Reiter syndrome

What is Reiter syndrome?

Reiter syndrome is a collection of symptoms but generally has three main features: arthritis, genitourinary tract symptoms and conjunctivitis. Lesions of the skin and mucous membranes also develop in some patients.

Some or all of these symptoms usually occur 1-3 weeks after an infection of the genitourinary tract or bacterial gastrointestinal infection causing diarrhoea. The arthritis is sometimes referred to as reactive arthritis, which means that the arthritis occurs as a reaction to an infection that started somewhere else in the body.

Reiter syndrome generally lasts several months. The symptoms are the same regardless of the origin of the triggering infection.

What causes Reiter syndrome?

The exact cause of Reiter syndrome remains unknown but it has been identified that people with a particular genetic type called HLA-B27 have an increased chance of developing the syndrome (about 80% of people with Reiter syndrome carry this gene). Having this gene does not mean you will develop Reiter syndrome but it may predispose you to it if you have certain infections.

Genitourinary Reiter syndrome is often a reaction to urethral infection that has been passed from one person to another by sexual intercourse. The infection is most commonly Chlamydia.

Gastrointestinal or enteric Reiter syndrome may develop after acute bacterial diarrhoea caused by eating food contaminated with bacteria such as salmonella, shigella or campylobacter.

How common is Reiter syndrome and who gets it?

People of all races, age and sex can get Reiter syndrome, however, it is more common in young males. It is the most common form of arthritis affecting men between 20-40 years old.

HIV-positive men who carry the HLA-B27 gene and are exposed to the appropriate triggers develop Reiter syndrome in 75% cases. For this reason, a newly diagnosed patient with Reiter syndrome should have their HIV status checked as well as undergoing urological and gastrointestinal screening for infections.

Clinical presentation

Reiter syndrome typically affects the genitourinary tract, joints and the eyes in that time sequence. Less commonly, skin and mucous membrane lesions may be present.

Reiter syndrome

Plaques on back

Keratoderma blennorrhagicum

What treatment is available?

There is no cure for Reiter syndrome. However, in many patients symptoms completely resolve for long periods of time. About 65% patients will settle within 6 months. Approximately 40% of patients will experience recurrence after the initial flare has settled down.

During an active phase of the disease, treatment may include:

• Antibiotics to eliminate original bacterial infection, especially if genitourinary
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce joint inflammation and pain
• Drainage of swollen joints then corticosteroid injections into painful joints
• Bed rest in acute early stages
• Strengthening exercises to maintain mobility.

In many ways Reiter syndrome may resemble psoriasis in appearance. The treatment of the skin condition is similar to that recommended for psoriasis and may include ointments (emollients, coal tar, calcipotriol, topical steroids), ultraviolet radiation (phototherapy). Oral medications (acitretin, methotrexate, ciclosporin, azathioprine) may be required to control the skin lesions and for patients with severe joint disease.

In severe cases of Reiter syndrome, symptoms may interfere with work and daily activities. In rare cases, the heart and nervous system may be involved.