Reiter's Syndrome

The exact cause of Reiter's syndrome is unknown. It occurs most commonly in men before the age of 40. It may follow an infection with Chlamydia, Campylobacter, Salmonella, or Yersinia. There may be a genetic predisposition to the syndrome.

The symptoms of urethritis usually appear within days or weeks of infection followed by a low-grade fever, conjunctivitis, and arthritis developing over the next several weeks. The arthritis may be mild or severe with involvement being asymmetric and in more than one joint.

The risk factors for the syndrome include infection with Chlamydia, Campylobacter, Salmonella, or Yersinia; being male; and possibly, genetic predisposition. The disorder is rare in younger children, but may occur in adolescents.

Symptoms of Reiter's Syndrome

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 4-28 days later. The arthritis usually affects the fingers, toes, and weight-bearing joints in the legs. Other symptoms include:

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  • urinary urgency
  • urethral discharge
  • burning or stinging on urination
  • redness of the eye
  • discharge from the eye
  • burning eye pain
  • joint pain in the large joints (hip pain, knee pain, and ankle pain are common)
  • low back pain
  • heel pain
  • Achilles tendon pain
  • small, painless ulcers in the mouth, tongue, and glans penis
  • skin lesions on the palms and soles that may resemble psoriasis

Additional symptoms that may be associated with this disease:

• urinary hesitancy
• skin redness or inflammation
• penis pain
• incontinence
• genital lesions (male)
• arthritis

Diagnosis of Reiter's Syndrome

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 of Reiter's Syndrome

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 of Reiter's Syndrome

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

Treatment of Reiter's Syndrome

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 of Reiter's Syndrome

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 of Reiter's Syndrome

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