Reiter's syndrome
Reiter's syndrome, also known as reactive arthritis, is an autoimmune disorder characterized by a combination of symptoms that include arthritis, urethritis, conjunctivitis, and skin or mouth ulcerations. The condition is often triggered by a bacterial infection, commonly associated with sexual contact, particularly with Chlamydia trachomatis, or through gastrointestinal infections caused by bacteria like Salmonella or Shigella. While the syndrome can affect individuals of all ages, it predominantly occurs in males between the ages of twenty and forty, and it has a notable genetic component, with many patients testing positive for the HLA-B27 gene.
Symptoms typically emerge within one to two weeks following the initial infection, starting with urethritis and often progressing to conjunctivitis and arthritis. The arthritis is characterized by swelling, redness, and pain in the joints, especially in the lower extremities, and may also be accompanied by low-grade fever and skin lesions. Although Reiter's syndrome can resolve on its own within three to six months, treatment often involves anti-inflammatory medications, corticosteroid injections, and physical therapy to manage symptoms and improve mobility. In some cases, more advanced therapies may be necessary to address persistent or severe symptoms. Awareness and proper management of the condition can help prevent long-term complications, such as joint deformity or chronic arthritis.
Reiter's syndrome
ALSO KNOWN AS: Reactive arthritis
ANATOMY OR SYSTEM AFFECTED: Eyes, gastrointestinal system, joints, mouth, skin, urinary system
DEFINITION: An autoimmune disorder with associated symptoms of arthritis, urethritis, conjunctivitis, and ulcerations of the skin and mouth
CAUSES: Bacterial infection, usually transmitted through sexual contact; may be related to genetic factors
SYMPTOMS: Urethritis (burning sensation during urination, mild urethral or genital discharge); conjunctivitis (mild to painful); arthritis of spine and lower extremities (swelling, redness, pain); low-grade fever; watery skin growths; lesions on palms, soles, trunk, and mouth; sometimes inflammation of iris
DURATION: Three to six months
TREATMENTS: Anti-inflammatory drugs (aspirin, ibuprofen, indomethacin, phenylbutazone), cortisone injections, tetracycline, topical medications for skin lesions, physical therapy, bed rest, occupational therapy
Causes and Symptoms
Although the exact cause of Reiter’s syndrome is unknown, the disease is associated with the entry of an infectious agent through the urinary or intestinal tract. Reiter’s syndrome associated with sexual contact occurs primarily in men and is most often linked to the Chlamydia trachomatis. Dysenteric Reiter’s syndrome is caused by other bacteria, particularly Salmonella or Shigella. Genetic factors may also play a vital role in causing the disease, as a large majority of patients with Reiter’s syndrome have the gene HLA-B27, while other people do not.
After the onset of Reiter’s syndrome, urethritis occurs within seven to fourteen days, typically followed by conjunctivitis and arthritis over the next several weeks. The is often accompanied by a burning sensation during urination and a mild discharge from the or the genitals. Conjunctivitis occurs in approximately 40 percent of the victims and ranges from mild to very painful. The usually involves the and large joints of the lower extremities, producing significant swelling, redness, and pain. The disease is often accompanied by low-grade fever, watery growths on the skin, and lesions on the palms of the hands, soles of the feet, trunk, and mouth. In some cases, an of the iris known as iritis may occur.
Treatment and Therapy
Treatment for Reiter’s syndrome includes taking anti-inflammatory drugs, such as aspirin, ibuprofen, indomethacin, or phenylbutazone, as well as cortisone injections. Tetracycline may help control associated urethritis, while cortisone drops can relieve conjunctivitis. Topical medications are used to treat skin lesions. Appointments with different specialists, including dermatologists, urologists, and ophthalmologists, may be necessary to treat specific symptoms of the disease. Some patients may require biologic agents such as adalimumab to suppress the immune system if other treatments do not work. In about half of the victims, Reiter’s syndrome resolves itself within three to six months.
In addition to medical therapy, physical therapy is often prescribed. Short periods of bed rest can reduce pain and inflammation. Exercises can increase joint mobility and improve muscle tone. Occupational therapy teaches victims how to place less stress on affected joints and how to better cope with painful symptoms by promoting positive attitudes. In rare cases that involve severe joint damage, orthopedic surgeons may need to reconstruct the joints.
Perspective and Prospects
Reiter’s syndrome was first diagnosed in a World War I soldier in 1916 by Hans Reiter, a German military physician. He described the disorder as inflammation of the joints, urinary tract, and eyes. It primarily affects males between the ages of twenty and forty. Approximately half of those who suffer one or two bouts with Reiter’s syndrome never have another attack. Subsequent attacks beyond that can lead to joint deformity and permanent arthritis.
Bibliography
Buchanan, W. Watson, Walter F. Kean, K.D. Rainsford, and Colin A. Kean. "Reactive Arthritis: The Convoluted History of Reiter's Disease." Inflammopharmacology, vol. 32, 2023, pp. 93-99. DOI: 10.1007/s10787-023-01336-4. Accessed 8 Apr. 2024.
Cheeti, Apoorva, Rebanta K. Chakraborty, and Kamleshun Ramphul. "Reactive Arthritis." StatPearls, 2 Jan. 2023, www.ncbi.nlm.nih.gov/books/NBK499831/. Web. Accessed 8 Aug. 2023.
Mayo Clinc. "Reactive Arthritis." Mayo Clinic, March 5, 2011.
Parker, James N. and Phillip M. Parker Reiter’s Syndrome: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, Calif.: ICON Group, 2004.
Rosenfeld, Isadore. Symptoms. New York: Bantam Books, 1994.
Standring, Susan, et al., eds. Gray’s Anatomy. 40th ed. New York: Churchill Livingstone/Elsevier, 2008.
Teitel, Ariel D. "Reactive Arthritis." MedlinePlus, 2 May 2021, medlineplus.gov/ency/article/000440.htm. Web. Accessed 8 Aug. 2023.
Teitel, Ariel D. "Reiter Syndrome—View of the Feet." MedlinePlus, June 15, 2012.
Toivanen, Auli, and Paavo Toivanen, eds. Reactive Arthritis. Boca Raton, Fla.: CRC Press, 1988.