Reiter's syndrome

What is Reiter's syndrome?

Reiter's syndrome is characterized by inflammation of the urethra, eyes (conjunctivitis), and joints. Most cases of Reiter's syndrome develop within days or weeks of an intestinal infection with certain bacteria (Shigella, Salmonella, Yersinia, or Campylobacter) or a sexually transmitted infection (Chlamydia trichomonas or Ureaplasma urealyticum). Reiter's syndrome following intestinal infection occurs equally in men and women, while venereal Reiter's occurs most commonly in young, white men.

How is it diagnosed?

History is usually of a recent intestinal or sexually acquired infection. The most common symptom is painful, swollen joints (usually multiple) especially of the feet, ankle, and knees. Walking may be painful, and the low back may be stiff and sore. Painful urination is reported in men. Redness of the eyes may be mild and not mentioned; if the iris becomes inflamed later in the course of the disease, eye pain and blurred vision may be reported. Individuals may have only a few of these symptoms. Some individuals report general symptoms of fatigue, weight loss, night sweats, and fever.

Physical exam may reveal inflammation of the urethra, and the prostate may be tender in men; the cervix may be inflamed in women, usually without causing symptoms. Affected joints will be swollen, tender, and have decreased range of motion; arthritis is usually seen in a non-symmetrical pattern. The sacroiliac joint will be involved in half of the individuals. Achilles tendon inflammation is a characteristic finding. Pus-filled skin lesions may be present. Painless ulcers in the mouth might be seen. Signs of heart involvement are rarely seen.

Tests are notable for being negative: blood tests for rheumatic diseases are normal, and cultures of joint fluid and skin lesions do not grow disease-producing organisms. The joint fluid will probably have a high number of white blood cells in it.

How is reiter's syndrome treated?

Reiter's syndrome is treated with rest and anti-inflammatory drugs. Injection of steroids can be done into very inflamed joints or around tendons. Unresponsive illness can be treated with a particular anti-cancer drug or sulfonamides. Advanced disease may require surgery for treatment of damage to the joints or heart.

Medications

Information	Brand	Generic	Label	Rating
	Minocin	Minocycline
	Augmentin	Amoxicillin/Clavulanate
	Noroxin	Norfloxacin

Activity

• Stay as active as your condition allows, but avoid sexual excitement and activity during the illness.
• Exercise the affected joints according to instructions. Don’t immobilize affected joints.
• To relieve foot pain, wear cushion pads and arch supports in your shoes.

What might complicate it?

Chronic inflammation may cause damage to joints or vertebrae. Heart rhythm disturbances or heart valve damage are seen rarely.

Predicted outcome

Most signs of the disease disappear within days or weeks, but over half of individuals will experience repeated episodes of arthritis. Permanent disability can occur in one-third. Recurrences involving any combination of the clinical manifestations are common. Permanent or progressive joint disease may occur if the disease is left untreated. If infections are treated early, the development of Reiter's syndrome may be curtailed; in this case, the prognosis improves.

Alternatives

Gonococcal arthritis resembles advanced Reiter's disease. Rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis share certain similarities. HIV infection is another possibility.

Appropriate specialists

Infectious disease specialist, orthopedic surgeon, cardiologist and dermatologist.

Last updated 18 December 2015