Reiter's Syndrome

The dominant feature of Reiter's syndrome is polyarthritis. This self-limiting syndrome also causes urethritis, mucocutaneous lesions, and conjunctivitis or, less commonly, uveitis.

Reiter's syndrome usually affects young men ages 20 to 40; it seldom occurs in women and children. Most patients recover in 2 to 16 weeks. About one­half of the patients have recurrent acute attacks; the remainder follow a chronic course, experiencing continued synovitis and sacroiliitis.

Causes

Although the exact cause of Reiter's syndrome is unknown, most cases follow venereal or enteric infection. The high incidence of human leukocyte antigen (HLA)­B27 in patients with Reiter's syndrome suggests a genetic susceptibility. The disease has also followed infections caused by Mycoplasma, Shigella, Campylobacter, Salmonella, Yersinia, and Chlamydia organisms. It's common in patients infected with the human immunodeficiency virus (HIV) and usually precedes or follows the onset of acquired immunodeficiency syndrome.

Symptoms

• Fever
• Weight loss
• Skin rash
• Inflammation
• Sore muscles.
• Pain in the lower back, or on the heel or bottom of the foot
• Thick, crusty red-purple sores on the palms of the hands or the soles of the feet.

Diagnostic tests

Your doctor will take a complete medical history and perform a thorough examination. Because symptoms appear over a period of time, your doctor will suspect Reiter's syndrome when arthritis symptoms are followed by inflammation of the mucous membranes such as the eye and urinary tract. He or she may perform blood tests to look for the HLA-B27 marker that indicates the genetic predisposition for Reiter's syndrome. Your doctor may also want to sample any discharge to test for other sexually transmitted diseases.

Treatment

No specific treatment exists for Reiter's syndrome. During acute stages, the patient may be restricted to limited weight bearing or may require complete bed rest.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin can help relieve discomfort and fever. If the patient doesn't respond to NSAIDs, the doctor may prescribe such cytotoxic agents as azathioprine and methotrexate to alleviate debilitating signs and symptoms. Corticosteroids may help to control persistent skin lesions; gold therapy may have limited value for bony erosion.

Physical therapy includes range-of-motion and strengthening exercises and the use of padded or supportive shoes to prevent contractures and foot deformities.

Prevention

The prevention of sexually transmitted diseases through condom use, and the prevention of gastrointestinal infection through hand washing and careful food preparation, may affect the prevalence of this disease.

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