Reiter’s syndrome

Definition:

A group of symptoms of unknown cause 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.

Alternative Names:

Reactive arthritis

Causes, incidence, and risk factors:

The exact cause of Reiter's syndrome is unknown. It occurs most commonly in men before the age of 40. It may follow a sexually transmitted or dysenteric infection with Chlamydia, Campylobacter, Salmonella, or Yersinia. There may be a genetic predisposition to the syndrome as evidenced by the increase in the prevalence of the HLA- B27 genetic marker in people affected with this disorder when compared to the general population.

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.

The risk factors for the syndrome include infection with Chlamydia, Campylobacter, Salmonella, or Yersinia; being a male; and possible genetic predisposition. The disorder is rare in younger children, but may start in adolescents.

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:

Signs and tests:

The diagnosis is based on the clinical features. 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:

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 precipitating 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 (analgesics). 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.

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.

Expectations (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.

Complications:

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

Calling your health care provider:

Call for an appointment with your health care provider if symptoms of Reiter's syndrome develop.

Prevention:

The prevention of sexually transmitted diseases and dysentery may affect the prevalence of this disease.

Review Date: 11/29/2001
Reviewed By: Birgit Kovacs, M.D., Division of Rheumatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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