Reiter's Syndrome

What Is It?

Reiter's syndrome is a rare disease that causes a form of arthritis, along with inflammation of the urinary tract and eyes. It is triggered by an infection, usually by a sexually transmitted organism or by certain gastrointestinal bacteria.

The most common infection causing Reiter's syndrome is the sexually transmitted disease chlamydia. Reiter's syndrome can also be caused by gastrointestinal infection from bacteria such as salmonella, shigella, campylobacter or Yersinia, which can cause diarrhea and vomiting. These bacteria often are found in contaminated food or water. These infections are common, but Reiter's syndrome is not. Scientists believe that people who develop Reiter's syndrome have a certain genetic makeup. In some studies, approximately 70% of people with Reiter's syndrome have a gene called HLA-B27, compared with 8% of the general population.

Reiter's syndrome is thought to be an autoimmune disorder, which means the body's immune system mistakenly attacks its own tissues. In this case, the immune system is jolted into action by the infection but continues attacking after the infection is gone.

Reiter's syndrome typically includes arthritis, eye inflammation (conjunctivitis or uveitis) and inflammation of the urethra (urethritis). However, some people develop only one or two of these. The arthritis without eye or urinary inflammation is often called reactive arthritis.

Reiter's syndrome is most common in people between the ages of 20 and 40. About 3 in 100,000 men under age 50 develop the disease.

Symptoms

Symptoms usually appear within a few weeks after someone has had chlamydia or diarrhea. Most people feel a little tired and have a slight fever, although a few have high fever, significant fatigue and weight loss. Other early symptoms include muscle aches, joint stiffness, and low back pain radiating into the buttocks or thighs. Back discomfort usually gets worse when you sit or lie still and gets better when you move around. Arthritis begins abruptly and usually affects one or several joints, especially the knees, ankles, feet or wrists. People often have pain at the back of an ankle or tenderness on the bottom of a heel (from inflammation at the spot where a tendon attaches to a bone).

Symptoms vary depending on what other areas of the body are inflamed:

• Arthritis Joint pain; swelling; limited motion, especially of the ankles, knees, feet and less commonly of the wrists, fingers or other joints; tendon pain; low back pain; swelling in a finger or toe
• Conjunctivitis Redness near an eyelid with sticky discharge from the eye, especially in the morning (usually mild and temporary)
• Uveitis Redness near the iris of the eye, pain (especially when exposed to light), blurred vision
• Urethritis Painful urination, a discharge from the penis or vagina
• Dermatitis Painless or painful sores in the mouth, a scaly rash on the soles of the feet, inflammation at the tip of the penis

Other symptoms that are more rare include inflammation of the prostate (prostatitis), bladder (cystitis) or heart lining (pericarditis) and leaking of the aortic valve.

Diagnosis

A doctor may suspect you have Reiter's syndrome when the typical symptoms develop after you had an infection. Your doctor will examine you and will order imaging tests, such as X-rays of the pelvis or lower spine. Your doctor may remove fluid from a painful joint with a needle so it can be examined in a laboratory. Fluid from an inflamed joint will contain a high number of white blood cells.

There is no single test that can confirm the diagnosis. Your doctor will diagnose Reiter's syndrome based on your history of infection, your symptoms and the physical exam. Tests may be done to check for other conditions that can cause joint inflammation, such as an infection or gout.

Expected Duration

For reasons that are not yet known, Reiter's syndrome sometimes gets better on its own over a number of months or years. However, it is often chronic (long-lasting) and treatment is needed long-term, even for a lifetime.

Prevention

There is no way to prevent Reiter's syndrome, but the infections that may trigger it can be prevented. You can help to prevent gastrointestinal infections by properly cooking food and washing your hands throroughly after contact with animals and before preparing food. You can prevent sexually transmitted diseases by practicing safe sex.

Treatment

The choice of treatment for Reiter's syndrome depends on your specific symptoms. If you still have the infection, your doctor will prescribe antibiotics, usually for 7 to 10 days. Some physicians treat Chlamydia infections with antibiotics for as long as three months. A limited number of studies have shown that this longer treatment helps to prevent Reiter's syndrome, but the treatment remains controversial. The sexual partners of a person with newly diagnosed chlamydia should also be treated.

For mild arthritis, a non-steroidal anti-inflammatory drug (NSAID) with or without a pain reliever such as acetaminophen (Tylenol and other brand names) may be enough. For more severe arthritis, injections of corticosteroids into the inflamed joint can relieve pain, although the relief is often temporary. Other medications that may be helpful include those used to treat rheumatoid arthritis, such as sulfasalazine, hydroxychloroquine or methotrexate (all sold as generics). Doctors usually do not prescribe medicines called oral corticosteroids, which are used to treat rheumatoid arthritis, because they usually do not work as well for Reiter's syndrome. Newer medications used to treat rheumatoid arthritis may also be used, including injectable adalimumab (Humira), etanercept (Enbrel) or infliximab (Remicade). Surgery to replace a joint may help severe arthritis that does not respond to medications.

It's important to balance rest and exercise. Biking and swimming, for example, can help to reduce stiffness and keep the joint moving. Your doctor may refer you to a physical therapist, occupational therapist or podiatrist. Splints, shoe inserts or braces can provide relief in ways that medications cannot.

For the other manifestations of disease, treatment options include:

• Corticosteroid cream or ointment for rash; supervision by a dermatologist is important, especially if the rash involves the penis or face
• Corticosteroid drops or pills for uveitis
• NSAIDs or other pain relievers for urinary tract inflammation (urethritis)

The care of people with Reiter's syndrome should be coordinated by their primary care physician with regular monitoring by appropriate specialists, which may include a dermatologist, ophthalmologist, rheumatologist or urologist.

When To Call a Professional

Call your doctor if you have symptoms of Reiter's syndrome such as joint pain, swelling, limited motion, red or painful eyes, or painful urination. If you notice pain or burning with urination, or a discharge from the penis or vagina, call your doctor right away. Let your doctor know if you have diarrhea that is persistent, bloody or associated with pain.

Prognosis

With therapy, the outlook for Reiter's syndrome is good, although the condition is quite variable. Severe cases may be associated with significant joint damage, vision problems and other disabling manifestations, whereas other cases are much milder and only intermittently bothersome. Risk factors for more severe disease include one or more of the following:

• Male gender
• Venereal infection (rather than intestinal infection)
• Limited back motion
• Hip involvement
• Swelling of a finger or toe
• Blood tests showing evidence of marked body-wide inflammation
• Presence of gene marker, HLA-B27
• Poor response to initial therapy

Additional Info

American College of Rheumatology

1800 Century Place

Suite 250

Atlanta, GA 30345-4300

Phone: 404-633-3777

Fax: 404-633-1870

http://www.rheumatology.org/

Arthritis Foundation

P.O. Box 7669

Atlanta, GA 30357-0669

Phone: 404-872-7100

Toll-Free: 1-800-283-7800

http://www.arthritis.org/

Spondylitis Association of America

P. O. Box 5872

Sherman Oaks, CA 91413

Toll-Free: 1-800-777-8189

Email: info@spondylitis.org

http://www.spondylitis.org