Reactive arthritis is an uncommon form of arthritis. It occurs as a reaction to a bacterial infection elsewhere in the body, such as a urinary tract infection. Experts believe that some viruses can cause reactive arthritis.

Arthritis is a condition that affects the joints, causing inflammation, stiffness, and pain. Unlike other types of the condition, reactive arthritis usually resolves on its own within a few months.

After the initial infection, reactive arthritis can appear several days to weeks later. Experts believe it is due to an overreaction by the body’s immune system.

Although bacteria are the typical trigger for reactive arthritis, some viruses, such as parvoviruses, may play a role in reactive arthritis.

This article explores if viruses can cause reactive arthritis.

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Reactive arthritis is a poorly defined condition. However, doctors widely accept that it occurs due to bacterial infections elsewhere in the body.

These infectious agents may occur within the genitourinary or gastrointestinal tracts. Examples of bacteria in the genitourinary tract include:

  • Chlamydia trachomatis
  • Neisseria gonorrhoeae
  • Mycoplasma hominis
  • Ureaplasma urealyticum
  • Escherichia coli

Infectious agents of the gastrointestinal tract include:

  • Salmonella enteritidis
  • Shigella flexneri and Shigella disenteriae
  • Yersinia enterocolitica
  • Campylobacter jejuni
  • Clostridium difficile

A person typically develops arthritic symptoms in the large joint around 1 to 4 weeks following infection.

However, doctors now believe reactive arthritis, a type of spondyloarthritis, may occur after any infection, including viral ones. While the infectious agents might not always cause direct damage to the joint, they can affect how the immune system responds to them. An atypical response can cause arthritis.

There is very little research discussing whether viruses can cause reactive arthritis. However, they can trigger viral arthritis.

Various viruses can cause viral arthritis, but the most common include:

Doctors now believe that HIV-induced arthritis is more common than they previously suspected. Around 30% of people with HIV might experience viral-induced arthritis as the first sign of their illness. Some of these individuals may either develop reactive arthritis or psoriatic arthritis.

Health experts do not fully understand the mechanism behind viral arthritis.

They believe viruses may invade the joint or cause immune complex formation.

An immune complex formation occurs when the body’s immune system makes antibodies to fight the infection. When these antibodies bind to the viral antigens, they form a complex. These compounds can become trapped in the joints and cause inflammation.

The synovium is the connective soft-tissue membrane lining the joint capsules. It contains many arthritis-causing viruses. These viruses can recruit inflammatory cells to the joints and cause a cascade of inflammation.

For example, with the alphaviruses, infections in the macrophages — a type of white blood cell — in the synovium are responsible for inflammation. Macrophages are specialized cells that detect and destroy harmful organisms. They can also release pro-inflammatory cytokines, which contribute to the inflammation cycle.

Reactive arthritis commonly affects white males, typically between the ages of 20 and 40 years. Females usually have milder symptoms and may not always receive a diagnosis.

However, everyone from children to older adults can be at risk.

Males are around nine times more likely to develop reactive arthritis following a sexually transmitted infection. Additionally, the risk of developing reactive arthritis after a gastrointestinal infection is the same for all individuals.

Symptoms of reactive arthritis can usually last from several days to several weeks and may come and go. However, in up to 50% of people, symptoms may return later in life or become a chronic problem. Most symptoms resolve within 6 months.

Some individuals with reactive arthritis experience mild symptoms of arthritis. Others may have no symptoms, and only lab testing will detect the pathogen. Individuals typically develop inflammation in the below areas:

  • The joints: Typically, two or more joints become involved within a few days, and the disease progresses rapidly. Symptoms can include:
    • pain
    • swelling and pain in lower joints, such as knees, feet, and ankles
    • swelling in the upper joints, such as the hands
    • heel pain
    • inflammation in the spine or the lower back where the spine connects to the pelvis
  • Urinary tract: It can affect the bladder or urethra, which helps excrete urine. If people experience symptoms, they will include:
    • pain when urinating
    • a need to urinate more often
    • females experiencing inflammation of the cervix, fallopian tubes, vulva, and vagina
  • Eyes: It can cause symptoms of inflammation in the eye area or conjunctivitis. Symptoms include:
    • pain
    • irritation
    • redness
    • blurry vision
    • atypical sensitivity to light, which doctors call photophobia

Reactive arthritis can also affect other parts of the body.

Skin rashes can occur on the palms and soles that may resemble psoriasis. A person may develop painless ulcers on the genitals and mouth area. They may also experience diarrhea that can occur with gastrointestinal infections.

Learn more about the symptoms of reactive arthritis.

Reactive arthritis is a clinical diagnosis, meaning that a doctor will reach a conclusion according to a person’s symptoms and medical history. No one test can confirm the diagnosis.

Serology testing may help identify the pathogen that is causing disease in some cases. These tests measure the amount of antibodies in the blood — these antibodies may be specific to the bacteria or virus.

However, a positive serology test does not always mean that the person currently has an infection. It may only indicate that they had the infection previously.

Doctors may use imaging studies to rule out other causes of arthritis or to assess for joint damage. These may include:

Additionally, the doctor may aspirate the joint — which involves removing fluid from it — to rule out other causes of joint swelling, including septic arthritis or crystalline arthritis. In reactive arthritis, the virus cannot be cultured from the joint. The joint fluid of reactive arthritis typically shows nonspecific inflammatory changes.

If someone has complications, such as uveitis — inflammation of the eye, a doctor may refer them to an ophthalmologist for further diagnostic testing and treatment.

The goal of treatment is to relieve pain and improve the function of affected areas. Typically, the treatment a doctor recommends depends on the stage of reactive arthritis.

If in the early and acute stage, a doctor may suggest nonsteroidal anti-inflammatory drugs. These medications can reduce inflammation, swelling, and pain. Options include:

  • naproxen (Aleve)
  • diclofenac (Voltaren)
  • celecoxib (Celebrex)

During the chronic stage, reactive arthritis may require medications called disease-modifying antirheumatic drugs. Examples of this type of drug include methotrexate or sulfasalazine.

Sulfasalazine is more useful when a gastrointestinal infection is causing reactive arthritis.

In some cases, very inflamed joints may benefit from corticosteroid injections.

For active infections that are underlying, such as genitourinary infections, doctors may recommend antibiotics. For example, doctors may suggest them for people with reactive arthritis and an active Chlamydia trachomatis infection as an underlying cause. However, for chronic arthritis, healthcare professionals do not generally recommend antibiotics.

Reactive arthritis is a form of arthritis that develops as a reaction to a bacterial infection. Doctors know little about whether viruses cause reactive arthritis. However, some viruses can cause viral arthritis.

Arthritic conditions cause pain, redness, and swelling in the joints. Reactive arthritis can also cause inflammation of the urinary tract, eyes, and other tissues.

Doctors typically diagnose reactive arthritis clinically, and no single test can confirm the diagnosis. Treatment focuses on relieving symptoms and improving function.