Diagnosis of Reactive Arthritis

There is no single test that doctors can use to diagnose reactive arthritis, but they may suspect that you have it if you have joint pain, and have had an infection of the digestive or urinary tract or the genitals in the past few weeks. The process doctors use to diagnose the condition typically involves the following.

Other types of spondyloarthritis can exhibit similar symptoms, including:

• Psoriatic arthritis.
• Ankylosing spondylitis.
• Inflammatory bowel disease-associated arthritis.
• Undifferentiated spondyloarthritis (variety of symptoms that are not specific to any one type).

Medical History and Physical Exam

During the examination, the doctor usually:

• Asks about your symptoms and when they began, including symptoms of a recent infection.
• Checks your joints for signs of tenderness or swelling, and skin and mucosal surfaces for rashes or ulcers.
• Examines your eyes for signs of inflammation.

Lab Tests

The doctor may order the following tests.

• HLA-B27. This blood test looks for the presence of HLA-B27, a genetic risk factor for reactive arthritis. Having this marker is consistent with having reactive arthritis, but it is not definitive—people who test negative can still have reactive arthritis, and not everyone who tests positive has the condition.
• Bacterial cultures. Culturing stool and urine specimens may reveal the presence of bacteria that frequently trigger reactive arthritis. But a negative result is not conclusive because in most cases, the infection has cleared by the time arthritic symptoms arise.
• Joint fluid (synovial fluid) test. This test is to assess the level of inflammation in the joint, and to rule out other causes for the pain, such as a joint infection or other condition, such as gout. The doctor will draw fluid from a joint using a needle and syringe, and will send it to a lab for analysis.
• Erythrocyte sedimentation rate (sed rate) and C-reactive protein. These blood tests are measures of inflammation, but they are not specific for reactive arthritis. A positive test result can indicate any inflammatory disorder. A negative test result does not rule out reactive arthritis because these markers are usually not elevated in the chronic form of the condition.

Imaging Studies

The doctor may order the following scans.

• X-rays can reveal the status of the joints, including signs of reactive arthritis such as inflammation of the sacroiliac joints in the lower back. They can also help rule out other causes of joint pain. X-rays often do not pick up abnormalities until later in the course of reactive arthritis.
• Ultrasounds, computed tomography (CT), and magnetic resonance imaging (MRI). These specialized imaging techniques are especially useful for visualizing joint changes that happen in the early stages of reactive arthritis.

Other Tests

To rule out conditions that have similar symptoms, doctors may order other types of blood tests, such as:

• Rheumatoid factor (RF) and anticyclic citrullinated peptide (anti-CCP) antibody tests, which are associated with rheumatoid arthritis.
• Antinuclear antibody (ANA) test, which is associated with systemic lupus erythematosus.

Treatment of Reactive Arthritis

There is no cure for reactive arthritis, so treatment is aimed at alleviating the symptoms. Doctors tailor treatment to each individual’s symptoms. Your doctor might use one or more of the following:

Medications

• Over-the-counter or prescribed anti-inflammatory and pain medications. These can help alleviate pain and swelling of the joints.
• Corticosteroids. Usually, these are injected into affected joints, but if multiple joints are involved, your doctor may prescribe them by mouth or intravenously. They are potent drugs, so doctors typically prescribe the lowest dose possible to achieve the desired benefit. You may need corticosteroid creams or eye drops for skin and eye symptoms, respectively.
• Disease-modifying anti-rheumatic drugs (DMARDs). These medicines suppress the immune system on a broad level, helping to block inflammation in the joints and other tissues. Doctors usually only use them when anti-inflammatories and corticosteroids have not worked.
• Antibiotics. Doctors may prescribe antibiotics if there is evidence of a current bacterial infection.

Physical Therapy

Physical therapy can help ease pain and improve joint function. A physical therapist can teach techniques for strengthening the muscles that surround a joint, providing support and improving joint flexibility.

Who Treats Reactive Arthritis?

Diagnosing and treating reactive arthritis usually requires a team effort involving several types of health care professionals. The condition is primarily treated by:

• Rheumatologists, who specialize in arthritis and other diseases of the bones, joints, and muscles.

Other health care specialists who may be involved in your care include:

• Dermatologists, who specialize in conditions of the skin, hair, and nails.
• Gynecologists, who specialize in the female reproductive system.
• Mental health professionals, who can help people cope with difficulties in the home and workplace that may result from their medical conditions. 
• Occupational therapists, who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy. 
• Ophthalmologists, who specialize in treating disorders and diseases of the eye. 
• Orthopaedists, who treat and perform surgery for bone and joint diseases.
• Physical therapists, who improve quality of life through prescribed exercise, hands-on care, and patient education.
• Primary care doctors, such as family physicians or internal medicine specialists, who coordinate care between the different health care providers and treat other problems as they arise.
• Urologists, who treat diseases of the urinary tract and male reproductive system.