Reiter’s disease begins with a bacterial infection and its usual symptoms. No sooner have these subsided than suddenly the joints ache, the eyes itch, and urination burns. Reiter’s syndrome, also called Reiter’s disease or urethro-oculo-synovial syndrome, prolongs the discomfort of an infection and can trouble sufferers for a long time.
Reiter’s disease – what is it?
Reiter’s disease is characterized by inflammation of various parts of the body, particularly the joints, urethra, and conjunctiva of the eye. It occurs as a secondary disease in up to four percent of patients with intestinal or urethral infections (primarily caused by chlamydia, but rarely by other pathogens such as mycoplasma and salmonella) and should be understood as a reaction of the body’s defenses. Presumably, remnants of the pathogens as foreign substances trigger an inflammatory reaction of the immune system, which is then directed against the body’s own cells. However, the exact cause is still unclear. Reiter’s disease is thus considered to be one of the autoimmune diseases and a special form of “reactive arthritis,” i.e., joint inflammation resulting from an infection that is distant from the joint.
Who is particularly at risk?
People with a hereditary predisposition (the congenital tissue characteristic HLA-B27), which is also found in ankylosing spondylitis, for example, are particularly at risk. Affected are in Western countries about three to five per 100,000 inhabitants; thereby more men than women, mostly between the 20th and 40th year of life.
Reiter’s disease: symptom joint inflammation.
Symptoms begin within a few days to weeks after a febrile gastrointestinal or urinary tract infection. Typical and almost always present are usually asymmetric inflammation of several joints (arthritis), accompanied by fever. The joints most affected are the knee and ankle joints and the sacroiliac joint between the intestine and sacrum. The symptoms range from mild to severe, seizure-like pain and can also spread to finger or toe joints and the attachments of vision and muscles. It is not uncommon for sufferers to complain of low back pain at night.
Other symptoms of Reiter’s disease
In addition to inflammation in joint, there may be conjunctivitis (inflammation of the conjunctiva) with photophobia and burning of the eyes, and inflammation of the urethra (urethritis) with burning pain when urinating and possibly discharge from the urethra. In addition to this typical combination, the “Reiter’s triad”, many other symptoms can also occur. In principle, the inflammatory reaction can affect all other organs. Not uncommon are:
- Psoriasis-like skin inflammation (Reiter’s dermatoses).
- Painless reddish nodules in the area of the glans penis
- Inflammation of the nails
The soles of the hands and feet may thicken due to excessive callus formation, small ulcers may appear on the oral mucosa. Rarely, internal organs such as the heart muscle, nervous system or intestines are affected.
Diagnosis of Reiter’s disease
Often, the medical history and the complaint pattern with the typical symptoms already lead to the correct diagnosis. Blood, stool or urine tests can be used to detect the pathogens. In the vast majority of patients, the hereditary antigen HLA-B27 is also found in the blood. X-ray and ultrasound examinations can provide information about the extent of the joint inflammation. Computed tomography is also used if organ involvement is suspected.
Therapy of Reiter’s disease
If the original infection is still active, it is treated with antibiotics; in the case of urinary tract infections or venereal disease, the partner must be examined and, if necessary, treated as well. Beyond that, treatment depends on the symptoms. Physical applications such as cold therapy and anti-inflammatory painkillers such as ibuprofen or diclofenac help against joint inflammation. If several joints are affected, if the inflammation in the eye spreads to the iris, or if organs are involved, cortisone is also used.
Course and prognosis of Reiter’s disease
In about one-third of patients, acute Reiter’s disease progresses to a chronic form. The sooner the disease is recognized and treated, the better the prognosis. Therefore, a physician should be consulted at an early stage, especially if new joint symptoms develop after an infection of the gastrointestinal or urinary tract.In about half of those affected, the disease is cured after six months, in some even after a year. The more joints affected, the longer it can take – an average of three years, in rare cases up to 15 years.
Complications of the chronic course of Reiter’s disease.
Complications of a chronic course may include increasing destruction of the affected joints and even complete loss of function. If the inflammation in the eyes spreads to the iris and the suspensory apparatus of the lens (iridocyclitis), visual disturbances or glaucoma may result.
