Reiter's Syndrome.
Last updated Friday, February 11, 2005
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About
Basics of reiter's syndrome
Reiter's syndrome is a form of arthritis that produces pain,
swelling, redness, and heat in the joints. It is one of a family of
arthritic disorders affecting the spine. Reiter's commonly involves the
joints of the spine and the sacroiliac joints, areas where the spine
attaches to the pelvis.
In 1916 Hans Reiter, a German military physician, described the
disease in a World War I soldier who had recovered from a bout of
diarrhea. Dr. Reiter described three characteristic features of the
disease: inflammation of the joints, urinary tract, and eyes. More recently, doctors have recognized a fourth major feature: ulcerations of the skin and mouth.
Prognosis
Most people with Reiter's syndrome can expect to live normal life spans. The majority of people with the disease maintain a near-normal lifestyle with modest adaptations to protect the involved joints.Incidence
Reiter's syndrome primarily affects young white men between the ages of 20 and 40, although it can occur in older people or children. African American men rarely get the disease, and women get it only a fifth as often as men.Symptoms
Reiter's syndrome often begins following inflammation of the
intestinal or urinary tract. In susceptible people, this inflammation
sets off a disease process that involves the joints, eyes, urinary
tract, and skin. A brief description of how each of these may be
affected is below.
Not all of these symptoms occur in every person with Reiter's
syndrome. Nor do they all occur at once in the same person. Symptoms of
the disease tend to come and go, but not always at the same time as the
worsening of the joints.
Joint swelling
When Reiter's syndrome first begins, it is characterized by a great deal of swelling and pain in the affected joints.
Joint involvement is usually asymmetric (meaning it affects different
joints on opposite sides of the body) and confined to a small number of
joints. Often, the spine, sacroiliac joints, and large joints of the
legs are involved. A few small joints in the toes or fingers also may
be affected. In addition, people with Reiter's syndrome may experience
inflammation in areas where tendons connect to bones, as in the heels.
The joint involvement of Reiter's syndrome tends to follow one of
two courses. A small percentage of people have continuing joint
involvement that is constant. Most people, however, have periodic
attacks of arthritis that last from three to six months. In each
attack, the general pattern and severity tend to be similar to previous
attacks, with a small number of joints--often different
joints--involved each time.
After the first attack, almost half of those with Reiter's will
never have another attack. Statistics are similar after the second
attack. But with subsequent attacks, it is more likely that the disease
will become a permanent form of arthritis.
In most cases, the joint inflammation that is associated with
Reiter's syndrome does not lead to permanent joint damage or disability.
Conjunctivitis
About 40 percent of people with Reiter's experience conjunctivitis,
an inflammation of the membranes under the eyelids, early in the
disease process. Conjunctivitis may be so mild that it's hardly
noticed, or it may be painful and accompanied by secretions.
Fortunately, it usually is short-lived and rarely causes permanent
damage.
Later in the disease process, about five percent of people with the
disease develop iritis, an inflammation of the iris and deeper tissues
that causes the pupil to open and close. Iritis is a serious condition;
immediate medical attention by an ophthalmologist is required. If it is
not promptly treated, scarring may occur and affect vision.
Urinary tract involvement
The most common form of urinary tract involvement in people with
Reiter's syndrome is urethritis, an inflammation of the urethra, or
tube that drains urine from the bladder out of the body. The typical
symptom of urethritis, burning during urination, may or may not be
present.
In men, Reiter's often is accompanied by a discharge from the penis.
The discharge usually is painless and carries no bacterial infection.
Inflammation also may appear in the prostate gland of men with
Reiter's. Cystitis, which is an inflammation of the bladder, is a
common form of urinary tract involvement in women with Reiter's
syndrome.
In most cases these problems will go away on their own and cause no permanent damage.
Skin problems
People with Reiter's often experience small, hardly noticeable sores
on the soft palate or back of their throat. Painless superficial sores
on the penis occur in about one-third of men with Reiter's syndrome.
Some women with the disease develop sores on their external genitalia.
In addition, people with Reiter's syndrome may experience a rash on
the soles of the feet made up of thickened and over-pigmented outer
layers of skin. This type of skin involvement occurs less commonly on
the palms of the hands and on other areas of the body.
Causes
The direct cause of Reiter's syndrome is not known; however, both
genetic and environmental factors are involved. About 75 percent of
people with Reiter's syndrome have a gene called HLA-B27. HLA-B27 is
one of a family of genes that play an important role in the body's
defense against infection.
It is important to note that having the HLA-B27 gene does not mean
you will develop Reiter's syndrome. Approximately eight percent of
white Americans and two to three percent of African Americans carry the
gene; the majority of them don't have any form of arthritis. Having the
gene, however, may predispose certain people to react to an infectious
agent that enters the body through the urinary or intestinal tract.
When people get Reiter's syndrome through inflammation of the
intestinal tract, it usually follows a bout of diarrhea caused by
eating foods contaminated with bacteria such as salmonella, shigella,
campylobacter, or yersinia. There is speculation that the inflammation
in the urinary tract is caused by a variety of different organisms, but
no specific infectious agent has been identified.
Some researchers
have found fragments of infectious agents in the affected joints. The
arthritis appears to result from an immune or inflammatory reaction to
the fragments. Exactly how joints and other organs become involved
after the initial infection is not known.
Studies show that some people develop or have a relapse of Reiter's
syndrome after having sexual intercourse with a new partner, yet
Reiter's syndrome itself cannot be transmitted through sexual contact.
Diagnosis
Getting a definite diagnosis of Reiter's syndrome may take some
time, since diagnosis primarily depends on a physical examination
showing characteristic physical findings or signs of the disease.
Sometimes not all signs are present at once, and not all people
exhibit all of them. The more physical findings you experience, the
more definite the diagnosis.
Certain features, especially the skin lesions, are so characteristic
that their presence, along with joint involvement, is sufficient to
make the diagnosis of Reiter's syndrome.
Uncertainty in making a diagnosis happens if joint inflammation
occurs without the other symptoms. In such cases, a doctor may suspect
Reiter's and perform a test for the HLA-B27 genetic type. If that test
is positive, or if the spine and sacroiliac joints are involved, your
doctor can at least tell that the disease is in the family of the
spondyloarthropathies. In those cases, a physician may make a diagnosis
of incomplete Reiter's syndrome. You may need to see an arthritis
specialist.
Treatment
Appropriate treatment can suppress the disease activity and manage the symptoms of Reiter's syndrome.
The goal of treatment for arthritis associated with Reiter's
syndrome is to reduce inflammation in the affected joints, thereby
reducing the accompanying pain and limited mobility.
Health care team
Because the disease affects different parts of the body, some people
with Reiter's may need to see different specialists over the course of
the disease. The arthritis specialist will be able to coordinate the
treatment of this disorder. Other specialists you may need to see
include dermatologists, who diagnose and treat disorders of the skin;
ophthalmologists, who specialize in diseases of the eye; and
urologists, who treat the urinary tract. Your treatment team also may
include physical and occupational therapists.Exercise and therapy
Physical and occupational therapy often is prescribed in conjunction
with medical therapy. Physical therapy consists of different treatments
to reduce inflammation as well as exercises
to increase the mobility of joints and strengthen surrounding tissues.
By promoting improved muscle tone, you can help protect your joints
from damage and keep them working optimally.
Occupational therapy involves learning to perform activities of
daily living in an efficient manner, placing less stress on joints, and
thus making activities easier and joint damage less likely.
Medications
Medications usually include a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs).
These drugs usually are sufficient to suppress the swelling, heat, and
pain of the joints. In some cases, doctors use injections of the
hormone cortisone to control pain and inflammation in specific joints.
If neither of these keeps the disease under control, stronger drugs may
be needed.Surgery
In the vast majority of people with Reiter's syndrome, the above
approaches are sufficient. In the few people for whom management does
not prevent severe joint damage, surgical reconstruction of the joints such as total hip replacement or total knee replacement by orthopedic surgeons can restore pain-free function.Long-term management
The symptoms of urinary tract and skin involvement often clear up on
their own, but the use of appropriate antibiotics and topical skin
medications may be necessary at times.
Iritis, because of its potential for damaging the eye, requires
close supervision by an ophthalmologist. Depending on the severity of
the condition, your doctor may prescribe anti inflammatory medication
in the form of eye drops, pills, or direct injection into the eye
tissues.
Because Reiter's has been associated with sexual exposure in some
people, some doctors recommend using a condom to prevent recurrences of
the disease. The condom is used to prevent a recurrence, not to prevent
transmission of the syndrome.
Asking for help
Coping with the pain and unpredictability of Reiter's syndrome can be difficult at times.
It's important that you learn as much as you can about the disease and how to manage it. Sometimes talking to a family member
or friend can provide much needed emotional support. Working with a
counselor, psychologist, or social worker helps some people with
Reiter's syndrome develop better coping skills.
Support groups have been a source of help for thousands of people
with different forms of arthritis. Just knowing that you are not alone
and that others understand what you're going through can make coping a
little easier.
Credits
Some of this material may also be available in an Arthritis Foundation
brochure. Contact the Washington/Alaska Chapter Helpline: (800)
542-0295. If dialing from outside of WA and AK, contact the National
Helpline: (800) 283-7800.
Adapted from the pamphlet originally prepared for the Arthritis
Foundation by Harry G. Bluestein, M.D. This material is protected by
copyright.