Reiter's Syndrome and Reactive Arthritis

What is Reiter's Syndrome and Reactive Arthritis?
Statistics on Reiter's Syndrome and Reactive Arthritis
Risk Factors for Reiter's Syndrome and Reactive Arthritis
Progression of Reiter's Syndrome and Reactive Arthritis
How is Reiter's Syndrome and Reactive Arthritis Diagnosed?
Prognosis of Reiter's Syndrome and Reactive Arthritis
How is Reiter's Syndrome and Reactive Arthritis Treated?
Reiter's Syndrome and Reactive Arthritis References
Drugs/Products Associated with Reiter's Syndrome and Reactive Arthritis

What is Reiter's Syndrome and Reactive Arthritis?

Reiter's syndrome is a seronegative arthritis involving mainly the peripheral joints, occuring after an episode of urethritis or diarrhoea and associated with conjunctivitis. Reactive arthritis is an inflammatory arthropathy following an infection in which no viable microorgansim is found in the synovial fluid. Reiter's is seen by some to be a subset of the reactive arthritides.

Statistics on Reiter's Syndrome and Reactive Arthritis

Believed to be the most common form of acute arthritis in the young adult population. The true incidence is not known but studies have shown that 1-3% of individuals infected during an epidemic of bacterial diarrhoea may develop Reiter's. There is a strong male prevalence in the venereal onset Reiter's.

Risk Factors for Reiter's Syndrome and Reactive Arthritis

The cause is believed to be a microbial agent that triggers the disease in a genetically susceptible individual. Common gastrointestinal organisms include Shigella, Salmonella, Yersina and Campylobacter and the genitourinary pathogen Chlamydia Trachomatis.

Progression of Reiter's Syndrome and Reactive Arthritis

Treatment has generally helped the symptoms of the conditon without affecting the natural history.

Almost 60% of patients have chronic relapses of peripheral arthrits when followed over a longer period and nearly 35% become diasbled in some way.
50% have back pain and evidence of sacroiliitis. The flares may recur spontaneously or follow a repeated genitourinary infection or bout of diarrhoea.
No clinical features are especially helpful in establshing a prognosis.
Those with HLA B27 are more likley to have back pain but not necessarily more frequent or severe relapses.

How is Reiter's Syndrome and Reactive Arthritis Diagnosed?

Urinalysis - sedimentation rate often raised.
Full blood count - white cell count often raised.

If indicated:

Urethral swabs/First Void Urine in men or High vaginal and Endocervical swabs in women - for PCR for Chlamydia trachomatis.
Stool sample - only if there is a disabling gastrointestinal upset.

Prognosis of Reiter's Syndrome and Reactive Arthritis

The majority of patients have symptoms lasting from weeks to months. Up to 50% of patients may have repeated episodes of arthritis, and 15-30% of patients may have long term arthritis.

How is Reiter's Syndrome and Reactive Arthritis Treated?

Rest and Physical therapy
Pharacotherapy - non-steroidal anti-inflammatories - used to manage acute and chronic flares.
Conjuctivitis does not require treatment. Treating the chlamydial urethral infection may shorten the course of the arthritis. Treatment consists of azithromycin (or a tetracycline).
Corticosteroids - ued intra-articularly to treat 1-3 resistant joints or managing plantar fascitis or Achilles tendinitis. Only rarely will large oral doses be be needed (40-80mg).
Immunosuppressives (methotrexate, azathioprine) - used for the small subgroup who have progresive disease unresponseive to the above measures.

Reiter's Syndrome and Reactive Arthritis References

Braunwald, Fauci, Kasper, Hauser, Longo, Jameson. Harrison's Principles of Internal Medicine. 15th Edition. McGraw-Hill. 2001
Cotran, Kumar, Collins 6th edition. Robbins Pathologic Basis of Disease. WB Saunders Company. 1999.
Haslet C, Chiliers ER, Boon NA, Colledge NR. Principles and Practice of Medicine. Churchill Livingstone 2002.
Hurst JW (Editor-in-chief). Medicine for the practicing physician. 4th edition Appleton and Lange 1996
Kumar P, Clark M. CLINICAL MEDICINE. WB Saunders 2002 Pg 427-430. Longmore M, Wilkinson I, Torok E. OXFORD HANDBOOK OF CLINICAL MEDICINE. Oxford Universtiy Press. 2001
McLatchie G and LEaper DJ (editors). Oxford Handbook of Clinical Surgery 2nd Edition. Oxford University Press 2002.
Raftery AT Churchill's pocketbook of Surgery. Churchill Livingsone 2001.