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Reiter's syndrome


- See: Spondyloarthropathies

- Discussion:
    - involves arthritis of large joints (knees & ankles), uveitis, skin lesions, & urethritis, however only a minority will have classic triad of symptoms;
          - conjunctivitis is observed early, usually before or at the onset of arthritis;
          - urethritis is usually mild and painless with frequent nonpurulent urethral discharge;
    - severity of inciting infection does not correlate w/ intensity of arthritis which tends to appears one or two weeks later;
          - viable organisms are not present in the synovium, but bacterial antigens are present & may provide stimulus for persistent synovitis;
    - although some pts have only one episode of this illness, majority of pts have recurrent attacks, and some develop AS;
    - asymmetric large jonit polyarthritis may result from enteritis caused by salmonella, shigella, campylobacter, or yersinia;
          - urogenital infection (Chlamydia trachomatis) may also be involved;
          - yersiniosis:
                 - more likely to have atypical presentation w/ pharyngitis & cervical adenopathy resembling rheumatic fever;
    - European varient:
          - diarrhea occurs instead of urethritis;
          - Shigella, Yersinia, & Salmonella are involved in pathogenesis;


- Clinical Manifestations:
    - arthritis of large joints (knees & ankles), uveitis, skin lesions, & urethritis.
    - arthritis:
          - usually involves several joints at once - more common in the lower extremities (with oligoarthritis, reconsider the diagnosis);
          - usually more painful than the arthritis of JRA;
          - arthritis lasts less than 6 weeks.
          - typically there will be asymmetry of the affected joints;
    - spine:
          - sacroiliitis & spondylitis may occur;
    - enthesopathy:
          - pain in the heels or at sites of tendon or ligament insertion;
    - hand: dactylitis ("sausage digits");
          - diffuse swelling of fingers and/or toes does not occur frequently, but when it does occur, it is very specific for Reiters syndrome;
    - skin:
          - pts w/ Reiter's syndrome will have pustular lesions on sole of feet (keratoderma blennorrhagicum) which is not found in other forms of arthritis;
          - balanitis circinata: painless, erythematous lesion on the glans penis;


- Radiographic Features:
      - beaklike nonmarginal syndesmophytes are seen (also w/ Psoriatic arthritis);
      - there is a tendency toward exuberant periostitis, particularly in heel.
      - calcification of soft tissue


- Labs:
    - HLA-B27:
           - present in approx 90 % of pts w/ urogenital infection;
           - present in > 50% of those w/ enteric infection;
    - antibody titers:
           - w/ enteric infection, a rising antibody titer may confirm the diagnosis when cultures are negative;


- Treatment:
    - early treatment w/ tetracycline may shorten duration of illness in reactive arthritis that follows chlamydial infection;
    - relapses can be expected several years after the first episode with recurrence of both articular and non articular symptoms;
    - consider work up and treatment of GC joint sepsis
    - good initial response to NSAIDS is common but is not always seen (especially if an the syndrome occurred from GC or chlamydia).



Spondyloarthropathies: Reiter's Syndrome. Diagnosis and Clinical Features.    



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, August 22, 2012 10:28 am