How Doctors Treat Reactive Arthritis

The recommended treatment for reactive arthritis depends on the patient, the initial infection, and the symptoms and their severity. Initial treatment may include antibiotics to clear the initial infection, though this is not common. Other treatments focus on relieving pain and other symptoms associated with reactive arthritis inflammation.

Antibiotics (Not Common)

In certain cases, antibiotics may be prescribed right away to clear up the original infection. Antibiotics are most often prescribed when reactive arthritis is triggered by Chlamydia infections, which can last for months (even though symptoms might not be present).

In most cases, however, the original infection goes away before reactive arthritis occurs. Moreover, antibiotics are usually not recommended to treat gastrointestinal infections—with or without reactive arthritis. In fact, people often report gastrointestinal side effects, such as stomach cramping and diarrhea, from taking antibiotics.¹Barber CE, Kim J, Inman RD, Esdaile JM, James MT. Antibiotics for treatment of reactive arthritis: a systematic review and metaanalysis. J Rheumatol. 2013;40(6):916-28.

When antibiotics are prescribed, the use of a probiotic may prevent opportunistic infections such as C. Diff (Clostridium Difficile),²Mcfarland LV. Primary prevention of Clostridium difficile infections - how difficult can it be?. Expert Rev Gastroenterol Hepatol. 2017;11(6):507-521.^,3Johnston BC, Goldenberg JZ, Parkin PC. Probiotics and the Prevention of Antibiotic-Associated Diarrhea in Infants and Children. JAMA. 2016;316(14):1484-1485. which can be life-threatening. Choose a probiotic that has been quality assured (carries the cGMP seal).

Whether or not antibiotics are prescribed, other pain-relieving medication may be recommended.

Medications for Pain Relief

In mild cases that last less than 6 months, patience and over-the-counter medications called NSAIDs may be all that is needed. If the person has moderate to severe joint pain, a doctor may recommend prescription NSAIDs and/or steroid treatment. For more severe or protracted cases, prescription medications called DMARDs and biologics may be recommended.

NSAIDs. Non-steroidal anti-inflammatories, such as ibuprofen and aspirin, may be taken to reduce inflammation and pain. These drugs are available over-the-counter or by prescription in higher strengths. Long-term daily use of NSAIDs can have side effects, including stomach, kidney, and liver damage, so patients and doctors should discuss other options if symptoms are prolonged.

See Pain Medications for Arthritis Pain Relief

Steroid injections. If NSAIDs have been taken for an extended period or do not adequately treat symptoms, the doctor may recommend a steroid injection into the painful joint(s). Steroid injections are not recommended more than once over 3 months, and caution must be used, especially around the Achilles and plantar fascia.

See Cortisone Injections (Steroid Injections)

Oral steroids. When NSAIDs and steroid injections do not work, or when several joints are affected, then oral steroids may be prescribed. Oral steroids reduce inflammation. Patients are advised to discuss possible side effects with their doctors before taking oral steroids.

DMARDs. Patients who have had symptoms for several months and have already tried NSAIDs and steroids may be advised to take disease-modifying antirheumatic drugs (DMARDs). DMARDs decrease inflammation by suppressing the immune system. The most common DMARD used to treat reactive arthritis is called sulfasalazine. Methotrexate is another DMARD option.

While DMARDs can reduce many reactive arthritis symptoms, they are usually less effective in reducing swelling in the fingers and toes (dactylitis) and treating planter fasciitis, Achilles tendonitis, or other types of enthesitis.

Biologics. If NSAIDs and DMARDs fail to control the painful symptoms of chronic reactive arthritis, a doctor may recommend biologic drugs. Examples of biologics used to treat reactive arthritis include etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade).

See Biologics: Basic Facts for Patients

These drugs target and prevent a specific biochemical reaction from happening in the body, stopping the inflammatory process in its tracks, before inflammation can be seen or felt.

See Biologics for RA and Other Autoimmune Conditions

Biologics are often effective but also carry serious side effects. Most notably, biologics suppress the immune system and make people more prone to infections.

See Risks and Side Effects of Biologics

What type of medication is used to treat reactive arthritis will depend on many factors, including the type of symptoms the patient is experiencing, the severity of those symptoms, the potential side effects of the medications, and patient and doctor preference.

A medication may be effective for many months or years and then slowly lose its effectiveness. When this happens, the patient and doctor may try a new medication(s).

Diet and Exercise

While it can be tempting to rely solely on medications to treat reactive arthritis, diet and exercise should not be dismissed. A poor diet can exacerbate inflammation in the body, so people should make an effort to eat whole foods like fresh fruits and vegetables. A gluten-free diet may also be of great benefit to help manage systemic inflammation. And even when joints are stiff and achy, gentle exercise and stretching can promote overall health. Water-based exercises may be preferred depending on which joints are involved.