Reiter's Syndrome

Basic Information

Reiter's Syndrome is a kind of arthritis -- also known as reactive arthritis, as this disease usually follows an infection either of the gastrointestinal system (shigella, salmonella, campylobacter) or the genito-urinary system (chlamydia). Thus it is believed that Reiter's Syndrome is caused by an autoimmune reaction to an earlier infection.

Most patients affected are males under 50, with most cases diagnosed in the third decade. There appears to be an undeniable genetic or familial disposition to acquire Reiter's Syndrome in those patients who have the human leukocyte-antigen B27 (HLA-B27). Roughly two-thirds of those patients with HLA-B27 seem to be at risk for this disease after becoming infected with salmonella, shigella, chlamydia or certain other pathogens or disease-producing agents.

This disease is an asymmetric polyarthritis and typically follows a bout of urethritis, cervicitis, diarrhea or inflammatory eye disease, usually within several weeks.

The lower extremities are most often affected such as the feet, ankles, and knees. Heel pain at the entryway of the Achilles tendon often occurs. Wrists and fingers may also be affected and slow the ability to perform daily tasks and routines. Lower back pain and joint stiffness may also interfere with routine activities. Eye inflammation which blurs vision is also associated with this disease.

Thus the disease is often defined as a triad of:

• arthritis;
• urethritis or cervicitis;
• conjunctivitis or uveitis (retinal detachment).

Symptoms

Besides the above symptoms of which joint stiffness and lower back pain are usually the earliest, other symptoms may include:

• "sausage toe" -- bony outgrowths at the beginning of the tendons;
• swollen joints that are often painful (especially in the morning or after rest periods);
• urethritis -- including discharge from the penis and pain on urination;
• rashes on the penis;
• rashes on the soles of the feet (resembling psoriasis);
• fatigue;
• muscle aches;
• low-grade fevers;
• spine involvement (in severe cases).

Diagnosis/Treatment

Though a number of infections may trigger this disease, at the time of diagnosis of Reiter's Syndrome there may or may not be any clinical evidence of these infections. In fact the patient may not be aware of these initial infections which may include sexually transmitted diseases (STDs). That is why your health care provider may want to test you for STDs such as syphilis, herpes, hepatitis B and gonorrhea.

Also a discussion about HIV is important and indicated and HIV testing may be recommended by your health care provider if you have risk factors such as past IV drug use or unprotected sex. HIV infection is associated with severe cases of Reiter's Syndrome.

Diagnosis of Reiter's Syndrome itself is based on a careful physical exam, especially examining the eyes and skin. Your health care provider will also want to take your family medical history for HLA-B27 association. Also cultures for gonococcus (stool, cervical, urethra) are routinely taken as well as X-rays and sometimes radiographs of the affected joints. Laboratory tests are usually not performed. Antibiotics may be prescribed for the initial urethral infection.

If you are diagnosed with Reiter's Syndrome, your health care provider will usually recommend working with a physical therapist. Though half of the cases resolve on their own within six months, 50% of patients have recurrent arthritis and that is why it is important to maintain range of motion of the joints. Treatment is generally individualized but almost all therapies involve a combination of medicine and physical therapy.

NSAIDs (nonsteroidal anti-inflammatory drugs) help the stiffness, swelling and pain caused by the joint inflammation. This is the primary treatment, which can be prolonged, with NSAID dosages usually prescribed once or twice a day. There can be side effects with this medicine including stomach ache, dizziness, ulcers, headaches and diarrhea.

Other medications like methotrexate or sulfasalazine are prescribed in persistent cases and they too have side effects that can include rash, stomach ache and nausea. If you have these medications prescribed for you, routine blood and liver function tests are also indicated. That is why it is important to be followed-up by your health care provider when taking medications prescribed for this disease and never try to medicate yourself with over-the-counter medications without asking your health care provider if you are able to take them in conjunction with your prescribed medication.

Sometimes cortisone injections into the affected joints prove helpful.

If conjunctivitis or uveitis (retinal detachment) is involved it is important to follow up with an ophthalmologist because untreated uveitis can lead to blindness.

A team of health care professionals is advised, especially in chronic cases. A rheumatologist may need to be consulted if treatment with NSAIDs does not prove effective.

Physical therapy is all important. The resting of swollen joints until the inflammation improves is usually followed by a regime of easy stretching and strengthening exercises. Learning to maintain good posture is essential, not only for lessening joint discomfort, but for restoring normal motion in the joints as well.

If you feel you have symptoms of Reiter's Syndrome, please see your health care provider promptly.

Additional Resource(s):

• Arthritis Foundation 800-283-7800