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Reactive Arthritis Lawyer:  Post-Infectious Reactive Arthritis

A recent gastrointestinal infection from a foodborne pathogen can lead to post infectious reactive arthritis (or “post infectious RA”). These cases of RA are called post-infectious RA because they are follow an original bacterial[1] or viral infection derived from a food borne pathogen such as salmonella, Campylobacter, Yersinia, Shigella, E. coli, and Vibrio (among bacteria) and the flu, HIV, and Parvovirus (among viruses).[2] While close to 95% of victims of food borne illness will not acquire post infectious RA, it is found routinely in about 5% of the population who have suffered a recent bout of food borne illness.[3] 

Unfortunately, post infectious RA can be much worse than the initial illness and have life-long consequences, including the most common effect, recurring joint pain and swelling in one or more joints.  But while post infectious RA tends to target the joints in a person’s knees, ankles, and feet, according to the Mayo Clinic, RA inflammation can also cause serious swelling or inflammation in the eyes, skin, and urethra.[4]

Some cases of post infectious RA can resolve in a matter of months, but in many more it can last years and develop into a life-long condition that, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, will require a great deal of medical treatment such as pharmaceutical, surgery, or alternative therapies.[5]

Reiter’s Syndrome: Closely linked to reactive arthritis, and sometimes used interchangeably while diagnosing such disorder, is Reiter’s syndrome.  Reiter’s Syndrom has similar effects on the knees, elbows, shoulders, and ankles with the potential to impact the eyes and urethra.[6]

Does Food Poisoning Really Cause Post-Infectious RA?

Medical research has established, unequivocally, that food borne illness can and does lead to post infectious RA, with the most concentrated area of study for food borne illness and infectious RA, as it  relates to food borne illness, in the area of salmonella infections.[7] Studies vary as to the number of post infectious reactive arthritis cases follow salmonella infection (acute salmonellosis), but seem to range between 6% of victims and 30% of victims.[8] One study, for example, in the journal Clinical Infectious Diseases entitled “Reactive Arthritis and Reiter’s Syndrome Following an Outbreak of Gastroenteritis Caused by Salmonella enteritidis” found that 29% of the case victims had the symptoms of reactive arthritis following acute gastroenteritis.[9]  

But while the strong correlation/connection is very clear, there are a number of theories about HOW these food borne illnesses cause arthritis to set in, with ongoing research into the precise causal mechanism.[10]  The research has developed several compelling theories, including some as to why some people develop post-infectious RA while others do not. There is some evidence, for example, that certain persons are more genetically predisposed to acquiring RA, and in fact, as many as 75% of those who suffer RA have tested positive for a genetic marker called HLA-B27.[11],[12] Other research shows that gender, age, triggering pathogen, and the presence of recurrent arthritis elsewhere in the body also play key roles in who gets post infectious arthritis.[13]

But while research continues to explain the causal mechanism behind post infectious RA, there is no lingering doubt that gastrointestinal infectious can and does lead to post infectious RA in a subset of the population.  Decades of research has now shown the strong correlations between RA and the “triggeing” bacterial infection that contributes to the induction of the reactive arthritis in food borne illness outbreaks of Shigella, E. coli, Salmonella, Yersinia, Cyclsospora, or Campylobacter bacteria.[14] [15] 

Avoiding Post Infectious Reactive Arthritis – Difficult at Best

Unfortunately, there is only one way to protect against RA caused by a gastrointestinal illness, and that is by avoiding food poisoning in the first place.[16] Unfortunately, that is nearly impossible to do for most consumers who must rely on the manufacturers, handlers and those who prepare their food. 

For this reason, people who become sick with food poisoning usually only have remedial action at their disposal.  They can bring a claim against the companies who produced, handled or served the tainted food to them in order to prevent this from happening again and to seek recovery for the damage caused by the poison food they consumed.  In fact, it is precisely because consumers have almost no control over the quality of what they eat when purchasing food that most victims do not even have to prove those companies were negligent. 

This theory, available to most consumers in the country, is called strict liability. Bringing a claim for food poisoning is, in fact, one of the oldest legal theories in the United States because a patron should be able to rely on the experience and professionalism of the food manufacturers they rely on for safe food.

For more information about legal rights, contact the food borne illness attorneys of Ron Simon & Associates HERE.

How and Where does Post-Infectious RA Strike Most?

Post infectious RA begins to manifest itself in the one to six weeks following the causative illness, such as Salmonella.[17] Possible symptoms of RA may include:

  1. Visible signs include sores or rashes on the soles, palms of the hand (called Keratoderma blennorrhagica), or ulcers in the mouth;
  2. Inflammation of the knees, ankles, and joints in the feet,
  3. Inflammation of tendons attaching to bone (a condition known as Enthesitis);[18]
  4. Inflammation of toes and fingers (a condition known as dactylitis);[19]
  5. Inflammation leading to elbow pain, finger swelling or pain, and arm joint pain;
  6. Inflammation in the eye, a dangerous condition called conjunctivitis;
  7. Spinal inflammation (spondylitis) and lower back (sacroiliitis);[20]
  8. Inflammation of the prostate gland and the cervix can lead to a number of problems, including urgency

Because these symptoms often do not present for weeks after exposure or even after the original gastrointestinal symptoms have subsided, many people will not draw the causal link.   Even doctors often fail to diagnose post infectious RA because of the diffuse symptoms and because they often focus on a very narrow diagnosis of the symptom they are treating, such as knee pain or eye pain.  An additional problem is that people often see different physicians for different ailments, such as a Gastroenterologist (GI) for the gastroenteritis and then a specialist in arthritis for the joint pain, often with visits months apart where the current treating physician is not looking for a condition caused by food poisoning after the person has recovered from the acute gastrointestinal symptoms associated with food poisoning.[21]

This can lead to several problems. 

  • First, a patient may not receive the proper medical treatment if the link is not established.
  • Second, a patient will be left without a proper understanding or explanation as to the sudden onset of a condition that did not exist only weeks of months earlier. 
  • Finally, a person seeking to preserve their legal rights may settle for a nominal amount in a food borne illness case not realizing they may have thousands of dollars of related medical treatment in the future that they have failed to incorporate into their demand.

This is where the experience and expertise of the food borne illness lawyers at Ron Simon & Associates comes in.  While many lawyers can prosecute a personal injury claim, there are very few attorneys who understand post-infectious reactive arthritis, the science and identification of such cases, and the process whereby a claim for post-infectious reactive arthritis or post-infectious irritable bowel syndrome can be fully prosecuted. For more information, call 1-888-335-4901 or contact us.

[1] See “A case of reactive arthritis after Salmonella enteritis in in a 12-year-old boy,” by Peter Chun, et. al., available at


[3] Id.



[6] Hughes RA, Keat AC. Reiter’s syndrome and reactive arthritis: a current view. Semin Arthritis Rheum. 1994;24:190–210; Wu, Ines B., and Robert A. Schwartz. “Reiter’s Syndrome: The Classic Triad and More.” Journal of the American Academy of Dermatology, vol. 59, no. 1, 2008, pp. 113–121., doi:10.1016/j.jaad.2008.02.047; Colmegna I, Cuchacovich R, Espinoza LR. HLA-B27-associated reactive arthritis: pathogenetic and clinical considerations. Clin Microbiol Rev. 2004;17:348–369;


[8] Hill Gaston JS, Lillicrap MS. (2003). Arthritis associated with enteric infection. Best Practices & Research Clinical Rheumatology. 17(2):219-239.


[10] See “A case of reactive arthritis after Salmonella enteritis in in a 12-year-old boy,” by Peter Chun, et. al., available at


[12]  Sampaio-Barros PD, Bortoluzzo AB, Conde RA, Costallat LT, Samara AM, Bértolo MB (June 2010). “Undifferentiated spondyloarthritis: a longterm followup”. The Journal of Rheumatology. 37 (6): 1195–1199. doi:10.3899/jrheum.090625PMID 20436080.

[13] Colmegna I, Cuchacovich R, Espinoza LR. HLA-B27-associated reactive arthritis: pathogenetic and clinical considerations. Clin Microbiol Rev. 2004;17:348–369.

[14] Granfors K, Jalkanen S, Lindberg AA, Mäki-Ikola O, von Essen R, Lahesmaa-Rantala R, et al.Salmonella lipopolysaccharide in synovial cells from patients with reactive arthritis. Lancet. 1990;335:685–688; Leirisalo-Repo M. Reactive arthritis. Scand J Rheumatol. 2005;34:251–259; Colmegna I, Cuchacovich R, Espinoza LR. HLA-B27-associated reactive arthritis: pathogenetic and clinical considerations. Clin Microbiol Rev. 2004;17:348–369.







[21] A database for rheumatologists can be found here on the American College of Rheumatology website

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