Reiter's Syndrome

What is Reiter's syndrome?

Reiter's syndrome is a type of arthritis called reactive arthritis. It causes inflammation of joints and in the areas where tendons attach to joints. Other parts of the body, such as the eyes and the urinary tract, may also become inflamed.

How does it occur?

Reiter's syndrome is usually a reaction to an infection. Most of the time the infection is in the intestines or it is a sexually transmitted infection. The tendency to have this reaction to infections appears to be inherited. Men between the ages of 20 and 40 are most likely to develop Reiter's syndrome. It is the most common type of arthritis affecting young men.

Bacteria that most often cause infections and Reiter's syndrome are chlamydia, salmonella, shigella, yersinia, and campylobacter. You may get chlamydial infections from sexual intercourse or other intimate contact with the genital or rectal area. You may get the other types of infection by eating contaminated food.

You cannot get Reiter's syndrome from another person. However, the bacteria that trigger it can be passed from one person to another.

What are the symptoms?

The symptoms usually begin within a few weeks after you have an infection. They can affect many different parts of the body. They may be so mild that you do not notice them.

Possible symptoms are:

• pain and swelling in joints, such as the knees, ankles, and feet
• redness of the eyes, eye pain and irritation, blurred vision
• signs of inflammation in the urinary tract, especially in men, such as an increased need to urinate, pain or discomfort when you urinate, and discharge from the penis
• fever
• chills
• low back pain

Less common symptoms are mouth sores and skin rashes.

Some women also have inflammation of the fallopian tubes, vulva, or vagina. This may not cause any symptoms or it may cause pain in the abdomen or pelvic area, or vaginal discharge.

How is it diagnosed?

Reiter's syndrome may not be diagnosed for several months. The symptoms may not all appear at the same time and there are no simple lab tests to confirm the diagnosis. Your healthcare provider will ask about your symptoms and examine you. Your provider will review your medical history and ask about your sexual activity and if you practice safe sex. Tell your provider about any flulike symptoms you have had, such as fever, vomiting, or diarrhea, even if they were mild. This information helps determine what infection may have triggered your symptoms.

You will have blood tests. If you have pain or swelling in your joints, you may have X-rays. Your healthcare provider may do tests for chlamydia, using samples from your throat as well as from the urethra in men or from the cervix in women, or samples of urine. Stool samples may also be tested looking for foodborne infections. If you have a swollen joint, fluid maybe taken from it to look for signs of infection or inflammation.

How is it treated?

There is no cure for Reiter's syndrome, but treatment can help relieve symptoms. Your healthcare provider may recommend:

• Medicine
  • Acetaminophen can often help with pain but will not reduce inflammation.
  • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as aspirin, ibuprofen, and naproxen, help both pain and inflammation. NSAIDs may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason.
  • Your provider may prescribe steroids for pain and inflammation. Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider's approval. You may have to lower your dosage slowly before stopping it.
  • Your provider may prescribe antibiotics to kill bacteria that triggered Reiter's syndrome.
  • If your symptoms are very severe, you may need medicine that suppresses the immune system, such as sulfasalazine (Azulfidine) or methotrexate (Folex).
• Bed rest. Resting in bed for brief times during the day may lessen the inflammation and pain. Lying down may reduce the pressure of the body's weight on painful joints.

How long will the effects last?

Many symptoms will go away for long periods of time. Symptoms usually come and go over several months, gradually getting better. Most people with Reiter's syndrome recover fully within 2 to 6 months after the first symptoms appear. In some cases you may continue to have symptoms of arthritis that come and go for the rest of your life, but usually the symptoms are mild.

How can I take care of myself?

• Follow your healthcare provider's recommendations for bed rest and decreased activity.
• Take all of your medicine exactly as prescribed.
• Ask your healthcare provider if you need physical therapy for treatment of the arthritis or to maintain your muscle strength while you recuperate.
• Keep your follow-up appointments with your healthcare provider. Contact your healthcare provider before a regularly scheduled follow-up appointment if your symptoms get worse.

How can I help prevent Reiter's syndrome?

Reiter's syndrome caused by food poisoning can be hard to prevent, but you can follow these guidelines to help avoid food poisoning:

• Always wash your hands before eating, especially if you work in a day care center or other setting where you may be exposed to human waste. Wash your hands after each exposure to human waste.
• Drink bottled water when you travel to places where you are not sure how safe the water is. Avoid foods that have been washed with local water, such as salad greens, and avoid ice or foods made from local water unless the water has been boiled.

Reiter's disease caused by sexually transmitted infections, for example, chlamydia, may be prevented by practicing safe sex. Make sure you use latex or polyurethane condoms every time you have sex.