What is Reiter's Syndrome ?
Reiter’s syndrome (also known as Reiter’s disease) is a reaction to another infection within your body. Reiter’s syndrome can affect men and women of all ages, but is most common in men aged 20 to 40. Reiter’s syndrome affects about 5 out of every 100,000 people aged 18-60. It can be chronic or recurrent in some cases.
Reiter’s syndrome symptoms are:
Joint pains from a form of arthritis (inflammation of the joints and tendons) known as seronegative arthritis.
Inflammation of the eyes due to conjunctivitis (inflammation of the outer surface of the eye)
Burning on passing urine due to urethritis (inflammation of the urethra)
Reiter's syndrome is sometimes called reactive arthritis, because it develops as a ‘reaction’ to an infection in part of your body other than your joints. Your body's immune system reacts to infection by attacking the bacteria that causes it. Reiter's syndrome develops when your immune system over-reacts and attacks your body's own tissues instead. As many as one or two out of every hundred individuals with these infections may develop an attack of arthritis.
The most common infections to trigger Reiter’s syndrome are infections of the genitourinary tract (bladder, urethra, penis, or vagina), such as chlamydia, non-gonococcal urethritis, gonorrhoea, and infections of the gut (gastroenteritis). In women cervicitis ( inflammation of the cervix of the womb) may also be a cause. Less often, viral infections such as a sore throat or cough can be a trigger. HIV infection is also known to cause the condition. However, in about a quarter of cases, no triggering infection can be identified.
Most people who get an infection that can potentially cause Reiter's syndrome will not go on to develop the condition. Approximately 1 person in 20 has a gene called HLA-B27, which seems to increase the risk of developing Reiter's syndrome after a bacterial infection. About three-quarters of those who develop Reiter's syndrome have this gene.
Symptoms of Reiter's Syndrome
The symptoms of Reiter’s syndrome usually develop 1-4 weeks after the infection that triggers the condition, often after that infection has gone. However, not all of the symptoms may develop at the same time.
These usually develop fairly quickly, over a period of a day or so, although in some cases they may develop more gradually. The arthritis often affects just one joint, or only a few major joints such as the knees, ankles or toes. The affected joints are swollen and sore. The tendons and ligaments next to some joints may also become inflamed, particularly the Achilles tendon at the back of your ankle. If the ligaments in a finger or toe become inflamed at the same time as the joint, the whole finger or toe may look swollen.
Pain on urination (Urethritis)
Urethritis causes discharge from your urethra (you may often notice it first as staining on your underpants) and a burning pain when you urinate. You may find it difficult to start urinating or to keep a steady flow (known as urinary hesitancy).
Inflammation of eyes (Conjunctivitis)
Conjunctivitis makes your eyes become puffy, red and sore and they may discharge pus. This condition usually gets better by itself. But in a few people the condition is due to iritis ( sometimes called acute anterior uveitis), which can quickly damage the eyesight. Grittiness, pain or redness of the eye could be a very serious symptom and this therefore need to be assessed urgently by an eye specialist.
Reiter’s syndrome can also cause other symptoms, including:
scaly skin rash over your hands or feet
inflammation and redness at the end of the penis (balanitis)
uveitis (inflammation of a deeper part of the eye)
When Reiter’s syndrome first appears it will normally be as an acute condition, but it can become a chronic condition with regular flare-ups.
Testing for Reiter's Syndrome
There are no specific tests to diagnose Reiter’s syndrome. In the presence of the three symptoms, putting together a number of different pieces of information, for example inflammation of the urethra or cervix is common in reactive arthritis, therefore, it is usually necessary to be examined by a specialist in genito-urinary medicine. Simple quick tests will show whether there is urethritis or cervicitis. If there is a history of previous sexually transmitted infections or diarrhoeal illnesses, a presumptive diagnosis of this condition is made. The majority of patients are positive for a genetic marker called HLA B27, which can be confirmed with blood tests. Blood tests are usually taken to help rule out other possibilities and assess the severity of the condition. These may need to be repeated. X-rays may be helpful though not always necessary.
Treatment of Reiter's Syndrome
Treatment for Reiter’s syndrome or reactive arthritis must allow for the fact that it tends to go away naturally. Therefore, potentially toxic drugs are often best avoided, but it is of course, important to treat the infection that gave rise to it. Unfortunately, this does not usually seem to affect the course of the arthritis itself. Once started, it will run its natural course. Treatment involves treating any triggering infection as well as treating the symptoms of the syndrome itself. Reiter’s syndrome can be treated with pain killers and anti-inflammatory drugs. Some clinicians use a course of antibiotics. Reiter’s syndrome can be painfully recurrent.
If an infection of the urethra - such as chlamydia - is the trigger for Reiter’s syndrome, your doctor will usually prescribe antibiotics.
Most gut infections will have cleared up by the time that Reiter’s syndrome develops.
Conjunctivitis normally needs no treatment, although severe eye inflammation may require a corticosteroid ointment or eyedrops. Uveitis can be treated with steroid eye drops to reduce inflammation in the eye.
Arthritis and other tissue inflammation is usually treated with non-steroidal anti-inflammatory drugs and painkillers, as these can help with pain and stiffness. If your joints are badly swollen you may need to rest them until the symptoms ease, but as soon as you can it is important to get them moving and exercising again. If a joint becomes very swollen, the fluid can be removed with a needle and syringe, which should help ease the pain. An injection of steroid medicine directly into the joint can also help.
In most cases, the symptoms of Reiter’s syndrome last 3-12 months, although they may become milder over time. However, in some cases the arthritis may last much longer, sometimes as long as years.
Some people who develop Reiter’s syndrome will recover but then find that their symptoms return months or even years later. In some cases this may be a reaction to a new triggering infection, but in others there may be no apparent reason.
Prevention of Reiter's Syndrome
It is sensible to take precautions to avoid sexually-transmitted infections such as the use of condoms. Using a barrier method of contraception greatly reduces the risk of sexually transmitted infections such as chlamydia, which are one of the main types of infection that can lead to Reiter’s syndrome. The most effective barrier method is the male condom.
If you have been diagnosed with Reiter’s syndrome your sexual partners will need to be checked (and possibly treated themselves) to avoid reinfecting you.
If you have already had Reiter’s syndrome you should take particular care to avoid sexually transmitted diseases and food poisoning, as this makes these infections more likely to trigger a further episode. Anyone travelling to places where there is a high risk of diarrhoeal illness, should take special care especially concerning drinking water and uncooked food.
Complications from Reiter's Syndrome
Reiter’s Syndrome can be painfully recurrent.
The urethritis must be treated with antibiotics to avoid the infection in the urinary passages and prostate becoming chronic, and therefore more difficult to eradicate.
Most other symptoms would return to normal by themselves. However, without treatment, pains would last longer.
Repeated infections, if untreated, may trigger further attacks of arthritis and the development of chronic joint deformities.
I May Have Reiter's Syndrome
If you have any concerns relating to this condition, or any conditions described on this website, please contact the Sunshine Clinic by telephone to arrange an appointment with Dr Sood,