Definition of Reiter’s Syndrome
Reiter’s syndrome is a type of reactive arthritis. Characteristically, Reiter’s syndrome is identified by these four main symptoms: arthritis, urethritis, conjunctivitis and skin rash.
Causes of Reiter’s Syndrome
The etiology of Reiter’s syndrome-associated arthritis is strongly linked to a host of bacterial infections as well as gender, age and genetic predisposing factors. These can include:
- Bacterial infection
- Gastrointestinal infection
- Shigella dysenteriae
- Salmonella typhimurium
- Yersinia enterocolitica
- Campylobacter jejuni
- Sexually Transmitted Infections:
- Chlamydia Trachomatis
- Ureaplasma Urealyticum
- Gastrointestinal infection
- Genetics i.e. HLA-B27 – two thirds of all people with the HLA-B27 gene tend to develop Reiter’s syndrome.
- White, male and less than 40 years.
Symptoms of Reiter’s Syndrome
Reiter’s syndrome-associated arthritis can be contagious when the source of infection is an active bacterial infection. Over 50% of cases are self-limiting and resolving spontaneously after 2 – 4 weeks. However, serious complications such cardiac events and kidney failure are not uncommon. The classical triad or recently formed tetrad includes:
- Inflammation of the urethra or cervix
- Inflammation of the eyes
- Skin rash
Depending on the etiological factors, the symptoms of Reiter’s syndrome can include:
- Arthritis in weight bearing joints, descending to the lower limbs e.g. hip joint, knees, ankles and toes of the feet. Typically asymmetric, affecting less than 3 joints.
- Joints produce excruciating pain, become hot and stiff. Redness and swelling around the joint is common especially in the toes and fingers causing sausage-shaped fingers (dactylitis). Swelling can sometimes collect excessive amounts of non-infectious joint fluid (joint effusion) making it unbearable to perform simple daily tasks. Achilles tendinitis and muscular pain are also often reported.
- Eyes may be red and itchy
- Urinary symptoms such as burning sensation during urination, lower abdominal pain, increased frequency of urination, increased urgency, bloody urine or pus-filled urine.
- Painless ulcers and sores (sometimes containing pus) in the mouth, palms of hand, soles, penis or vagina
- Fatigue, generalized body malaise, fevers
- Heart and kidney problems e.g. chest pain, bloody urine etc.
Treatment of Reiter’s Syndrome
Arthritis associated with Reiter’s syndrome requires early diagnosis and prompt management. For which we recommend Dr. Burke, an orthopedic specialist excellent at spotting and diagnosing Reiter’s syndrome-associated arthritis. He offers the most up-to-date treatment modalities including:
- Antibiotics e.g. doxycycline
- NSAIDs such as diclofenac
- Steroids, oral and joint injections
- DMARDS such as methotrexate, sulfasalazine etc.
- TNF inhibitors e.g. infliximab
- Orthopedic corrective intervention e.g. arthroscopy, drainage of joint effusion etc.