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Reiter syndrome

Author: Vanessa Ngan, Staff Writer, 2003.

What is Reiter syndrome?

Reiter syndrome has been reclassified as reactive arthritis and is a type of spondyloarthropathy. This page will undergo revision to reflect the name change.

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 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.

What is the clinical presentation of Reiter syndrome?

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.

SiteClinical features of Reiter syndrome
Genitourinary tract
  • Prostate, urethra and penis may be affected in men
  • Fallopian tubes, uterus, cervix, vagina and urethra may be affected in women
  • The most common and usually first symptom is a burning sensation when passing urine
  • There may be a discharge from the penis especially in the morning
  • Inflammation of the prostate gland may cause fever and chills (prostatitis)
  • Some patients, especially women, may experience no genitourinary symptoms
  • Arthritis occurs in 95% of patients
  • Varies in severity from week to week, episodes last about 1-4 months
  • First symptoms are pain and swelling of the knees, ankles and feet
  • Usually, several joints are involved at once
  • Tendon involvement is common and results in heel, foot and back pain (enthesopathy)
  • Low backache and morning stiffness (sacroiliitis)
  • Conjunctivitis occurs in 50% of patients
  • Uveitis may also arise (inflammation of the inner eye)
  • Signs and symptoms include redness of the eyes, pain, irritation and blurred vision
Skin and mucous membranes
  • 1–2 months after the onset of arthritis, some patients develop keratoderma blennorrhagicum. This refers to hard tender lumps and scaly patches &/or pustules and blisters on the soles of the feet and may extend up the fronts of the legs. Chlamydia trachomatis has been isolated from the affected skin.
  • The tips of fingers, toes and nails may develop painful lumps, scaly areas and pus-filled blisters
  • Scaly red patches may occur on other parts of the body including the face, resembling psoriasis
  • Recurrent mouth ulcers on the tongue, lip, gums, the roof of the mouth and soft palate
  • Rash on the head of the penis (circinate balanitis)
  • Much more common in genitourinary Reiter syndrome than in gastrointestinal Reiter
Reiter syndrome

What treatment is available for Reiter syndrome?

There is no cure for Reiter syndrome. However, in many patients symptoms completely resolve for long periods of time. About 65% of 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 the 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.

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