A B C D E F G H I J K L M N O P R S T U V W

REITER'S SYNDROME

What is Reiter's Syndrome ?

A syndrome is a combination of symptoms. They may not necessarily all be present in a particular patient. Reiter's syndrome consists of three groups of symptoms: a discharge from the urethra or urinary passage perhaps with some burning on passing urine (called urethritis), inflammation of a joint (arthritis) and inflammation of the eye (conjunctivitis). A wide variety of other symptoms may occasionally occur: skin rashes, inflammation of tendons, ulcers on the mouth and penis and inflammation of nerves. The disease is either sexually acquired or occurs after a bout of gastroenteritis. When sexually acquired the patient has urethritis with pain and discharge usually starting about 2 weeks after sexual intercourse, which is often casual. These first symptoms are often mild. The arthritis affects only a few joints, often those in the legs. In arthritis, the lining of the joint cavity, called the synovium, gets inflamed. Normally it produces a small amount of fluid to lubricate the joint. When inflamed it becomes thickened and swollen. A large amount of fluid can collect in the joint. To the patient the arthritic joints are red, hot, swollen and painful to move or use. The fluid in the joint restricts its movement. The joints in the back may also be inflamed. This causes pain and stiffness, usually in the lower part of the spine. If present, conjunctivitis produces redness, swelling and irritation of the eyes which can last for some days.

How does Reiter's Syndrome occur ?

The sexually-acquired urethritis or gastroenteritis acts as a trigger to set off the disease. The body's immune (defence) system responds to these infections by attacking the germs. However, the immune system appears to be faulty. It over-reacts and starts to attack (inflame) its own tissues, causing the arthritis and conjunctivitis. Some current research suggests that the germ chlamydia is not only a trigger but may actually get into joints. The exact mechanism for the start of the inflammation is not known.

Why does Reiter's Syndrome occur ?

Reiter's syndrome is much more common in men. It affects particularly young adults who have casual sexual intercourse. Those men who inherit a gene called HLA B27 are forty times more likely to develop Reiter's disease.

Treatment Involved for Reiter's Syndrome

For the urethritis you will usually be treated with the antibiotic tetracycline, given as tablets for 14 days. However, this does not influence other symptoms of Reiter's syndrome. Your arthritis will be treated with anti-inflammatory drugs. These are called non-steroidal anti-inflammatory drugs (NSAIDs). There are more than 40 different types. Their effectiveness varies from patient to patient. They are usually taken as tablets. Some are available as suppositories or gels to rub on to the inflamed joint. They can be taken regularly for many months without people becoming too dependent on them. They reduce the pain and swelling of the inflamed joint. As the inflammation settles, you can take them just when necessary for the pain. Physiotherapy is helpful to maintain muscle tone and function around painful joints. Inflammation of the spine needs careful long-term supervision by a physiotherapist.

During Treatment for Reiter's Syndrome

The urethritis and conjunctivitis usually settle in a few days. The arthritis settles during regular treatment with NSAIDs. The joints should gradually improve over a few weeks leaving disease-free joints which return to completely normal function. You should take anti-inflammatory drugs with food to avoid indigestion. If you suffer from peptic ulcers, you should avoid these tablets. They may also cause fluid to be retained, causing swollen ankles. If a rash develops this signifies an allergy. You should then stop the tablets and contact the doctor.

After Treatment for Reiter's Syndrome

You can expect your joints to return to normal. However, some patients experience recurrences for many years. With repeated attacks, scar tissue can form in the joints. Permanent disability and deformities can occur. This is very rare.

If Reiter's Syndrome is Left Untreated

The urethritis must be treated with antibiotics to avoid the infection in the urinary passages and prostate becoming chronic, and therefore more difficult to eradicate. Most other symptoms would return to normal by themselves. However, without treatment, pains would last longer. Repeated infections, if untreated, may trigger further attacks of arthritis and the development of chronic joint deformities. Left untreated, and particularly without the correct physiotherapy, the back inflammation may lead to a rigid stooping spine, a condition called ankylosing spondylitis.

Effects on Family of Reiter's Syndrome

Your sexual partners will need to be checked (and possibly treated themselves) to avoid reinfecting you.