What Is Reiter's Syndrome?
Reiter's syndrome is a disorder that causes three
seemingly unrelated symptoms: arthritis, redness of the eyes, and
urinary tract signs. Doctors sometimes refer to Reiter's syndrome as a
seronegative spondyloarthropathy because it is one of a group of
disorders that cause inflammation throughout the body, particularly in
parts of the spine and at other joints where tendons attach to bones.
(Examples of other seronegative spondyloarthropathies include psoriatic
arthritis, ankylosing spondylitis, and inflammatory bowel syndrome
arthritis.) Inflammation is a characteristic reaction of tissues to
injury or disease and is marked by four signs: swelling, redness, heat,
and pain.
Reiters syndrome is also referred to as reactive
arthritis, which means that the arthritis occurs as a reaction to an
infection that started elsewhere in the body. In many patients, the
infection begins in the genitourinary tract (bladder, urethra, penis, or
vagina). The infection is most commonly passed from one person to
another by sexual intercourse. This form of the disorder is sometimes
called genitourinary or urogenital Reiter's syndrome. Another form of
the disorder, called enteric or gastrointestinal Reiter's syndrome,
develops when a person eats food or handles substances that are tainted
with bacteria.
What Causes Reiter's
Syndrome?
When a preceding infection is recognized, symptoms of
Reiter's syndrome appear about 1 to 3 weeks after the infection.
Chlamydia trachomatis is the bacteria most often associated with
Reiter's syndrome acquired through sexual contact. Several different
bacteria are associated with Reiter's syndrome acquired through the
digestive tract, including Salmonella, Shigella,
Yersinia, and Campylobacter. People may become infected
with these bacteria after eating or handling improperly prepared food,
such as meats that are not stored at the correct
temperature.
Doctors do not know exactly why some people exposed
to these bacteria develop the disorder and others do not, but they have
identified a genetic factor (HLA–B27) that increases a person'’s chance
of developing Reiter's syndrome. About 80 percent of people with
Reiter's syndrome are HLA–B27 positive. Only 6 percent of people who do
not have the syndrome have the HLA–B27 gene.
Is Reiter's Syndrome
Contagious?
Reiter's syndrome is not contagious; that is, a person
with the disorder cannot pass it to somebody else. However, the bacteria
that can trigger it can be passed from one person to another, although
not all people infected with the bacteria will develop Reiter's
syndrome. Rather, it is likely that people who develop the disease have
inherited a trait that makes them susceptible.
Who Gets Reiter's Syndrome?
Men between the ages of 20 and 40 are most likely to
develop Reiter's syndrome. It is the most common type of arthritis
affecting young men. Among men under age 50, about 3.5 per 100,000
develop Reiter's syndrome each year. Three percent of all men with a
sexually transmitted disease develop Reiter's syndrome. Women can also
develop the disorder, though less often than men, with features that are
often milder and more subtle.
What Are the Symptoms of
Reiter's Syndrome?
The symptoms can affect many different parts of the body,
but most typically affect the urogenital tract, the joints, and the
eyes. Less common symptoms are mouth ulcers, skin rashes, and
heart-valve problems. The signs may be so mild that patients do not
notice them. They usually come and go over a period of several weeks to
several months.
Urogenital Tract Symptoms
Reiter's syndrome often affects the urogenital tract,
including the prostate, urethra, and penis in men and the fallopian
tubes, uterus, and vagina in women. Men may notice an increased need to
urinate, a burning sensation when urinating, and a discharge from the
penis. Some men with Reiter's syndrome develop prostatitis, inflammation
of the prostate gland. Symptoms of prostatitis can include fever,
chills, increased need to urinate, and a burning sensation when
urinating.
Women with Reiter's syndrome also develop signs in the
urogenital tract, such as inflammation of the cervix (cervicitis) or
inflammation of the urethra (urethritis), which can cause a burning
sensation during urination. In addition, some women also develop
salpingitis (inflammation of the fallopian tubes) or vulvovaginitis
(inflammation of the vulva and vagina). These conditions may or may not
cause any symptoms.
Joint Symptoms or Arthritis
The arthritis associated with Reiter's syndrome typically
affects the knees, ankles, and feet, causing pain and swelling. Wrists,
fingers, and other joints are less often affected. Patients with
Reiter's syndrome commonly develop inflammation where the tendon
attaches to the bone, a condition called enthesopathy. Enthesopathy may
result in heel pain and the shortening and thickening of fingers and
toes. Some people with Reiter's syndrome also develop heel spurs, bony
growths in the heel that cause chronic or long-lasting foot pain.
Arthritis in Reiter's syndrome can also affect the joints
in the back and cause spondylitis (inflammation of the vertebrae in the
spinal column) or sacroiliitis (sa-kro-il-e-i-tes), inflammation of the
joints in the lower back that connect the spine to the pelvis. People
with Reiter's syndrome who have the HLA–B27 gene have a greater chance
of developing sacroiliitis and spondylitis.
Eye Involvement
Conjunctivitis, an inflammation of the mucous membrane
that covers the eyeball and eyelid, develops in about 50 percent of
people with urogenital Reiter's syndrome and 75 percent of people with
enteric Reiter's syndrome. A few people may develop uveitis, an
inflammation of the inner eye. Conjunctivitis and uveitis can cause
redness of the eyes, eye pain and irritation, and blurred vision. Eye
involvement typically occurs early in the course of Reiter's syndrome,
and symptoms may come and go.
Other Symptoms
About 20 to 40 percent of men with Reiter's syndrome
develop small, shallow, painless sores or lesions, called balanitis
circinata, on the end of the penis. A small percentage of men and women
develop rashes of small hard nodules on the soles of the feet, and less
often on the palms of the hands or elsewhere. These rashes are called
keratoderma blennorrhagica. In addition, some people with Reiter's
syndrome develop mouth ulcers that come and go. In some cases, these
ulcers are painless and go unnoticed.
About 10 percent of people with Reiter's syndrome, usually
those with prolonged disease, develop heart problems including aortic
regurgitation (leakage of blood from the aorta into the heart chamber)
and pericarditis (inflammation of the membrane that covers and protects
the heart).
How Is Reiter's Syndrome
Diagnosed?
Diagnosing Reiter's syndrome is often difficult because
there is no specific test to confirm that a person has it. When a
patient reports symptoms, the doctor must examine him or her carefully
and rule out other causes of arthritis.
The doctor will take the patient’s complete medical
history, noting current symptoms as well as any previous diseases,
problems, and infections. Because the symptoms of Reiter's syndrome can
be vague, it is sometimes useful for the patient to keep a log of the
symptoms that occur, when they occur, and for how long. It is especially
important to report any flulike symptoms, such as fever, vomiting, or
diarrhea, even if they were mild, because they may be associated with
the initial bacterial infection.
The doctor may use various blood tests to help rule out
other conditions and confirm a suspected diagnosis of Reiter's syndrome.
Tests may be done to determine the presence of rheumatoid factor or
antinuclear antibodies. Results of these tests are abnormal in patients
with other types of arthritis such as rheumatoid arthritis or lupus, but
they typically are normal in patients with Reiter's syndrome. Doctors
may determine the erythrocyte sedimentation rate, or sed rate, which is
the rate at which red blood cells settle at the bottom of a test tube of
blood. An elevated sed rate indicates inflammation somewhere in the
body. Typically, people with rheumatic diseases, including Reiter's
syndrome, have an elevated sed rate. In some patients with suspected
Reiter's syndrome, the doctor may do a blood test to determine the
presence or absence of HLA–B27.
The doctor is also likely to perform tests for infections
that might be associated with Reiter's syndrome. Patients are generally
tested for a Chlamydia infection because recent studies have
shown that early treatment in Chlamydia-induced Reiter's syndrome
may ameliorate the course of the disease. In many people with Reiter's
syndrome, there is no clear evidence of infection at the time they are
seen, although antibodies may be detected in the blood, indicating that
an infection was present in the past. The doctor may test samples of
cells taken from the patient’s throat as well as the urethra in men or
cervix in women. Urine and stool samples may also be tested. The
synovial fluid (the fluid that lubricates the joints) or the membrane
(synovium) that lines the joint may be removed from the joint affected
by arthritis. Studies of the fluid or the synovium can help the doctor
make certain there is no infection in the joint.
Doctors sometimes use X rays to help establish a diagnosis
of Reiter's syndrome and rule out other causes of arthritis. Common
findings on X rays of patients with Reiter's syndrome include
spondylitis, sacroiliitis, swelling of soft tissues, damage to cartilage
or bone margins of the joint, and bone deposits where the tendon
attaches to the bone.
What Type of Doctor Treats
Reiter's Syndrome?
A patient probably will see different doctors because
Reiter's syndrome affects different parts of the body. It may be helpful
to the doctors and the patient for one doctor to manage the complete
treatment plan. This doctor can coordinate treatments and monitor the
side effects from the various medicines the patient may take. A
rheumatologist (doctor specializing in arthritis) often manages a
patient’s treatment and treats the joint disease. The following
specialists treat other features that affect different parts of the
body.
-
Ophthalmologist—treats eye disease.
-
Gynecologist—treats urogenital symptoms in
women.
-
Urologist—treats urogenital symptoms in men.
-
Dermatologist—treats skin symptoms.
-
Orthopaedist—performs surgery on severely damaged
joints.
-
Physiatrist—supervises exercise regimens.
How Is Reiter's Syndrome
Treated?
Although there is no cure for Reiter's syndrome,
treatments that effectively relieve the symptoms are available. Many
symptoms may even disappear for long periods of time. The doctor is
likely to use one or more of the following treatments:
-
Bed rest—Short periods of bed rest are sometimes
effective in reducing the pain and inflammation of arthritis. Lying
down can reduce the pressure of the body’s weight on a painful joint
and provide relief for some patients.
-
Exercise—Even before symptoms disappear, some
strengthening and gentle range-of-motion exercises will maintain or
improve joint function. Strengthening exercises build up the muscles
around the joint to better support it. Isometric tightening of muscles
without moving the joints can be used even in active, painful disease.
Range-of-motion exercises improve movement and flexibility and reduce
stiffness in the affected joint. Before beginning an exercise program,
patients should talk to the doctor, who can recommend appropriate
exercises.
-
Nonsteroidal anti-inflammatory drugs
(NSAID’s)—This type of medicine effectively reduces joint
inflammation and is commonly used to treat patients with Reiter's
syndrome. Some NSAID’s, such as aspirin and ibuprofen, are available
without a prescription. Many others require a doctor’s prescription.
-
Corticosteroid injections—For people with severe
joint inflammation, injections of corticosteroids directly into the
affected joint may effectively reduce inflammation. Doctors typically
use this treatment only after trying to control arthritis with
NSAID’s. Corticosteroid injections are most commonly used for severe
knee or ankle inflammation.
-
Topical corticosteroids—This type of medicine can
be put directly on the skin lesions associated with Reiter's syndrome.
Topical corticosteroids reduce inflammation and promote
healing.
-
Antibiotics—Antibiotics may be prescribed to
eliminate the bacterial infection that triggered Reiter's syndrome.
The specific antibiotic prescribed depends on the type of bacterial
infection that has to be treated. Patients must carefully follow the
doctor’s instructions about how much medicine to take and for how
long; if the medicine is not taken correctly, the infection may not go
away. Often, an antibiotic is taken once or twice a day for 7 to 10
days or longer. Some doctors may recommend that a person with Reiter's
syndrome take antibiotics for a long period of time (up to 3 months).
Current research shows that this practice usually has no effect on the
course of the disease and is therefore unnecessary. However, in cases
when Chlamydia triggers Reiter's syndrome, prolonged antibiotic
treatment is effective in shortening the length of time that a person
has symptoms.
-
Immunosuppressive medicines—A small percentage of
patients with Reiter's syndrome have severe symptoms that cannot be
controlled with the treatments described earlier. For these people,
medicine that suppresses the immune system, such as sulfasalazine or
methotrexate, may be effective.
What Is the Prognosis for
People Who Have Reiter's Syndrome?
Most people with Reiter's syndrome recover fully from the
initial flare of symptoms and are able to return to regular activities
within 2 to 6 months after the first symptoms appear. Arthritis may last
up to 6 months, although the symptoms are usually very mild and do not
interfere with daily activities. Only 20 percent of people with Reiter's
syndrome will have chronic arthritis, which is usually mild. Some
patients experience symptom recurrence. Studies show that about 15 to 50
percent of patients will develop symptoms sometime after the initial
flare has disappeared. Back pain and arthritis are the symptoms that
most commonly reappear. A small percentage of patients will have
deforming arthritis and severe symptoms that are difficult to control
with treatment.
What Are Researchers Trying To
Learn About Reiter's Syndrome?
Researchers continue to investigate the causes of Reiter's
syndrome and study treatments for the condition. For example:
-
Researchers are trying to better understand the
relationship of infection to Reiter's syndrome. In particular, they
are trying to determine why an infection triggers arthritis and why
some people who develop infections get Reiter's syndrome and others do
not. Scientists have identified a genetic link—people who are positive
for HLA–B27 are more susceptible to Reiter's—and are studying why
these people are more at risk than others.
-
Researchers are trying to develop methods to detect the
location of the triggering bacteria in the body. Some scientists
suspect that after the bacteria enter the body, they are transported
to the joints, where they can remain in small amounts indefinitely.
-
Researchers are studying new treatments for Reiter's
syndrome; for example, prolonged treatment with antibiotics or a
combination of antibiotics and other drugs such as methotrexate or
sulfasalazine. Several recent studies have shown that prolonged
treatment with antibiotics may reduce the duration of symptoms in some
patients with Reiter's syndrome caused by Chlamydia infection.
Keeping on Top of Your Condition
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