Reiter’s syndrome (reactive arthritis)

Classified as an autoimmune condition that develops in response to an infection in another part of the body.

Inflammatory arthritis occurs after bacterial and viral syndromes.

A bacterial infection can trigger the disease.

Typically manifests as post infectious asymmetric oligoarthritis of the legs and may involve the spine.

The inciting infection may be cured or is in remission in chronic cases by the time the clinical manifestations are noted.

The mechanism of interaction between the infecting organism and the host is unknown, but the reactive arthritis is caused either by an autoimmune response or by bacterial antigens in the joints.

The clinical pattern commonly involves an inflammation of fewer than five joints which often includes the knee or sacroiliac joint.

More joints become inflamed in addition to the primarily affected one and or migratory arthritis with new joints become inflamed after the initially inflamed site has already improved).

The manifestations of Reiter’s Syndrome include the triad of symptoms: an inflammatory arthritis of large joints, inflammation of the eyes in the form of conjunctivitis or uveitis, and urethritis in men or cervicitis in women.

Additional manifestations can include mucocutaneous lesions, psoriasis-like skin lesions such as circinate balanitis, and keratoderma blennorrhagica.

The Achilles tendon may be involved resulting in heel pain.

Not all affected persons have all the manifestations of disease.

A RF-seronegative process.

HLA-B27-linked arthritis is often precipitated by genitourinary or gastrointestinal infections,

The most common triggers of reactive arthritis are intestinal infections with Salmonella, Shigella or Campylobacter and sexually transmitted infections with Chlamydia trachomatis or Neisseria gonorrheae.

Most common in patients aged 20–40 years of age.

More common common in men than in women.

More common in whites than in blacks, as there is higher frequency the of HLA-B27 gene in the white population.

Patients with HIV have an increased risk.

Symptoms generally appear within 1–3 weeks after onset of inciting process, but symptom onset can range from 4 to 35 days from inciting event.

The classical presentation starts with urinary symptoms such as burning pain on urination or an increased frequency of urination.

Patients may experience urogenital such as prostatitis in men and cervicitis, salpingitis and/or vulvovaginitis in women.

Following urogenital symptoms, arthritis that affects the large joints such as the knees, with relative sparing of small joints such as the wrist and hand may occur.

Eye involvement occurs in about 50% of men with urogenital symptoms and about 75% of men with enteric reactive arthritis.

Conjunctivitis and uveitis can may manifest with eye redness, pain, irritation, or blurred vision.

Eye involvement typically occurs early in the course of reactive arthritis,

Eye symptoms may be intermittent.

Approximately 20 to 40 percent of the men develop penile lesions called balanitis circinata.

A small percentage of men and women develop keratoderma blennorrhagica, small hard nodules on the soles of the feet and, less commonly, on the palms of the hands or elsewhere.

Some patients develop painless mouth ulcers that come and go, while others may suffer with recurrent aphthous stomatitis, geographic tongue and migratory stomatitis.

Some patients have serious gastrointestinal symptoms.

About 10 percent develop cardiac manifestations, including aortic regurgitation and pericarditis.

May be a pre-cursor for other joint conditions, including ankylosing spondylitis.

Clinical process is dominated by arthritis in one or more joints, with pain, swelling, redness, and heat at the involved joints.

Cultures of joint fluids, urine, stool, urethra, cervix and throat may be attempted with diagnosis.

C-reactive protein and erythrocyte sedimentation rate elevations corroborate the diagnosis of the syndrome.

Treatment is to identify and eradicate the underlying infectious source, if still present.

Treatment is otherwise symptomatic and include: NSAIDs, sulfasalazine, steroids and immunosuppressants.

Prognosis varies from self-limiting, recurring, chronic or progressive.

Most patients have symptoms lasting a few weeks to six months.

15 to 50 percent of patients have recurrent bouts of arthritis.

Chronic arthritis or sacroiliitis occurs in 15-30 percent of cases.

Recurrent attacks over many years are common.

Patients sometimes end up with chronic and disabling arthritis, heart disease, amyloidosis, ankylosing spondylitis, IgA nephropathy, cardiac conduction abnormalities, or aortic regurgitation.

Most patients have a normal life span and maintain a near-normal lifestyle.

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