Reiters Syndrome


Reiter's Syndrome

Description, Causes and Risk Factors:

Alternative Name: Reactive arthritis.

Abbreviation: RS.

The term Reiter's syndrome describes a triad of inflammatory lesions occurring in the synovium, conjunctiva, and urethra. The condition is said to be extremely rare in children.

Majority of RS have been reported to occur between the ages of 16 and 35 years. In a large series of RS it was found that only 0.7% of 739 cases occurred in children below 16 years of age. The male to female ratio in children is said to be 4:1. Diarrhea precedes the onset of RS in 80% of the cases unlike that in adults where diarrhea is not a prominent feature.

The exact cause of Reiter's syndrome is unknown. However, enteric pathogens such as salmonella enteritidis, S.typhimurium, S. heidelberg; Yersinia enterocolitica, Y. pseudotuberculosis; Campylobacter fetus; Shigella flexneri. The two forms, the epidemic form, which follows venereal exposure, the most common type in the United States and the United Kingdom; and the postdysenteric form, the most common type of RS in continental Europe and North Africa.

Reiter's Syndrome often begins following a bacterial infection in the intestine (Salmonella, Shigella, Yersinia, Campylobacter, or Chlamydia). It is not know exactly why some people exposed to certain bacteria develop the disorder and others do not. However, the presence of a certain gene HLA-B27 (human leukocyte antigen B27) increases a person's likelihood of developing Reiter's syndrome.

Risk Factors May Include:

    Infection of the urethra: It is the most common trigger. About 1 in 100 people who have an infection of the urethra also develop Reiter's Syndrome.

  • Infection of the gut: These infections are often caused by 'food poisoning'. About 1 in 100 people who have a gut infection with one of these bacteria also develop Reiter's Syndrome.

  • Infection with Chlamydophila pneumoniae. This bacterium can cause a respiratory tract infection and can sometimes be a trigger factor for RS.

  • Viral infections that can cause a sore throat, skin rash are sometimes trigger for RS.

  • White males ages of 20 - 40 are at higher risk.

Symptoms:

    Pain, swelling, stiffness, and redness of joints (knee, ankle, spine, and feet).

  • Conjunctivitis, iritis, uveitis.

  • Urinary urgency.

  • Urethral discharge

  • Burning or stinging on urination.

  • Pus filled sores.

  • Rashes.

  • Women are affected in the urogenital area, including the fallopian tubes, uterus, and vagina. They often experience cervicitis or urethritis which can cause pain during urination. Some women may also experience saalpingitis or vulvovaginitis.

Diagnosis:

There does not exist any definite diagnostic criteria to detect Reiter's syndrome.Physical examination of the patient is the first and the most important of the diagnostic methods.Despite the fact that there is no specific test for diagnosing Reiter's Syndrome, there are various ways to check for symptoms of the disease that can indicate its presence. For example, the urethral discharge is typically tested for sexually transmitted diseases. Blood tests can indicate whether or not patients possess the HLA-B27 genetic marker. Its presence is typically associated with signs of inflammation, including an elevated white blood cell count and an increased erythrocyte sedimentation rate (ESR). Anemia, or the lack of sufficient red blood cells causing a lack of oxygen in the organs and tissues, is another indicator of Reiter's Syndrome.

Imaging studies may include X-ray of the lower spine and pelvic area and MRI scan.

In some patients, antinuclear antibodies, C-reactive protein, rheumatoid factor, and circulating immune complexes may be present.

Treatment:

The goal of treatment is firstly to identify and eradicate the underlying infectious source with the appropriate antibiotics. Otherwise, treatment is symptomatic for each problem. Steroids and analgesics may be given for severe joint inflammation. Immunosuppressants may be needed for patients with severe RS which do not respond to any other treatment.

Drug Therapies:

    Antibiotics.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). May include ibuprofen (Advil, Motrin), naproxen (Aleve).

  • Corticosteroids.

  • Immunosuppressants. May include sulfasalazine or methotrexate.

  • Tumor necrosis factor (TNF) inhibitors -- these drugs block a protein that causes inflammation in the body. They may be used in more severe cases and are also used to treat rheumatoid arthritis. TNF inhibitors include etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira)

Other Measure:

    Eat fewer foods that are high in saturated fat (like red meat and fried foods) and limit alcohol intake.

  • Shark cartilage or chondroitin sulfate may help provide pain relief over time.

  • Vitamin C, vitamin E, beta-carotene, selenium may help strengthen your immune system.

  • Omega-3 fatty acids help reduce inflammation and are good for your heart, but should be used only under the supervision of a physician.

Alternative Treatment Options:

    Herbs are generally a safe way to strengthen and tone the body's systems. The following herbs help reduce inflammation, although they have not been studied specifically for Reiter syndrome. Do not take these herbs without your doctor's supervision. These may include: Bromelain, turmeric or curcumin (Curcuma longa), white willow (Salix alba), Licorice (Glycyrrhiza glabra), Cat's claw (Uncaria tomentosa), Boswellia (Boswellia serrata).

  • For urethritis these may include: Uva ursi (Arctostaphylos uva ursi), Horsetail (Equisetum arvense), and meadowsweet (Filipendula ulmaria).

Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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