Reiter's Syndrome
Reiter's Syndrome, characterized by the triad of urethritis, conjunctivitis, and arthritis, is a seronegative spondyloarthropathy (autoimmune damage to the cartilages of joints) often precipitated by genitourinary or gastrointestinal infections. There is asymmetrical joint distribution occurring mostly in the feet. The syndrome may present with sacroiliitis.
Signs and symptoms
Reiter's syndrome occurs after bacterial urinary tract infections or enteritis. Typical pathogens are gonococcus or Shigella flexneri (shigellosis). Symptoms generally appear within 1-3 weeks but can range from 4-35 days from onset of inciting episode of disease.
Patients carrying tissue type HLA-B27 are at increased risk for developing Reiter's syndrome.
Diagnosis
Reiter's Syndrome was first described during World War I by the German doctor Hans Reiter, who identified the "classic triad" of urethritis, arthritis and conjunctivitis after observing it in a soldier-patient. He described three characteristic features of the disease: inflammation of the joints, urinary tract and eye disorders. More recently, doctors have recognized a fourth major feature: ulcerations of the skin and mouth. Urethritis usually occurs first. There are countless clinical symptoms, but the clinical picture is dominated by polyarthritis. There is pain, swelling, redness, and heat in the joints.
Treatment
The goal of treatment is to eradicate the infectious source, and symptomatic arthritis relief that is similar to rheumatoid arthritis, i.e. NSAIDs.
Prognosis
Reiter's syndrome may be self limiting, frequently recurring or develop continually. Most patients have severe symptoms lasting weeks to six months. Approximately 15-50 percent of cases have recurrent bouts of arthritis. Chronic arthritis or sacroiliitis occurs in 15-30 percent of cases. Repeated attacks over many years is common, and more than 40 percent of the patients end up with chronic and disabling arthritis, heart disease or impaired vision. However, most people with Reiter's syndrome can expect to live normal life spans and maintain a near-normal lifestyle with modest adaptations to protect the involved joints.