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Reiters Syndrome

What is Reiters syndrome?

Specific bacterial attacks in the gut organ, genital organ or urinary tract can cause reactive arthritis and one of the common type of reactive arthritis is Reiters syndrome. The term reactive is used due to it develops in reaction of infection. The chance of development of the Reiters syndrome is minimized by treating the infection completely. Reiters syndrome is not a contagious condition, but the responsible bacteria can pass from an affected person to other individuals.

Reiters syndrome

The symptoms are quite similar like arthritis, which do not differ with infectious agent. The Reiters syndrome is non curable, but available treatment can control the symptoms. ^{(1, 2, 4)}

Symptoms

The Reiter syndrome has similar type of symptoms like rheumatic disease, which means joints and organs like kidney, heart, lungs, eye, skin and mouth are affected by this syndrome.

In Reiters syndrome, three separate bodily system is involved and the symptoms are related to the affected system.

Musculoskeletal system

The major involvement in Reiters syndrome is Musculoskeletal system and joints of the body is majorly affected and pain and inflammatory symptoms are prominent as similar as arthritis. The affected joints include the knee, ankle, and pelvic joint. The included symptoms are tightness of the affected joint, pain in the joint, and inflammation in fingers, heels , back, hip joint.

Urinary system

The urinary symptoms arise due to inflammation of the urethra, the tube which pass out the stored urine from the urinary bladder to the exterior and clinically the condition is termed as urethritis. The included symptoms are feeling of pain or burning sensation during micturation (passing of urine) with a repeated push forward to urinate. Prostatitis is common in men, in this prostate gland become inflamed, whereas Cervicitis is common in women, in which cervix become inflamed. Both the conditions are signs of Reiters syndrome.

Skin and Eyes

Less commonly skin is involved, but rarely rashes and mouth sores are common.
Swelling in the eye or conjunctivitis is another common symptom, which is associated with pain, irritation and discharge.
Pus packed inflammation is can develop in the palm, soles and penis.
Other than these, associated cardiac problem is common in 10% of cases. ^(1,3,4)

Causes

Infection due to bacterial attack is a common source of all cases of Reiters syndrome. But the exact reason behind the association of infection and Reiters syndrome is not yet understood, as some persons are get affected with Reiters syndrome, whereas others are not. It is expected that genetic involvement may be the factor, which influence the occurrence of the Reiters syndrome.

The researchers got a clue that individuals having the gene HLA B27 are more susceptible towards the development of the Reiters syndrome, though this association is not generalized for all the cases of Reiters syndrome. The prevalence is more in some types of infections, which include STD (sexual transmitted disease caused by Chlamydia trachomatis (chlamydia), food poisoning caused by Shigella and Salmonella bacteria. (1,2,3)

Diagnosis

To diagnose the Reiters syndrome, the following diagnostic tests are performed:

Symptomatic analysis by physical examination
Blood test for identification of infection and check other associated cause of inflammation
In addition, determination of HLA B27 gene through blood test helps to conclude the possibility of development of the Reiters syndrome.
Further tests are performed to determine the STD, if the symptoms are similar like in Chlamydia infection.
Urethral swab is collected for men and cervical swab and a pelvic examination is performed in women.
Little fluid is aspirated out from the inflamed knee and the process is also known as arthrocentesis is conducted for the type of fluid, which also helps to identification of the nature of the fluid for proper treatment. (3)

Treatment

The initial treatment goal of Reiters syndrome is to treat the responsible infection by prescribing antibiotics, which is depending upon the type of the infection.
Additional treatment is needed for mouth ulcers, conjunctivitis and skin symptoms like rashes etc.
Treatment needs to continue for controlling the pain and inflammatory syndrome. Initially doctor prescribed non steroidal anti-inflammatory drugs. If the symptoms cannot be controlled, then corticosteroids drugs are prescribed. The route of administration depends upon the severity of the symptoms, which may be oral route or drug is injected into the affected joints. Steroidal drugs help to control the severe inflammation and related symptoms.
In rare cases, immunosuppressant disease like methotrexate or sulfasalazine is also need to prescribe.
Etanercept, infliximab, and adalimumab are the specific drugs which used to obstruct a protein called Tumor necrosis factor (TNF), which is responsible for inflammation in the body. Thus, these drugs are termed as Tumor necrosis factor (TNF) inhibitors. Severe inflammation, like as rheumatoid arthritis (RA) is treated with TNF blockers.
Additional therapy like steroid eye drop may also prescribe depending upon the specific symptoms.
Exercise and physiotherapy are the two complementary therapies, which also has a beneficial role for treat the restricted mobility and stiffness of the joints.
Supplementation of nutrients like the addition of calcium substitute, omega three fatty acids and avoidance of poly saturated fatty acids and trans fats may also provide adjuvant beneficial effect. (1, 2, 3)

References

Steven D. Ehrlich (20014); University of Mariland Medical Center; Retrieve from: http://umm.edu/health/medical/altmed/condition/reiter-syndrome
Reiter syndrome; DermNet NZ; Retrieve from: http://www.dermnetnz.org/scaly/reiter-syndrome.html
Erica Roth (2016); Reactive Arthritis; Retrieve from: http://www.healthline.com/health/reactive-arthritis#Overview1
Definition of Reiter syndrome, (2016); Retrieve from: http://www.medicinenet.com/script/main/art.asp?articlekey=5290