Reiters Syndrome aka Reactive Arthritis

What is Reiter's syndrome?

Reiter's syndrome, or reactive arthritis or Fiessinger-Leroy disease, is a form of arthritis that causes pain, swelling, and redness in the joints. It most commonly involves the joints of the spine and the sacroiliac joint areas (the region where the spine joins the pelvis).

In 1916, a German military physician named Hans Reiter described this disorder in a World War I soldier who had recently recovered from a case of diarrhoea. Dr Reiter described the main features of the disease as inflammation of the joints, urinary tract, and eyes. Later, a fourth characteristic feature was added - ulcerations of the skin and mouth.

Reiter's syndrome gets its name of 'reactive arthritis' because it is used to describe a general form of joint inflammation that develops as a 'reaction' to an infection in another part of the body. Reactive arthritis belongs to a group of related disorders (spondyloarthropathies), which are linked together through similar symptoms and the presence of a genetic marker called HLA-B27.

What are the causes of the disorder?

The exact cause of Reiter's syndrome is unknown but a combination of genetic and environmental factors are believed to be involved.

1. Genetics- A large percentage of people with Reiter's syndrome carry the gene called HLA-B27, which belongs to a family of genes responsible for playing a role in the body's immune defense.
2. Bacterial infection- Exposure or infection by certain bacteria is also known to cause Reiter's syndrome:
3. Chlamydia
4. Salmonella, Shigella, Campylobacter (causing diarrhea, fever, abdominal pain)

What one needs to know about symptoms or signs?

The disorder is characterized by an inflammation of the intestinal or urinary tract. Over time, this inflammation expands to involve the joints, skin, and urinary tract. However, not all symptoms occur in all patients. Symptoms manifest in the following ways:

1. Joint swelling
2. Conjunctivitis, which may be mild enough to be unnoticeable or severe and accompanied by secretions
3. Burning sensation during urination (urethritis, inflammation of the urethra)
4. Skin problems like sores on the back of the throat or soft palate. Some people may also experience a rash on the soles of their feet, which is made up of thickened and over-pigmented skin outer layers.

Which specialist should be consulted in case of signs and symptoms?

People experiencing symptoms similar to those of Reiter's syndrome should consult an orthopedic surgeon or a rheumatologist (who is a doctor who specializes in inflammatory diseases like arthritis).

What are the screening tests and investigations done to confirm or rule out the disorder?

The doctor will begin by conducting a physical exam to look for signs of skin sores or conjunctivitis. The lack of appearance of all symptoms at the same time and the absence of all symptoms in the same person in one go can delay diagnosis. However, the following tests may be performed for a more accurate diagnosis:

1. HLA-B27 antigen - Many people with Reiter's syndrome carry this gene marker. However, it is possible to get the disorder even without the gene.
2. Joint x-rays
3. Erythrocyte sedimentation rate (ESR)
4. Urinalysis

What treatment modalities are available for management of the disorder?

Treatment aims to relieve the symptoms and treat the infection that is causing the condition in the first place. The secondary manifestations of the disorder, like eye problem and skin sores do not require additional treatment - they resolve on their own once the infection is contained.

1. Medications - Antibiotics are prescribed to treat the infection. Non-steroidal anti-inflammatory drugs (NSAIDs) and pain relievers help ease joint pain. Corticosteroid injections may also be given to treat intense swelling of the joint.
2. Physical therapy- Exercises help to relieve pain and maintain muscle strength.

What are the dietary and physical activity requirements during the course of the treatment?

Physical therapy and occupational therapy allow a patient to perform daily life activities more efficiently while placing minimal stress on the joints and preventing any joint damage.

How can the disorder be prevented from happening or recurring?

Infections that can bring about Reiter's syndrome can be avoided by preventing the transmission of the causal organisms through safe sexual practices and avoidance of unhygienic foods that may cause food poisoning.

How can a caregiver give support and help the patient cope with the disorder?

The pain and unpredictability of the syndrome can make it difficult for the patient. A friend or family member can provide emotional support during the course of treatment and help out with chores during the day.

Best Orthopedics in India

Delhi NCR | Mumbai Region | Kolkata | Hyderabad | Chennai | All India

Sources:

"Reactive arthritis," Medline Plus, NLM, NIH, https://www.nlm.nih.gov/medlineplus/ency/article/000440.htm

"Reactive arthritis," Spondylitis Association of America,  https://www.spondylitis.org/about/reactive.aspx

"Reiter's Syndrome," Department Of Orthopaedics And Sports Medicine, University Of Washington, https://www.orthop.washington.edu/?q=patient-care/articles/arthritis/reiters-syndrome.html