Reiter Syndrome (Reactive Arthritis)

Reiter Syndrome (Reactive Arthritis)

Blake St. Clair

Author Bio -

Key Points:

*Systemic, autoimmune disease that is often associated with prior gastrointestinal or genitourinary infection

*Classic dermatologic manifestations include keratoderma blennorhagicum, oral ulcers, and a red, scaly rash

Reiter Syndrome is a multi-system disease that sometimes manifests as the classic triad of uveitis (inflammation of the eye), urethritis (inflammation of the urine outflow tract), and arthritis.  This may be remembered by the mnemonic “can’t see, can’t pee, can’t climb a tree.”  General flu-like symptoms such as fever and muscle aches are common.

It is frequently associated with skin lesions including “keratoderma blennorhagicum” which refers to hard, tender bumps that may develop on the palms and soles.   Skin examination may also reveal red, scaly patches that may mimic psoriasis.  In males, a rash at the head of the penis may also be present.  It is also frequently associated with mucous membrane lesions, particularly oral ulcers.

Reiter syndrome occurs 1-4 weeks after a person is exposed to pathogenic gastrointestinal bacteria such as Campylobacter jejuni or pathogenic genitourinary bacteria such as Chlamydia trachomatis.  In Reiter Syndrome, the disease is not caused by the infection itself, but rather it is an autoimmune phenomenon in which the bacteria induces an inflammatory state that causes the signs and symptoms of the disease.  The exact cause is unknown, but it is much more common in individuals who have the HLA-B27 gene which helps to determine a person’s immune system composition.

Differential Diagnosis

Psoriatic Arthritis/Psoriasis, Septic Arthritis

Diagnosis

*Reiter Syndrome is a clinical diagnosis of exclusion, there is no specific test that confirms the diagnosis

Although there is no specific test to diagnose Reiter syndrome, it is highly suspected in someone who sub-acutely develops arthritis, uveitis, urethritis, or dermatologic findings 1-4 weeks after having a gastrointestinal illness or urinary tract infection.  Performing synovial fluid (fluid in joint spaces) analysis to rule out gout or infection may assist in the diagnosis as does testing for the HLA-B27 gene. 

Treatment

*Non-Steroidal Anti-Inflammatories (NSAIDS) and other anti-inflammatories are the best initial treatment

*Antibiotics are not indicated in Reiter Syndrome unless the initial infection is still present

Since the disease is mediated through an inflammatory process, NSAIDS such as ibuprofen are indicated in initial treatment.  Antibiotics are only necessary in the treatment of the initial infection if it is still active but will be of no assistance if the infection clears and Reiter Syndrome develops because the antibiotics would not abate the inflammatory process effectively.

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