Reactive arthritis (ReA) is a sterile arthritis occurring in a genetically predisposed individual, secondary to an extra-articular infection, usually of the gastrointestinal or genitourinary tract. Intravesical instillation of Bacillus Calmette-Guerin (iBCG) is used as an effective immunotherapy of bladder cancer. Despite of the clinical efficacy, ReA could develop as adverse event and the frequencies are known as about 0.5 to 1% in Western countries and 2.0% in Japan. However, the trend of frequency and outcome of iBCG-induced ReA in Japanese patients have not been assessed in multi-centre studies. Herein, Japanese patients who received iBCG (n = 555) for bladder cancer from March 1997 to February 2017 were retrospectively assessed. Of the 555 cases, ReA was revealed in 11/555 (2.0%). Although the protocol of iBCG therapy was not statistically different over the 20 years, but a half dose of iBCG was used in 2007 to 2017 more than in 1997 to 2007. Despite the increase of the use of half dose of iBCG in 2007 to 2017, the overall frequency of iBCG-induced ReA was not significantly different between from 1997 to 2007 and from 2007 to 2017 (2.1% and 1.9%, respectively). This suggests that the development of iBCG-induced ReA was dose-independent. Furthermore, all iBCG-induced ReA, even if revealing sacroiliitis, did not progress to chronic peripheral arthritis type and spondyloarthritis over the last 20 years.