Reactive arthritis is triggered by an infection, and in most cases, the infection has resolved by the time reactive arthritis symptoms appear. Initially, only one joint may be affected, but over time more joints may become painful.
In addition to joint pain, people may experience other symptoms that affect the eyes and skin.
Arthritic joint pain. Arthritis inflammation can make a joint achy, swollen, and/or red. In cases or reactive arthritis, it is common for the knee joint to become inflamed.
Back or neck pain. People with reactive arthritis may experience back pain due to:
- Spondylitis, inflammation of the vertebrae in the spinal column, or
- Sacroiliitis, inflammation of the joints that connect the spine to the pelvis.
Swollen fingers or toes (dactylitis). It is common for joints in the fingers and/or toes to become inflamed, causing “sausage digits”—the fingers or toes become so swollen they look like sausages.
Enthesopathy. In addition to joint inflammation, joint pain may be caused by changes to an enthesis (en-THEE-sis), the point where a ligament or tendon attaches to bone. An enthesis may become irritated, degraded, or inflamed. The medical name for this is enthesopathy (en-THEE-sawp-a-thee), and it often affects the:
- Achilles tendon (Achilles tendonitis), or
- Planter fascia (plantar fasciitis)
See What Is Enthesopathy and Enthesitis?
Enthesopathy may also affect the knee or other joints.
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Eye inflammation. Inflammatory eye conditions are associated with reactive arthritis, including conjunctivitis (pink eye) and episcleritis. More serious eye problems, such as keratitis and anterior uveitis, are also possible. Patients who have unexplained redness, eye pain, or vision problems in one or both eyes should promptly see an ophthalmologist.
Skin symptoms. Some people with reactive arthritis report skin problems, including:
- Keratoderma blennorrhagicum, a skin rash that can occur on the bottoms of the feet, palms of hands, genitals, or anywhere else on the body.
- Erythema nodosum, the appearance of bruise-like blotches that typically appear on the shins and may be tender to the touch.
- Mouth or genital ulcers.
Genital discharge or trouble urinating. People who have reactive arthritis because of an infection of the genitals or urethra may experience genital discharge. They may also experience painful, frequent, or difficult urination.
Heart problems. While not common, reactive arthritis, particularly chronic reactive arthritis, can lead to heart problems. These problems include an abnormal heart rhythm, aortic valve insufficiency, or the inflammation of certain tissues lining the heart, which can cause a stabbing chest pain.
Some research suggests that people who have the HLA-B27 gene are more likely to experience severe symptoms and/or chronic symptoms. Testing for this gene may be done as part of the assessment.