Reiter’s Syndrome, also called reactive arthritis that develops in response to an infection and characterized by a triad of arthritis, conjunctivitis, and nonspecific urethritis. It is considered an autoimmune disease marked by inflammatory synovitis and erosion at the insertion sites of ligaments and tendons. It commonly occurs after the presence of venereal disease process or enteric infection.
Reiter's syndrome, is the most common type of inflammatory polyarthritis in young men. It is sometimes the first manifestation of human immunodeficiency virus infection. An HLA-B27 genotype is a predisposing factor in over two thirds of patients with Reiter’s syndrome. The syndrome most frequently follows genitourinary infection with Chlamydia trachomatis, but other organisms have also been implicated. Treatment with doxycycline or its analogs sometimes shortens the course or aborts the onset of the syndrome.
Reiter's syndrome may also follow enteric infections with some strains of Salmonella or Shigella, but use of antibiotics in these patients has not been shown to be effective. Reiter's syndrome should always be considered in young men who present with polyarthritis. Symptoms may persist for long periods and may cause long-term disability. Initial treatment consists of high doses of potent nonsteroidal anti-inflammatory drugs. Patients with large-joint involvement may also benefit from intra-articular corticosteroid injection.
Reiter's syndrome is a type of arthritis that occurs because of an infection. Arthritis is when joints become inflamed and painful. It affects men more often than women. It develops most often between ages 20 and 50. Reiter's syndrome usually targets knees and the joints of ankles and feet. Inflammation also can affect your eyes, skin and urethra. Reiter's syndrome is not common. For most people, signs and symptoms come and go, eventually disappearing within 12 months.
Causes of Reiter's Syndrome
The exact cause of Reiter syndrome remains unknown but it has been identified that people with a particular HLA-B27 genotype have an increased chance of developing the syndrome. Having this gene does not mean you will develop Reiter’s syndrome but it may predispose you to it if you have certain infections. Reiter's syndrome develops in reaction to an infection in your body, often in your intestines, genitals or urinary tract. You might not be aware of the triggering infection if it causes mild symptoms or none at all.
Genitourinary Reiter’s syndrome is often a reaction to urethral infection that has been passed from one person to another by sexual intercourse. The infection is most commonly Chlamydia. Gastrointestinal or enteric Reiter’s syndrome may develop after acute bacterial diarrhea caused by eating food contaminated with bacteria such as salmonella, shigella or campylobacter.
A bout of food poisoning or a gastrointestinal infection may also precede the disease. Shigella is the most common organism causing Reiter's syndrome following diarrhea. Chlamydia trachomatis is the most common cause of Reiter's syndrome following urethritis. Ureaplasma and mycoplasma are rare causes. There is some circumstantial evidence for other organisms causing the disease, but the details are unclear.
Reiter’s syndrome is not contagious, but it is caused by some infections that are contagious. It can cause infections in the bladder, urethra, penis, or vagina.
Symptoms of Reiter's Syndrome
Reiter’s syndrome may cause arthritis symptoms, such as joint pain and inflammation. It can also cause urinary tract symptoms and eye infection (conjunctivitis). Diarrhea may also occur if the intestines are affected. This is then followed by arthritis 4 to 28 days later that usually affects the fingers, toes, ankles, hips, and knee joints. Symptoms can last from 3 to 12 months. In a small number of people, the symptoms may turn into chronic disease. Symptoms may include:
- Joint pain and inflammation that often affect the knees, feet, and ankles. One also might have pain in heels, low back or buttocks.
- Inflammation of a tendon that is attached to bone. This may cause heel pain or shortening and thickening of the fingers.
- Many men who have Reiter’s syndrome also develop eye inflammation. Inflamed mucous membrane that covers the eyeball and eyelid (conjunctivitis).
- Burning sensation during urination. Increased frequency and discomfort during urination may occur, as can inflammation of the prostate gland or cervix.
- Bony growths in the heel (heel spurs) that can cause chronic pain
- Inflammation of the spine (spondylitis). Dactylitis, or "sausage digit", a diffuse swelling of a solitary finger or toe, is a distinctive feature of Reiter’s syndrome and other peripheral spondylarthritides but can also be seen in polyarticular gout and sarcoidosis.
- Inflammation of the lower back joints (sacroiliitis)
- Increased urine. The classical presentation of the syndrome starts with urinary symptoms such as burning pain on urination (dysuria) or an increased frequency of urination. Other urogenital problems may arise such as prostatitis in men.
- Discharge from penis
- Inflamed prostate gland (prostatitis)
- Painful and irritated eyes
- Blurry vision
- Inflammation of the inner eye (uveitis)
- Mouth ulcers
- Keratoderma blennorrhagica (patches of scaly skin on the palms, soles, trunk, or scalp)
The main symptoms of Reiter’s syndrome will often go away in a few months. Some people may have mild arthritis symptoms for up to a year. Others may develop mild, long-term arthritis. Up to half of people will have a high risk of Reiter’s syndrome in the future. In rare cases, the condition may lead to chronic, severe arthritis. This can lead to joint damage.
How Reiter's Syndrome is diagnosed?
Diagnosis of Reiter’s syndrome can be difficult. This is because there are no specific tests that can confirm the condition. Some blood tests may be done, such as rheumatoid arthritis and lupus. Other tests may include:
- Erythrocyte sedimentation rate (ESR or sed rate) - This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood’s proteins clump together and become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation.
- Tests for infections - This includes a test for chlamydia. It may also include tests for other infections that are linked to Reiter’s syndrome.
- Joint aspiration (arthrocentesis) - A small sample of the synovial fluid is taken from a joint. It’s tested to see if crystals, bacteria, or viruses are present.
- Urine and stool samples - These are used to look for bacteria or other signs of disease.
- X-rays - This test uses a small amount of radiation to create images of tissues, bones, and organs. X-rays are used to look for swelling or damage to the joint. This can check for signs of spondylitis or sacroiliitis.
- Gene testing - A test may be done to check for HLA-B27 genotype.
Risk factors of Reiter's Syndrome
Certain factors increase your risk of Reiter’s syndrome:
- Age - Reiter’s syndrome occurs most frequently in adults between the ages of 20 and 40.
- Sex - Women and men are equally likely to develop Reiter’s syndrome in response to foodborne infections. However, men are more likely than are women to develop Reiter’s syndrome in response to sexually transmitted bacteria.
- Hereditary factors - A specific genetic marker has been linked to Reiter’s syndrome. But many people who have this marker never develop the condition.
Treatment for Reiter's Syndrome
There is no cure for Reiter’s syndrome. However, in many patients symptoms completely resolve for long periods of time. About 65% of patients will settle within 6 months. The main goal of treatment is to identify and eradicate the underlying infectious source with the appropriate antibiotics. Otherwise, treatment is symptomatic for each problem. Nonspecific urethritis may be treated with a short course of tetracycline. Analgesics, particularly NSAIDs, are used. Steroids, sulfasalazine and immunosuppressants may be needed for patients with severe Reiter’s syndrome symptoms that do not respond to any other treatment. Local corticosteroids are useful in the case of iritis.
During an active phase of the disease, treatment may include:
- Antibiotics to eliminate the original bacterial infection, especially if genitourinary
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce joint inflammation and pain
- Drainage of swollen joints then corticosteroid injections into painful joints
- Bed rest in acute early stages
- Strengthening exercises to maintain mobility.
- Immunosuppressive medicines such as methotrexate to control inflammation
- Strong biological immunosuppressants given as a shot
In many ways, reactive arthritis may resemble psoriasis in appearance. The treatment of the skin condition is similar to that recommended for psoriasis and may include ointments (emollients, coal tar, calcipotriol, topical steroids), ultraviolet radiation (phototherapy). Oral medications (acitretin, methotrexate, ciclosporin, azathioprine) may be required to control the skin lesions and for patients with severe joint disease. In severe cases of Reiter’s syndrome, symptoms may interfere with work and daily activities. In rare cases, the heart and nervous system may be involved.
Preventive steps for Reiter's Syndrome
Genetic factors appear to play a role in whether you're likely to develop reactive arthritis. Though you can't change your genetic makeup, you can reduce your exposure to the bacteria that may lead to reactive arthritis.
Make sure your food is stored at proper temperatures and is cooked properly to help you avoid the many foodborne bacteria that can cause Reiter’s syndrome, including salmonella, shigella, yersinia and campylobacter. Some sexually transmitted infections can trigger Reiter’s syndrome. Using condoms might lower your risk.