Synonyms: Reactive Arthritis, Reiter’s Disease, Polyarthritis Urethrica, Urethro-conjunctivo-synovial Syndrome
Definition
Reiter’s syndrome describes an inflammatory joint disease that can occur as a secondary disease after inflammation of the gastrointestinal tract or the urogenital tract (urinary tract). Actually, Reiter’s syndrome comprises three or four main symptoms and is considered a special form of reactive arthritis.
Causes
Before Reiter’s syndrome occurs, the patient first has a bacterial infection. This infection can be, for example, a urinary tract infection (urethritis), which is either caused by Neisseria gonorrhoea, or a non-gonorrhoeic urinary tract infection caused by Chlamydia trachomatis, mycoplasmas or ureaplasmas. Likewise, a gastrointestinal infection caused by Yersinia, Salmonella, Shigella (so-called dysentery), Campylobacter jejuni or enteritis pathogens can also be the previous disease.
In addition, a genetic predisposition is present in 60 – 80 % of cases. This means that the affected patients have a change in an antigenic trait. These patients are HLA-B27 positive. In the normal population this gene is actually only pronounced in 8%. After a bacterial infection of the gastrointestinal tract or the urinary tract, a reactive disease with Reiter’s syndrome can occur after 2 – 6 weeks.
Diagnosis
In order to make a diagnosis, an anamnesis with specific questioning after a previous infection of the urinary tract or the gastrointestinal tract is first carried out. Furthermore, the typical symptoms (Reiter’s triad) can lead to a diagnosis of Reiter’s syndrome. A laboratory examination can also be performed.
In most cases, inflammation parameters such as an increased blood sedimentation rate (BSG) and an elevated CRP value (C-reactive protein) are detected. However, these are very unspecific. A genetic examination can be arranged, in which a HLA-B27 detection is sought.
In 80% of cases this is positive. It is usually difficult to detect the pathogen, since the acute infection usually occurred a few weeks ago and thus no germs are found in urine (in the case of a urinary tract infection) or stool (in the case of a gastrointestinal infection). In individual cases and depending on the germ, this may still be proven with certain procedures.
In serological diagnostics, the course of an infection can also be determined subsequently. This involves the detection of IgA and IgG antibodies in the blood. Such parallel titers would indicate an existing infection, but are not always found or detected in the blood.
2-3 % of the patients who have had certain gastrointestinal or urinary tract infections before, show Reiter’s syndrome afterwards. Depending on the literature, the gender distribution between men and women is given 1:1, 3:1 or 20:1. Reiter’s syndrome occurs mainly in the life span between the ages of 20 and 40.
