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Reiter's Syndrome

A Seronegative Arthritis

Feb 2, 2009 Hanish Babu

Reiter's syndrome is a seronegative arthritis presenting with a classic triad of arthritis, urethritis and conjunctivitis.

Reiter’s syndrome is defined as a disease with arthritis of more than one month duration associated with urethritis (cervicitis in women), conjunctivitis, thick crusty skin bumps on the palms and soles and erosions on the glans penis and inside the buccal cavity.

Usually seen in young adults, 90% of Reiter’s syndrome sufferers are males. It is more common in Caucasians and is rare in Asians and African blacks.

What is the Cause of Reiter’s Syndrome?

  • Genetic predisposition: Compared to 8% of healthy persons, HLA B27 gene is present in more than 75% patients of Reiter’s disease.
  • Epidemic form: This is the most common form in United States and United Kingdom and follows sexual exposures.
  • Post dysenteric form: 2-4 weeks following a gastrointestinal dysentery, the classical clinical features appear. This is the most common type in Europe and North Africa.
  • Bacteria belonging to the species salmonella, shigella, chlamydia, ureaplasma etc have been isolated from Reiter’s syndrome cases.

What are the Signs and Symptoms of Reiter’s Syndrome?

One to 4 weeks after an episode of dysentery or sexual contact, urethritis and/or conjunctivitis are the first to appear. Arthritis follows within a few days.

The early symptoms of Reiter’s syndrome consist of fever, body pain, severe burning pain while passing urine and discharge from the urethra. Eyes turn red, itchy and sensitive to sunlight. Peripheral joint pains and back pain may be unbearable. Skin lesion resembling those of psoriasis start appearing by the second week, mostly on the palms and soles.

The Signs of Reiter’s syndrome include specific features of the skin, joint, eye and mucous membrane involvement. Skin lesions of Reiter’s syndrome are brownish red crusted bumps with central thickening and breakdown. The skin lesion has a characteristic mollusk shell appearance, somewhat akin to a mountaneous terrain, and is known as keratoderma blenorrhagicum.

Psoriasiform plaques may also appear on the scalp, elbows and buttocks . The erosive rash on the glans penis is called circinate balanitis. Nails may show thickening and separation from the nail bed. Oral cavity shows erosive lesions inside the cheeks and on the tongue. Conjuctival inflammation is usually bilateral; sometimes the inflammation may complicate the internal eye structures as well.

Arthritis is mostly unilateral and asymmetric involving the knees, ankles, wrist and small joints of the hands and feet. Both sides may be involved in severe cases. Joints are tender and swollen and the movements become restricted. In severe cases, there are permanent deformities. The arthritis is severe in HIV positive patients.

Reiter’s Syndrome Diagnosis

Reiter’s syndrome is diagnosed from the typical clinical features as described above and confirmed through laboratory investigations like blood tests, culture of urethral discharge and stool, biopsy of skin lesions and radiological examination of the involved joints. Rheumatoid factor is usually negative; hence Reiter’s syndrome is classified as a seronegative arthritis disease.

How to Manage Reiter’s syndrome?

Most of the time, Reiter’s syndrome is self limiting, with gradual improvement over 3-12 months.

There is no specific treatment for Reiter’s syndrome. Prompt treatment of infective dysentery and urethritis may prevent the development of disease, but many times, patients have developed the disease even after treatment. The management of Reiter’s syndrome is usually carried out by a team of physicians including dermatologists and rheumatologists.

Treatment of skin lesions in Reiter's syndrome is similar to topical therapies for psoriasis. For the other manifestations, rest, anti-inflammatory medications, systemic steroids, methotrexate, azathioprine, sulfasalazine and biological agents have all been used depending upon the severity of the disease and response to treatment. Systemic retinoids and phototherapy are useful in extensive or refractory cases of Reiter’s syndrome.

Reference

Disclaimer: The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.

The copyright of the article Reiter's Syndrome in General Medicine is owned by Hanish Babu. Permission to republish Reiter's Syndrome in print or online must be granted by the author in writing.
Reiter's Syndrome Skin & Joint Involvement , Dr.Hanish Babu, MD Reiter's Syndrome Skin & Joint Involvement
Circinate Balanitis in Reiter's Syndrome, Galderma Circinate Balanitis in Reiter's Syndrome
 
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