Definition

Reiter’s syndrome is an inflammatory reaction to an infection somewhere in the body. It usually follows a urogenital or intestinal infection. Symptoms of the disorder primarily involve three body systems:

  • The joints
  • The eyes
  • The urinary or genital tract

Causes

Reiter's syndrome is triggered by certain infections in a genetically susceptible person. The infection often starts in the urinary or genital tract, and is usually caused by the bacterium Chlamydia trachomatis.Chlamydia is passed between people through sexual activity.

The infection can also begin in the digestive system. In these cases, the infection occurs after eating food tainted with bacteria, usually Shigella, Salmonella, Yersinia, or Campylobacter.

About 1 to 4 weeks after the infection, a susceptible person may develop Reiter’s syndrome. Doctors do not know why some people develop the disease and others do not. But most patients with the condition carry a specific genetic factor called HLA-B27 (or the B27 gene).

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition. Risk factors for Reiter's syndrome include:

  • Family members with Reiter's syndrome
  • Inheriting the genetic trait associated with Reiter’s syndrome (HLA-B27)
  • Sex: male
  • Sexual orientation: homosexual or bisexual man
  • Age: 20 to 40
  • Having a sexually transmitted disease
  • Recent new sexual partner
  • Eating improperly handled food

Symptoms

Symptoms occur in three main areas of the body: the joints, the eyes, and the urinary tract and genitals. Men and women may experience different symptoms. The disease may be milder in women. Symptoms may come and go. In rare cases, heart problems may develop later in the disease.

Specific symptoms include the following:

In the Joints:

  • Swelling, pain, and redness, especially in the knees, ankles, and feet
  • Heel pain
  • Shortening and thickening of fingers and toes
  • Back pain and stiffness

In the Eyes:

  • Redness
  • Pain
  • Irritation
  • Blurred vision
  • Tearing
  • Discharge
  • Sometimes, sun sensitivity or swollen eyelids

In the Urinary Tract and Reproductive System

In men:

  • Frequent urination
  • Burning sensation when passing urine
  • Penal discharge
  • Sores at end of penis
  • Fever
  • Chills

Male Urinary System

Male Genito-urinary System

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In women:

  • Burning sensation when passing urine
  • Inflamed vagina and cervix

Other Symptoms Include:

  • Rash, especially on the palms or soles
  • Ulcers in the mouth or on the tongue
  • Weight loss
  • Poor appetite
  • Fatigue
  • Fever

Rare Complications May Include:

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. Your doctor uses these findings to help make the diagnosis. There is no specific test to check for Reiter’s syndrome.

Testing may include:

  • Blood tests to check for:
    • Signs of inflammation (sedimentation rate)
    • Signs of infection (complete blood count)
    • The genetic factor associated with Reiter's syndrome (HLA-B27)
  • Culture, gram stain, or other tests to look for bacteria that commonly cause infections associated with Reiter’s syndrome
  • Removal of synovial fluid from around the joints to check for infection
  • X-rays—a test that uses radiation to take a picture of structures inside the body such as joints
  • Ultrasound—a test that uses sound waves to examine the inside of the body
  • MRI scan—a test that uses magnetic and radio waves to make pictures of the inside of the body
  • CT scan—a type of x-ray that uses a computer to make pictures of the inside of the body

Treatment

There is no cure for Reiter’s syndrome. However, early treatment of the infection may slow or stop the course of the disease. Most patients recover from the initial episode within six months. But some develop a mild, chronic arthritis. Some patients suffer from additional bouts of the disorder.

Treatment aims to relieve symptoms and may include:

Bed Rest

Short-term bed rest to take strain off the joints

Exercise

This includes:

  • Gentle range-of-motion to improve flexibility
  • Strengthening to build muscles that can better support the joints
  • Physical therapy with specific exercises to keep muscles strong and joints moving

Protecting the Joints

This includes:

  • Assistive devices as recommended by your doctor
  • Occupational therapy to learn how to take it easy on joints during daily activities

Medications

Your doctor may prescribe some of the following:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as:
    • Aspirin
    • Ibuprofen (Motrin, Advil)
  • Sulfasalazine (Azulfidine)
  • Steroid injections into the inflamed joint
  • Topical steroid creams applied to skin lesions
  • In some cases, antibiotics to treat the triggering infection
  • Immunosuppressive drugs (drugs that decrease the immune system’s ability to function):
    • Azathioprine (Imuran)
    • Methotrexate
  • Eye drops

Prevention

The key to preventing Reiter's syndrome is avoiding the triggering infection. To do so, take these steps:

  • Avoid sexually transmitted diseases (STDs), either by abstaining from sex or practicing safe sex, which includes:
    • Always use a latex condom during sexual activity
    • Ask sex partners about any history of sexual disease
    • Have sex with only one partner who only has sex with you
    • Do not go back and forth between sexual partners
    • Have regular checkups for STDs
  • Take steps to prevent chlamydia urogenital infections:
    • If you are age 25 or younger, get tested for chlamydia annually
    • If you are pregnant, get tested for chlamydia
  • Avoid intestinal infections:
    • Wash hands before eating or handling food
    • Only eat foods that have been stored and prepared properly