Reiter's Syndrome

Reiter's syndrome (RS), which is also known as arthritis urethritica, venereal arthritis, reactive arthritis, and polyarteritis enterica, is a form of arthritis that affects the eyes, urethra, and skin, as well as the joints. It was first described by Hans Reiter, a German physician, during World War I.

Description

Reiter's syndrome is marked by a cluster of symptoms in different organ systems of the body that may or may not appear simultaneously. The disease may be acute or chronic, with spontaneous remissions or recurrences.

RS primarily affects sexually active males between ages 20–40, particularly males who are HIV positive. Most women and children who develop RS acquire the disease in its intestinal form.

Causes and symptoms

The cause of Reiter's syndrome was unknown as of early 1998, but scientists think the disease results from a combination of genetic vulnerability and various disease agents. Over 80% of Caucasian patients and 50–60% of African Americans test positive for HLA-B27, which suggests that the disease has a genetic component. In sexually active males, most cases of RS follow infection with Chlamydia trachomatis or Ureaplasma urealyticum. Other patients develop the symptoms following gastrointestinal infection with Shigella, Salmonella, Yersinia,or Campylobacter bacteria.

The initial symptoms of RS are inflammation either of the urethra or the intestines, followed by acute arthritis four to 28 days later. The arthritis usually affects the fingers, toes, and weight-bearing joints in the legs. Other symptoms include:

• inflammation of the urethra, with painful urination and a discharge from the penis
• mouth ulcers
• inflammation of the eye
• keratoderma blennorrhagica. These are patches of scaly skin on the palms, soles, trunk, or scalp of RS patients

Diagnosis

Patient history

Diagnosis of Reiter's syndrome can be complicated by the fact that different symptoms often occur several weeks apart. The patient does not usually draw a connection between the arthritis and previous sexual activity. The doctor is likely to consider Reiter's syndrome when the patient's arthritis occurs together with or shortly following inflammation of the eye and the genitourinary tract lasting a month or longer.

Laboratory tests

There is no specific test for diagnosing RS, but the physician may have the urethral discharge cultured to rule out gonorrhea. Blood tests of RS patients are typically positive for the HLA-B27 genetic marker, with an elevated white blood cell (WBC) count and an increased sedimentation rate of red blood cells. The patient may also be mildly anemic.

Diagnostic imaging

X rays do not usually reveal any abnormalities unless the patient has had recurrent episodes of the disease. Joints that have been repeatedly inflamed may

Keratoderma, a skin condition characterized by horny patches, is one symptom of Reiter's syndrome. (Photograph by Milton Reisch, M.D., Corbis Images. Reproduced by permission.)

show eroded areas, signs of osteoporosis, or bony spurs when x rayed.

Treatment

There is no specific treatment for RS. Joint inflammation is usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs.) Skin eruptions and eye inflammation can be treated with corticosteroids. Gold treatments may be given for eroded bone.

Patients with chronic arthritis are also given physical therapy and advised to exercise regularly.

Prognosis

The prognosis varies. Most patients recover in three to four months, but about 50% have recurrences for several years. Some patients develop complications that include inflammation of the heart muscle, stiffening inflammation of the vertebrae, glaucoma, eventual blindness, deformities of the feet, or accumulation of fluid in the lungs.

Prevention

In males, Reiter's syndrome can be prevented by sexual abstinence or the use of condoms.