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Tests and diagnosis
By Mayo Clinic staffReactive arthritis can go undiagnosed for a long time because your signs and symptoms may be mild. While there is no single test that will confirm a diagnosis of reactive arthritis, the results of a variety of tests make it possible to rule out other conditions that may be causing your signs and symptoms.
Physical examination
During a physical exam, your doctor may check:
- The range of motion in your affected joints
- Your skin for rashes
- Your eyes for inflammation
Blood tests
Samples of your blood can reveal:
- Infections. Sometimes, the triggering bacteria are still evident in your blood. But in many cases, your reactive arthritis symptoms begin long after you've recovered from the infection.
- Inflammation. Your doctor may check a blood test to see if you have an elevated sedimentation rate — which is the speed at which your red blood cells settle to the bottom of a tube. An elevated rate can indicate inflammation. People with reactive arthritis often have an elevated sedimentation rate.
- Evidence of other problems. Rheumatoid factor is an antibody often found in the blood of people with rheumatoid arthritis. Anti-nuclear antibodies are proteins that are generally found in people who have connective tissue or autoimmune disorders. If you have reactive arthritis, you'll probably test negative for rheumatoid factor and anti-nuclear antibody, meaning neither antibody is detected in your blood.
- Genetic markers. The inherited HLA-B27 antigen increases your risk of reactive arthritis. Reactive arthritis can also occur in people without HLA-B27.
Joint fluid tests
Your doctor may use a needle to withdraw a sample of fluid from within an affected joint. This fluid will be tested for:
- Infections. Even though reactive arthritis is triggered by an infection in another part of your body, this infection doesn't affect your joints. If an infection is found in your joint fluid, you may have septic arthritis, which can result in severe joint damage.
- Crystals. If uric acid crystals are found in your joint fluid, you may have gout. This very painful type of arthritis often affects the big toe.
Tests of other body fluids
Your doctor may also check for infections in your:
- Urine
- Stool
- Genital secretions
- Throat mucus
Imaging tests
X-rays of your joints can indicate whether you have any of the characteristic signs of reactive arthritis, including soft tissue swelling, calcium deposits where tendons attach to bones and cartilage damage. X-rays can also rule out other types of arthritis.
- Lam GK, et al. Reactive arthritis. In: Imboden JB, et al. Current Rheumatology Diagnosis & Treatment. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2007. http://www.accessmedicine.com/content.aspx?aID=2725203. Accessed Jan. 31, 2011.
- Yu DT. Reactive arthritis (formerly Reiter syndrome). http://www.uptodate.com/home/index.html. Accessed Jan. 27, 2011.
- Questions and answers about reactive arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Reactive_Arthritis/default.asp. Accessed Jan. 27, 2011.
- Yu DT, et al. Undifferentiated spondyloarthritis and reactive arthritis. In: Firestein GS, et al. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2009. http://www.mdconsult.com/das/book/body/208746819-6/0/1807/0.html. Accessed Jan. 31, 2011.
- Septic arthritis. American Association for Clinical Chemistry. http://www.labtestsonline.org/understanding/conditions/septic.html. Accessed Jan. 27, 2011.
- Questions and answers about gout. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Gout/default.asp. Accessed Jan. 27, 2011.
- Carter JD, et al. Reactive arthritis: Clinical aspects and medical management. Rheumatic Disease Clinics of North America. 2009;35:21.
- Wechalekar MD, et al. Prolonged remission of chronic reactive arthritis treated with three infusions of infliximab. Journal of Clinical Rheumatology. 2010;16:79.
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