Reiter's Syndrome

 

 

Reiter’s Syndrome is a type of reactive arthritis that happens as a reaction to a bacterial infection in the body. It is characterized by urethritis, conjunctivitis, and join arthritis. Urethritis is inflammation of the urethra with the most common symptom being painful or difficult urination. Conjunctivitis is inflammation of the outer membrane of the eyeball and the inner eyelid. The eye itself is not infected, however the immune system is acting as if the eye is infected. The knees and the joints of the ankles and feet are the usual targets of reactive arthritis. Fluid culture is negative for infection. The infection enters the body and triggers the immune system. The immune system creates antibodies. These antibodies attack the infection. These antibodies then cross over and attack the normal body cells. This is why they call it reactive arthritis.


 It reacts to the infection that the body already went through. It usually is associated with infection after the initial infection is gone (residual immune effect). GI infections such as salmonella and shigella and GU infections such as gonorrhea and chlamydia are often infections associated with Reiter’s syndrome. Some people are more susceptible to get Reiter’s syndrome than others. Most cases resolve within weeks but may last longer. Recurrence occurs in about 50% of the patients. Reiter’s syndrome usually starts 1-3 weeks after the original infection (up to 45 days). The patient is usually seronegative spondyloarthropathy which is in the same family of disorders as ankylosing spondylitis and psoriatic arthritis. 75% of patients are positive for HLA-B27. Remember that in a test exam, they may test you on a patient with Achilles tendon pain (Achilles tendonitis) with heel pain (plantar fasciitis) and it’s associated with Reiter’s syndrome. Also remember that Cipro (antibiotic that is used to treat bacterial infections) can cause rupture of the Achilles tendon. Do symptomatic treatment and observe. Use antibiotics for the underlying infection and steroids for severe cases. Reiter’s syndrome is not gonococcal urethritis.

Author
Nabil Ebraheim, MD

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