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Diagnosis of Reactive Arthritis

Because there is no specific laboratory test to confirm reactive arthritis (ReA), doctors sometimes find it difficult to diagnose. As with other forms of spondyloarthritis, a rheumatologist is commonly the type of physician who will make a diagnosis of ReA. A medical examination, which may include various blood tests to rule out other conditions, is necessary. X-rays may also be ordered, and cell samples may be tested.

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Medical Exam

A doctor will take the patient's complete medical history, noting current symptoms as well as any previous diseases, problems, and infections. In addition to evaluating symptoms, diagnostic signs of reactive arthritis (ReA) include:

  • Long-standing, persistent low back pain that came on gradually (commonly radiating from the buttocks) before the age of 45. 
  • Generalized body stiffness that is most severe upon awaking, and gets better with exercise rather than worse. 
  • A history of swelling in the feet and hands, especially heel pain.

It may be useful to keep a log of symptoms that occur, noting when they occur and for how long. It is especially important to report any flu-like symptoms (e.g. fever, vomiting, diarrhea) even if they were mild, since they may be indicators of a bacterial infection.

Various blood tests may be ordered to help rule out other conditions when ReA is suspected. The presence of rheumatoid factor or antinuclear antibodies indicate the person may have a different form of arthritis, such as rheumatoid arthritis or lupus.

Other tests may be ordered to check for infections commonly associated with ReA. Testing for the presence of Chlamydia is important, as studies show that early treatment of Chlamydia-induced ReA may reduce the progression of the disease. 

A doctor may look for bacterial infections by testing cell samples from the patient’s throat, urethra, or cervix. Urine and stool samples also may be tested. A sample of synovial fluid (the fluid that lubricates the joints) may be removed from an arthritic joint and tested to rule out infection in the joint.

X-rays may also be ordered to determine sacroiliac involvement, swelling of the soft tissues, damage to cartilage, and bone deposits where the tendon attaches to the bone.

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