Dr. Abhijeet Bhosikar
Spondyloarthritis

Reactive Arthritis — Treatment in Pune

Also known as: ReA · Post-infectious Arthritis

Arthritis that follows an infection elsewhere — usually self-limiting, occasionally not.

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What is Reactive Arthritis?

Reactive arthritis is a sterile joint inflammation that develops one to four weeks after an infection at a distant site — most often the gut or the genitourinary tract. The joint itself is not infected.

It classically affects a few large joints of the lower limb asymmetrically, often with enthesitis, dactylitis, eye inflammation and sometimes urethritis.

Most cases settle within three to six months. A minority persists and evolves into chronic spondyloarthritis, particularly in HLA-B27-positive patients.

A therapist's hands assessing a patient's lower backIllustrative
Inflammatory back pain is worse at rest and better with movement — the opposite of a mechanical strain.

In the Indian context

Post-dysenteric reactive arthritis following Salmonella, Shigella or Campylobacter infection is comparatively common in India, and is frequently mistaken for rheumatic fever or dismissed as 'weakness after typhoid'.

Symptoms of Reactive Arthritis

Early signs

  • Sudden painful swelling of a knee, ankle or foot joint, one to four weeks after a gut or urinary infection
  • Asymmetric involvement of a few lower-limb joints
  • Heel pain from Achilles or plantar fascia enthesitis
  • Red, gritty eyes (conjunctivitis)
  • Burning on passing urine or urethral discharge

If left untreated

  • Persistent arthritis lasting beyond six months
  • Inflammatory low back pain and sacroiliitis
  • Keratoderma blennorrhagicum on the soles, or circinate balanitis
  • Nail changes resembling psoriasis
  • Recurrent uveitis

Causes & risk factors

  • Gastrointestinal infection: Salmonella, Shigella, Campylobacter, Yersinia
  • Genitourinary infection: Chlamydia trachomatis, Ureaplasma
  • HLA-B27 positivity, which raises both risk and likelihood of chronicity
  • Rarely, post-vaccination or other infective triggers

How Reactive Arthritis is diagnosed

No single test diagnoses a rheumatic disease. The diagnosis comes from combining the pattern of symptoms, the examination findings, and only the investigations that answer a specific question.

  1. Detailed infection history

    Specific questioning about diarrhoea, fever or urinary symptoms in the preceding six weeks — patients rarely connect the two themselves.

  2. Joint aspiration

    Essential to exclude septic arthritis and crystal disease. In reactive arthritis the fluid is inflammatory but sterile.

  3. Infection testing

    Stool culture, Chlamydia NAAT on first-void urine, and HIV testing where the presentation is severe or atypical.

  4. HLA-B27 and inflammatory markers

    Support the diagnosis and help predict which patients will develop chronic spondyloarthritis.

  5. Imaging

    Ultrasound for enthesitis and effusion; sacroiliac imaging where back pain persists.

Treatment options

NSAIDs at full anti-inflammatory dose

First-line, and sufficient for the majority of cases.

Intra-articular corticosteroid injection

Highly effective for one or two persistently swollen joints, once infection has been definitively excluded.

Treating the triggering infection

Antibiotics for confirmed Chlamydia, including partner treatment. Antibiotics do not shorten post-dysenteric arthritis once it has started.

DMARDs for persistent disease

Sulfasalazine or methotrexate when arthritis continues beyond three to six months.

Biologics for chronic cases

TNF inhibitors for the small proportion that evolves into treatment-resistant chronic spondyloarthritis.

Physiotherapy

Maintains range of movement and manages enthesitis, especially at the heel.

Seek urgent medical attention if you have

  • A single hot joint with high fever — septic arthritis until proven otherwise
  • Painful red eye with visual blurring (uveitis, not conjunctivitis)
  • Symptoms persisting beyond six months
  • New back pain and morning stiffness suggesting progression to axial disease
  • Severe or unusual presentation warranting HIV testing

Do not wait for a scheduled appointment for any of the above. Call the clinic on +91 70571 19999 or attend the nearest emergency department.

Frequently asked questions about Reactive Arthritis

Will it go away on its own?
In most patients, yes — the majority resolve within three to six months. A minority, particularly those who are HLA-B27 positive, develop chronic spondyloarthritis and need ongoing treatment.
Do I need antibiotics?
Only if an active infection is still present, most importantly Chlamydia. Once post-dysenteric reactive arthritis has begun, antibiotics do not change its course — the infection has already cleared and the immune response is the problem.
Can it come back?
Yes, particularly after another gut or genitourinary infection. Food and water hygiene and safe sexual practice are genuinely preventive here.

Get an expert opinion on Reactive Arthritis in Pune

Consultations at the Ravet clinic in Pimpri-Chinchwad. Bring your previous reports — a properly reviewed history usually saves repeating tests.

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Part of a wider group

Spondyloarthritis & Back PainBack pain that is worse at rest and better with movement is not a mechanical strain.

Related conditions

  • Ankylosing Spondylitis

    The back pain that improves with exercise and worsens with rest — and is missed for years.

  • Psoriatic Arthritis

    When psoriasis moves into the joints — often years after the first skin patch.

  • Gout

    The most curable form of arthritis — and the most commonly mistreated.

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