Reiter’s Syndrome

(Reactive Arthritis)

Definition

Reiter’s syndrome is an inflammatory reaction to an infection somewhere in the body. It usually follows an infection of the urinary, genital, or digestive tract. Symptoms of the disorder primarily involve:
  • The joints
  • The eyes
  • The urinary or genital tract

Causes

Reiter's syndrome is triggered by certain infections in a genetically sensitive person. The infection often starts in the urinary or genital tract. It is usually caused by the bacterium Chlamydia trachomatis.Chlamydia is passed between people through sexual activity.
The infection can also begin in the digestive system. In these cases, the infection occurs after eating food tainted with bacteria, usually Shigella , Salmonella , Yersinia , or Campylobacter .
About 1 to 4 weeks after the infection, a susceptible person may develop Reiter’s syndrome. Doctors do not know why some people develop the disease and others do not. Most patients with the condition carry a specific genetic factor called HLA-B27 (or the B27 gene).

Risk Factors

Factors that increase your risk of getting Reiter's syndrome include:
  • Family members with Reiter's syndrome
  • Inheriting the genetic trait associated with Reiter’s syndrome (HLA-B27)
  • Having a chlamydia infection or an infection in the digestive system

Symptoms

Symptoms occur in three main areas of the body: the joints, the eyes, and the urinary tract and genitals. Men and women may experience different symptoms. The disease may be milder in women. Symptoms may come and go. In rare cases, heart problems may develop later in the disease.
Specific symptoms include the following:

In the Joints:

  • Swelling, pain, and redness, especially in the knees, ankles, and feet
  • Heel pain
  • Back pain and stiffness

In the Eyes:

  • Redness
  • Burning
  • Irritation
  • Blurred vision
  • Tearing
  • Discharge

In the Urinary Tract and Reproductive System

In men:
  • Frequent urination
  • Burning sensation when passing urine
  • Penal discharge
  • Sores on the penis
Male Urinary System
Male Genito-urinary System
Copyright © Nucleus Medical Media, Inc.
In women:
  • Burning sensation when passing urine
  • Inflamed vagina and cervix

Other Symptoms Include:

  • Rash, especially on the palms or soles
  • Ulcers in the mouth or on the tongue
  • Weight loss
  • Poor appetite
  • Fatigue
  • Fever

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor uses these findings to help make the diagnosis. There is no specific test to check for Reiter’s syndrome.
Your doctor may need to test your bodily fluids and tissues. This can be done with:
  • Blood tests
  • Culture, gram stain, or other tests
  • Removal of synovial fluid
Your doctor may need pictures of your bodily structures. This can be done with X-rays.

Treatment

There is no cure for Reiter’s syndrome. Most patients recover from the initial episode within 12 months. But some develop mild, chronic arthritis. Some patients suffer from additional episodes of the disorder.
Treatment aims to relieve symptoms and may include:

Bed Rest

Short-term rest to take the strain off the joints

Protecting the Joints

This includes:
  • Assistive devices as recommended by your doctor
  • Occupational therapy to learn how to take it easy on joints during daily activities

Medications

Your doctor may prescribe some of the following:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen
  • Sulfasalazine
  • Steroid injections into the inflamed joint
  • Topical steroid creams applied to skin lesions
  • In some cases, antibiotics to treat the triggering infection
  • Immunosuppressive drugs (drugs that decrease the immune system’s ability to function):
    • Azathioprine
    • Methotrexate
  • Eye drops

Prevention

The key to preventing Reiter's syndrome is avoiding the triggering infection. To do so, take these steps:
  • Avoid sexually-transmitted diseases (STDs), either by abstaining from sex or practicing safe sex, which includes:
    • Always use a latex condom during sexual activity
    • Ask sex partners about any history of sexual disease
    • Have sex with only one partner who only has sex with you
    • Do not go back and forth between sexual partners
    • Have regular checkups for STDs
  • Take steps to prevent chlamydia urogenital infections:
    • If you are a women age 25 or younger, get tested for chlamydia annually
    • If you are pregnant, get tested for chlamydia
    • If you are a man who has sex with men, get screened annually.
  • Avoid intestinal infections:
    • Wash hands before eating or handling food
    • Only eat foods that have been stored and prepared properly

RESOURCES

Arthritis Foundation http://www.arthritis.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov

Spondylitis Association of America http://www.spondylitis.org

CANADIAN RESOURCES

The Arthritis Society http://www.arthritis.ca/

Public Health Agency of Canada http://www.phac-aspc.gc.ca/

References

Questions and answers about reactive arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/health%5Finfo/reactive%5Farthritis/default.asp . Accessed January 2, 2013.

Reactive arthritis. American College of Rheumatology website. Available at: http://www.rheumatology.org/practice/clinical/patients/diseases%5Fand%5Fconditions/reactivearthritis.asp . Updated February 2012. Accessed January 2, 2013.

Reactive arthritis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated November 29, 2011. Accessed January 2, 2013.

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