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Reactive arthritis - Nail and Distal Digit
See also in: Overview,Anogenital
Other Resources UpToDate PubMed

Reactive arthritis - Nail and Distal Digit

See also in: Overview,Anogenital
Contributors: Shari Lipner MD, PhD, Jonathan S. Hausmann MD, Susan Burgin MD
Other Resources UpToDate PubMed


Reactive arthritis (previously called Reiter syndrome) is a type of seronegative spondyloarthropathy that affects large joints of the lower extremities, typically 1-4 weeks following an episode of enteritis or urethritis. It is called "reactive" as opposed to "septic" because the arthritis is sterile; bacteria provoke the arthritis without directly invading the joint space. Typically, fewer than 5 joints are affected and it presents as acutely painful oligoarthritis. Patients can also complain of stiffness and pain of the lower back. Enthesitis is especially common, and dactylitis (sausage digits) can also be seen. Patients occasionally have systemic features, including fever, weight loss, and fatigue. Only a minority of patients present with the classic triad of arthritis, urethritis, and conjunctivitis.

Reactive arthritis may rarely occur in children; it is termed epidemic or post-dysenteric. In adults, it is termed epidemic or venereal. It was initially described after infections with specific bacteria: Chlamydia trachomatis, Shigella, Salmonella, Yersinia, and Campylobacter. However, recent studies have implicated Clostridioides difficile, Giardia, and other atypical infections as triggers for ReA. Chlamydia trachomatis is the most common trigger and it may be asymptomatic in 10% of patients. It is unclear how infections trigger the disease. When reactive arthritis is secondary to a gastrointestinal infection, it affects both sexes equally. However, reactive arthritis secondary to C trachomatis infection is more common in men. Those patients who are positive for human immunodeficiency virus (HIV) or human leukocyte antigen (HLA)-B27 typically have more severe arthritis.

Nail involvement affects 20%-30% of patients with reactive arthritis. Changes resemble those of nail psoriasis including onycholysis, nail pitting, subungual hyperkeratosis, and pustules affecting the nail folds. Paronychia is also common. Other reported findings are ridging, splitting, elkonyxis (loss of nail plate substance above the lunula only), and brown-red discoloration.

For most patients, reactive arthritis is a self-limited disease and they recover completely within 2-6 months. A chronic arthritis may persist in a minority, usually in association with HLA-B27 phenotype. Other patients can develop recurrent episodes of reactive arthritis after encountering the same organism.


M02.30 – Reiter's disease, unspecified site

67224007 – Reactive arthritis

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Last Reviewed:10/17/2017
Last Updated:10/16/2022
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Patient Information for Reactive arthritis - Nail and Distal Digit
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Contributors: Medical staff writer


Reactive arthritis (formerly called Reiter syndrome) is a type of arthritis triggered by infection. The infection causes an autoimmune reaction of arthritic joint pain, stiffness, and inflammation. The joints often affected are your knees, ankles, and joints in your upper extremities. The arthritis may also occur along the spine and lower back. A small number of patients also have inflammation in the urethra, eyes, and skin.

Reactive arthritis is a rare condition that usually goes away on its own in as few as 2-6 months. Less commonly, it can persist beyond 6 months (referred to as chronic reactive arthritis). It can also recur. Foodborne illnesses and sexually transmitted chlamydial infections are both common precursors to reactive arthritis.

Who’s At Risk

Reactive arthritis most commonly affects young adults (aged 20-40). Women and men develop reactive arthritis to foodborne infections at about the same rate, but men have a higher chance of developing reactive arthritis due to sexually transmitted bacteria. A family history of reactive arthritis also increases the likelihood of developing reactive arthritis.

The following bacteria have been known to cause reactive arthritis:
  • Chlamydia
  • Salmonella
  • Yersinia
  • Campylobacter
  • Shigella
  • Clostridioides difficile
  • Giardia

Signs & Symptoms

The symptoms of reactive arthritis typically begin 1-4 weeks after the initial infection. They may include:
  • Joint pain and swelling
  • Eye inflammation or pink eye
  • Increased frequency and discomfort during urination
  • Swollen toes and fingers (sausage digits)
  • Fever, fatigue, and weight loss
  • Changes in fingernails and toenails (ridging, peeling, discoloration)
  • Some people have changes in bowel movements, such as diarrhea or constipation

Self-Care Guidelines

These measures can be taken to reduce your risk of developing an infection that could lead to reactive arthritis:
  • Store food at its proper temperature and cook it properly
  • Use condoms to lower your risk of sexually transmitted infections

These measures can be taken to manage symptoms:
  • Talk to your doctor about following an anti-inflammatory diet
  • Exercise regularly, preferably with activities easy on the joints (swimming, walking, bicycling)
  • Do stretching exercises to maintain joint movement and range of motion

When to Seek Medical Care

Contact your health care provider if you have joint pain or swelling for longer than a week.


If your reactive arthritis is caused by a bacterial infection that is still active, your health care provider may prescribe an antibiotic.

To relieve the symptoms of arthritis, the health care provider may recommend:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve inflammation, such as ibuprofen
  • Corticosteroid injections into joints to reduce inflammation
  • Some types of rheumatoid arthritis drugs help to reduce pain
  • Physical therapy to increase strength of joints, joint flexibility, and range of motion
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Reactive arthritis - Nail and Distal Digit
See also in: Overview,Anogenital
A medical illustration showing key findings of Reactive arthritis : Abdominal pain, Fatigue, Fever, Hands and/or feet, Low back pain, Pustule, Thick scaly plaque, Arthralgia, Conjunctival injection, Dysuria, Myalgia, General weakness
Clinical image of Reactive arthritis - imageId=167480. Click to open in gallery.  caption: 'A close-up of brown, incipient crusts, some with overlying scale, on the sole.'
A close-up of brown, incipient crusts, some with overlying scale, on the sole.
Copyright © 2023 VisualDx®. All rights reserved.