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 Reiter's
syndrome, also known as reactive arthritis, is an arthritis usually
associated with an infection elsewhere in the body, especially the
gut (intestines) and genitals.
It
is the most common type of arthritis affecting young men, with men
between the ages of 20 and 40 most likely to develop it.
Reiter's
syndrome belongs to a group of disorders collectively termed the
spondyloarthropathies. These disorders are characterized by arthritis
of varying degree and a genetic risk factor by carrying the gene
HLA-B27. Other diseases in this group of disorders include psoriatic
arthritis, ankylosing spondylitis, and colitic arthritis, which
is associated with inflammatory bowel disease.
How
does it occur?
The
disease process is not completely understood, but as the name "reactive
arthritis" implies, the disease is a "reaction" to some other illness.
Bacterial infections of the gut causing diarrhea, and bacterial
infections of the genitals from sexual contact have both been implicated
in Reiter's syndrome. The symptoms of Reiter's syndrome usually
develop a few days to a few weeks after the onset of a dysenteric
or sexually transmitted disease (STD).
Although
bacterial illnesses precede the development of Reiter's syndrome,
it is quite rare to find bacteria in affected areas once Reiter's
syndrome develops.
The
bacteria seem to play some undefined role in causing the symptoms.
There also appears to be a genetic risk factor for those individuals
with the gene HLA-B27, which has close associations with the body's
immune system's functions.
What
are the symptoms?
Patients
will note symptoms of dysentery or genital infection prior to the
development of symptoms for Reiter's syndrome.
Reiter's
syndrome primarily affects the joints, eyes, genitals, and mouth.
Of these, joint involvement is usually the most significant.
Joints: arthritis of one or several joints with the lower
extremities most commonly involved; the spine is also a common
site causing back pain
Eyes:
conjunctivitis (redness of the eye), blindness
Genitals:
burning on urination, redness on the tip of penis
Mouth:
oral ulcers
Other
findings may include systemic signs of illness such as fever, fatigue,
weight loss, and nausea and vomiting.
How
is it diagnosed?
Diagnosis
is based clinically and not on one specific test. The history, physical,
and supplementary tests all aid in the diagnosis.
Blood
tests to look for the HLA-B27 gene and markers of inflammation are
also usually performed. Some patients may also have evidence of
anemia on their blood tests.
Joints
with active signs of inflammation (e.g., swelling, warmth, redness)
may be "tapped" using a needle and the fluid cultured to rule out
other diseases.
X-rays
may also be done to look more closely at joint spaces.
A
final diagnosis can only be made after synthesizing all the information
gathered.
How
is it treated?
Nonsteroidal
anti-inflammatory drugs (NSAIDs) are the mainstay of treatment.
Drugs such as indomethacin have been found to reduce symptoms of
arthritis. Other agents such as sulfasalazine may be used if NSAID
therapy proves non-effective.
The
role of antibiotics in Reiter's syndrome is controversial. Some
evidence suggests that tetracycline may benefit those patients whose
antecedent illness was a sexually transmitted one. Antibiotics have
not been shown to be effective in those patients whose antecedent
illness was dysentery.
The
prognosis for patients varies widely and is correlated with the
severity of disease. Up to 25 percent of patients may develop chronic
arthritis.
For
more information about Reiter's syndrome contact the National Institute
of Arthritis and Musculoskeletal and Skin Diseases of the National
Institutes of Health http://www.nih.gov/niams.
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