Rhumatoid arthritis - Reiters syndrome

Reiter's syndrome is a rheumatory arthuritis disorder causing three seemingly unrelated symptoms: arthritis, urinary tract signs and redness of the eyes.

	Reiters syndrome

Reiter's syndrome is sometimes also called seronegative spondyloarthropathy. It is one of several disorders (conditions) causing inflammations throughout the whole body, especially partially in the spine and in other joints where there are attachments between tendons and bones.

Other conditions in this group are psoratic arthritis, inflammatory bowel syndrome arthuritis and ankylosing spondylitis. The inflammation is a typical reaction, marked by signs of swelling, heat, pain and redness.

This condition, Reiter's syndrome, is also known as reactive arthiritis because the arthritis occurs originally a a reation starting from an infection elsewhere in the body. It is quite common that this infection starts in the genitourinary region (penis, vagina, bladder or urethra). In this form, the condition is sometimes also called urogenital Reiter's syndrome (or genitourinary) - since it is passed via sexual intercourse. There is another variety, known as enteric, or gastrointestinal Reiter's syndrome. It can develop from eating food infected with bacteria (or handling such food). 

What will cause Reiter's syndrome?

Symptoms of Reiter's will show up 1-3 weeks after the infection. The bacteria which most frequently is the culprit, is Chlamydia trachomatis, passed through sexual contact. There are also several other bacterias connected to Reiter's syndrome, these are acquired through the digestive tract. Examples of these are salmonella, shigella, campylobacter and Yersinia. It is possible to get infected with any of these after eating or handling food that has been prepared badly, such as meat that has been stored badly or cooked badly. 

Not all people who are exposed to the bacteria mentioned above will develop a full blown Reiter's syndrome. It is not entirely clear why some people get infected and others not. There is a genetic factor, the HLA-B27, which increases the risk that you will develop this disease. About 1/10th of the population has this (HLA-B27) gene, but on the other hand, over 80% of the patients with Reiter's also have HLA-B27.

Is Reiter's syndrome a contagious disease?

No. Reiter's syndrome is not a contagious disease. So, if you have it, you can't pass it on to anyone else. The bacteria which may trigger a Reiter's syndrome developing can however pass over from one person to another. However, not all people who have the bacteria will ever develop the diseast. It is more plausible that people developing Reiter's syndrome have a genetic predisposition for this.

How can Reiter's syndrome be diagnosed?

Diagnosing Reiter's syndrome is often difficult since there is no specific test actually confirming whether a patient has it or not. A careful examination is necessary, including listening to reports on symptoms and with the aim to rule out other rheumatory atrhitis causes.

For a proper diagnosis, a complete medical history is essential, including notes of prior problems and diseases, infections and all current symptoms. The symptoms or Reiter's can be vague and it is therefore useful if the patient can keep a log of symptoms as they occur with timings. Symptoms of special interest are any that resembles flu since these may have an association with the original bacterial infection. 

Ruling out other conditions and to confirm the diagnosis or Reiter's syndrome, there are several blood tests that can be done in order to establish the presence of rheumatoid factor (antinuclear antibodies). These results will not be present in patients with other types of arthritus such as rheumatoid arthritis or lupus but they are significant with the Reiter's syndrome patient. Via blood sample, it is also possible to determine the erythrocyte sedimentation rate. This is the rate at which the red blood cells will sediment out at the bottom of a blood test tube. An increased rate here will point towards an inflammation which is typical for patients with reumatory disease, including Reiter's syndrome.

Other tests revealing infections connected to Reiter's syndrome are Chlamydia. Tests for other infections can be taken from the throat, the urethra in men or cervix in women. Urine and stool samples can also be used for testing.

X-ray testing is also used to some extent. Common findings on Reiter's patients X-rays include sacroilitis, spondylitis, swelling of soft tissue and damage to either cartilage or bone margins in the joints (mainly the minor joints).

Treatment of Reiter's syndrome

·  Nonsteroidal anti-inflammatory drugs (NSAID’s)— a type of drugs that effectively reduces joint inflammation and is commonly used in patients with Reiter's syndrome. Some NSAID’s, such as aspirin and ibuprofen, are available over the counter. Others require a prescription.

·  Corticosteroid injections— Mainly for patients with severe joint inflammation, when corticosteroids are injected directly into the joint which can effectively reduce the inflammation. This is often the second step, after first trying NSAID's and it is often used for severe ankle or knee inflammations.

·  Topical corticosteroids— This is a type of medicine that can be applied directly on the skin lesions associated with Reiter's syndrome. This can reduce inflammation and help healing.

·  Antibiotics— Antibiotics can be prescribed to stop any bacterial infection that originally started off Reiter's syndrome. The exact antibiotic to prescribe will depend on the type of bacterial infection it is supposed to treat. In most cases, antibiotics are taken once or twice a day for a week or up to ten days. A patient with Reiter's syndrome may take antibiotics for a longer period, as much as up to 3 months.

·  Immunosuppressive medicines— A small amount of patients affected with Reiter's syndrome have severe symptoms which are difficult to control with previous treatments. In these cases, drugs to suppress the immune system - such as methotrexate or sulfasalazine can be effective.

 

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