Definition

Reiter's syndrome (or Reactive Arthritis) is a group of symptoms consisting of arthritis (inflammation of the joints), urethritis (inflammation of the urethra), conjunctivitis (inflammation of the lining of the eye), and lesions of the skin and mucous membranes.

Causes,incidence, and risk factors

The exact cause of Reiter's syndrome is unknown, but it likely caused by an interaction between a genetic factor (HLAB27) and trigger by some environmental factor (such as an infection).  The disorder is rare in younger children, but may occur in adolescents.  It occurs most commonly in men before the age of 40. It may follow an infection with Chlamydia, Campylobacter, Salmonella, or Yersinia.

The symptoms of urethritis usually appear within days or weeks of infection followed by a low-grade fever, conjunctivitis, and arthritis developing over the next several weeks. The arthritis may be mild or severe with involvement being asymmetric and in more than one joint.

Symptoms

• urinary urgency
• urethral discharge
• burning or stinging on urination
• redness of the eye
• discharge from the eye
• burning eye pain
• joint pain in the large joints (hip pain, knee pain, and ankle pain are common)
• low back pain
• heel pain
• Achilles tendon pain
• small, painless ulcers in the mouth, tongue, and glans penis
• skin lesions on the palms and soles that may resemble psoriasis

 

Additional symptoms that may be associated with this disease:

• urinary hesitancy
• skin redness or inflammation
• penis pain
• incontinence
• genital lesions (male)
• arthritis

Signs and tests

The diagnosis is based on symptoms, exam findings, labs, and sometimes x-ray. Since the symptoms may occur at different times, the diagnosis may be delayed. A physical examination may reveal conjunctivitis or typical skin lesions.

Tests that may be performed include:

• joint X-rays (knees, Sacroiliac joints, etc)
• urinalysis
• HLA-B27 antigen
• Blood test (Sedimentation Rate, CRP)

Treatment

The objective of treatment is to alleviate the symptoms associated with the syndrome and to treat any underlying infection. In general, the conjunctivitis and skin lesions associated with the syndrome do not require treatment, and will resolve on their own.

Any underlying infection should be treated with antibiotics, although this has not been shown to affect the course of the arthritis. The arthritis is treated with nonsteroidal anti-inflammatory medications (NSAIDS) and pain relievers. These medications are tolerated better when they are taken with food. Local administration of corticosteroids may help relieve the symptoms associated with persistent inflammation in one joint. In severe case stringer immunosuppressant agents such as sulfasalazine, methotrexate, or biological agents (such a TNF inhibitors) may be helpful.

Physical therapy exercises for specifically involved areas and the back are helpful in relieving pain, maintaining mobility of the affected joints, and maintaining muscular strength. Adjustments in occupational tasks may be required if lifting or strenuous use of the back is required.

Therapy to suppress the immune system may be considered for individuals with a severe case of the disease, but this treatment is not used in most people because of the toxic side effects.

Prognosis

The illness may resolve in 3 to 4 months, but up to one-half of those affected experience recurrences of the arthritis or other symptoms of the syndrome over a period of several years. The condition may become chronic in which case the immunosuppressant medication can be used.

Complications

• aortic insufficiency (rare)
• arrhythmias caused by defects of the heart's electrical conduction system (rare)
• uveitis

Prevention

The prevention of sexually transmitted diseases through condom use, and the prevention of gastrointestinal infection through hand washing and careful food preparation, may affect the prevalence of this disease.