagnosing reactive arthritis generally begins with a physical exam. A healthcare provider will examine your joints for swelling, tenderness and warmth, and test your range of motion, according to Mayo Clinic. They may check for additional symptoms such as rashes, conjunctivitis and ulcers.

Next, they might run a blood test to identify infections, signs of inflammation, antibodies and the genetic variant HLA B27, per Mayo Clinic. An antibody test can help rule out other diseases, such as rheumatoid arthritis or lupus, which can produce similar symptoms.

Additional tests might include:

• Joint aspiration
• Urinalysis
• X-rays
• CT (computerized tomography) scan
• MRI (magnetic resonance imaging)

Treatment

Once a doctor has determined reactive arthritis is present, they'll address the underlying infection, most often with antibiotics.

About 95 percent of people can cure chlamydia successfully with antibiotics, and success rates are similar to other infections. Although reactive arthritis isn't contagious, STIs are, so prevent their transmission by taking medication as directed and practicing safer sex.

Food poisoning usually resolves on its own within a week without long-term repercussions but in some cases can lead to complications such as dehydration, meningitis and kidney damage.

To ameliorate mild arthritis symptoms, nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen are generally suitable, Kteleh said.

However, if symptoms are severe and the condition advanced, a doctor might recommend disease-modifying antirheumatic drugs (DMARDs) such as methotrexate to slow disease progression. Additionally, a provider might suggest corticosteroid injections to alleviate inflammation and pain.

Remember, reactive arthritis isn't contagious. Cases often resolve when the infection that caused them resolves. That doesn't mean, however, that early detection and treatment aren't important to mitigating the condition's potential risks and complications.