Reiter's syndrome


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Reiter's Syndrome

 

Definition

Reiter's syndrome (RS), which is also known as arthritis urethritica, venereal arthritis, reactive arthritis, and polyarteritis enterica, is a form of arthritis that affects the eyes, urethra, and skin, as well as the joints. It was first described by Hans Reiter, a German physician, during World War I.

Description

Reiter's syndrome is marked by a cluster of symptoms in different organ systems of the body that may or may not appear simultaneously. The disease may be acute or chronic, with spontaneous remissions or recurrences.
RS primarily affects sexually active males between ages 20-40, particularly males who are HIV positive. Most women and children who develop RS acquire the disease in its intestinal form.

Causes and symptoms

The cause of Reiter's syndrome was unknown as of early 1998, but scientists think the disease results from a combination of genetic vulnerability and various disease agents. Over 80% of Caucasian patients and 50-60% of African Americans test positive for HLA-B27, which suggests that the disease has a genetic component. In sexually active males, most cases of RS follow infection with Chlamydia trachomatis or Ureaplasma urealyticum. Other patients develop the symptoms following gastrointestinal infection with Shigella, Salmonella, Yersinia, or Campylobacter bacteria.
The initial symptoms of RS are inflammation either of the urethra or the intestines, followed by acute arthritis four to 28 days later. The arthritis usually affects the fingers, toes, and weight-bearing joints in the legs. Other symptoms include:
  • inflammation of the urethra, with painful urination and a discharge from the penis
  • mouth ulcers
  • inflammation of the eye
  • keratoderma blennorrhagica, these are patches of scaly skin on the palms, soles, trunk, or scalp of RS patients

Diagnosis

Patient history

Diagnosis of Reiter's syndrome can be complicated by the fact that different symptoms often occur several weeks apart. The patient does not usually draw a connection between the arthritis and previous sexual activity. The doctor is likely to consider Reiter's syndrome when the patient's arthritis occurs together with or shortly following inflammation of the eye and the genitourinary tract lasting a month or longer.

Laboratory tests

There is no specific test for diagnosing RS, but the physician may have the urethral discharge cultured to rule out gonorrhea. Blood tests of RS patients are typically positive for the HLA-B27 genetic marker, with an elevated white blood cell (WBC) count and an increased sedimentation rate of red blood cells. The patient may also be mildly anemic.

Diagnostic imaging

X rays do not usually reveal any abnormalities unless the patient has had recurrent episodes of the disease. Joints that have been repeatedly inflamed may show eroded areas, signs of osteoporosis, or bony spurs when x rayed.

Treatment

There is no specific treatment for RS. Joint inflammation is usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs.) Skin eruptions and eye inflammation can be treated with corticosteroids. Gold treatments may be given for eroded bone.
Patients with chronic arthritis are also given physical therapy and advised to exercise regularly.

Prognosis

The prognosis varies. Most patients recover in three to four months, but about 50% have recurrences for several years. Some patients develop complications that include inflammation of the heart muscle, stiffening inflammation of the vertebrae, glaucoma, eventual blindness, deformities of the feet, or accumulation of fluid in the lungs.

Prevention

In males, Reiter's syndrome can be prevented by sexual abstinence or the use of condoms.

Resources

Books

Berktow, Robert, editor. "Musculoskeletal and Connective Tissue Disorders: Reiter's Syndrome (RS)." In The Merck Manual of Diagnosis and Therapy. 16th ed. Rahway, NJ: Merck Research Laboratories, 1992.
Hellman, David B. "Arthritis & Musculoskeletal Disorders." In Current Medical Diagnosis and Treatment, 1998, edited by Stephen McPhee, et al., 37th ed. Stamford: Appleton & Lange, 1997.

Key terms

Acute — Having a sudden onset and lasting a short time.
Chronic — Of long duration.
Keratoderma blennorrhagica — The medical name for the patches of scaly skin that occur on the arms, legs, and trunk of RS patients.
Reactive arthritis — Another name for Reiter's syndrome.

Reiter's syndrome

 [ri´-terz]
a triad of symptoms of unknown etiology comprising urethritis, conjunctivitis, and arthritis (the dominant feature), appearing concomitantly or sequentially associated with mucocutaneous manifestations of keratoderma blennorrhagicum, circinate balanitis, and stomatitis, chiefly affecting young men, and usually running a self-limited but relapsing course.

Reiter's syndrome

[rī′tərz]
Etymology: Hans Reiter, German physician, 1881-1969
an arthritic disorder predominantly of adult males, resulting from infection with Shigella flexneri, Salmonella, Yersinia, or Chlamydia or from enterocolitis. It most often affects the ankles, feet, and sacroiliac joints and is usually associated with conjunctivitis and urethritis. The onset may be marked by unexplained diarrhea and low-grade fever, followed in 2 to 4 weeks by conjunctivitis. Superficial ulcers may form lesions on the palms and the soles. Arthritis usually persists after the conjunctivitis and urethritis subside, but it may become episodic. Treatment includes a short course of tetracycline to treat the infection and phenylbutazone to relieve pain and inflammation in the joint. Sexual partners should also be tested. Recovery is expected, but recurrent arthritic symptoms may continue for several years. See also dactylitis, reactive arthritis.

Reiter's syndrome

A disorder affecting mainly young men and featuring a non-gonococcal discharge from the penis, ARTHRITIS, CONJUNCTIVITIS and sometimes UVEITIS or a skin rash. The condition is thought to be an abnormal response to infection and is almost confined to people of the tissue type HLA B-27. There is no specific remedy and recurrences after the first attack are common. (Hans Conrad Julius Reiter, 1881–1969, German physician)
References in periodicals archive ?
Although Reiter's syndrome was thought to belong to the group of reactive arthritis for years, the growing evidence emerged during last two decades suggesting that RS is infectious arthritis.
Like Kawasaki disease, Reiter's syndrome is thought to represent a response to an infection.
However, this patient had originally been diagnosed with and treated for Kawasaki disease, which, like Reiter's syndrome, is thought to be a response to an infection.
In view of your urethritis, conjunctivitis and inflammation of the pupil area, uveitis, I think you could have Reiter's syndrome.
Scientists know more about what causes ankylosing spondylitis and Reiter's syndrome than they do for many other rheumatic diseases, and this knowledge could lead to better therapeutic approaches in the future.
This patient was diagnosed with Reiter's syndrome, based on her clinical syndrome of conjunctivitis, arthralgias, mucositis, and cervicitis.
A SUFFERERS of Reiter's syndrome have conjunctivitis, arthritis in more then one joint and urethritis - inflammation of the urinary tract.
Reiter's syndrome involves both inflammation within and around the joints, particularly where ligaments and tendons attach to bones.
Iritis can also be related to systemic diseases, such as ankylosing spondylitis, Reiter's syndrome, Behcet's disease, syphilis, juvenile rheumatoid arthritis, and inflammatory bowel diseases.
Low-dose weekly methotrexate has been reported to be effective in the treatment of polymyositis, Reiter's syndrome, psoriatic arthritis and juvenile rheumatoid arthritis.