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Wednesday, Dec 03, 2008 | 11:50 AM
Madisons Foundation - Moms And Dads In Search Of Needed Support
Reiter's Syndrome (RS)
Reactive Arthritis
Wednesday, 03 September 2003
Last Updated Tuesday, 03 February 2004
What
Reiter’s syndrome (RS) is composed of a group of autoimmune-mediated symptoms including reactive arthritis (pain, swelling, redness, and heat in the joints), inflammation of the urinary tract, inflammation of the lining of the eye, and sores and/or thickening of the skin, and sores in the mouth. autoimmune diseases are disorders in which the body’s immune system mistakenly attacks one or more of its own organ systems. The arthritis is called reactive because infectious organisms are not grown from the joint fluid, although an infection outside the joint may trigger the development of arthritis.Who
This condition is observed mostly in young men before the age of 40 and rarely in children before adolescence. When children do develop RS, the symptoms are often more intense (please see the second Arthritis Foundation reference). This syndrome also occurs in females, although up to 10 times less commonly.Signs and Symptoms
A person with this syndrome may have the following symptoms: 1. Joints: pain, stiffness, and swelling, in large joints (hip, knee, ankle). Constant inflammation may result in sausage-like finger or toe. Other symptoms involving the muscles and/or bones include pain in the heels, lower back, and/or Achilles tendon (back of foot above heel). 2. Urinary tract: burning or stinging while urinating, or urethral discharge, which is clear, cloudy, or bloody fluid coming from the urinary tract. Individuals may also experience urinary urgency (urgent need to urinate). 3. Eyes: redness, clear to yellow discharge, and/or burning of the eye. People may also have eyelid swelling, photophobia (increased sensitivity to the light), or decreased vision. 4. Skin and mouth: small painless sores in the mouth, tongue, or tip of the penis, or thickened finger and toenails. The skin lesions may look like blisters or thickened skin patches on the palms and soles. Since Reiter’s syndrome is an autoimmune disease, other organ systems including gastrointestinal and cardiac may be affected. People with RS may experience low-grade fever, malaise (tiredness), abdominal pain and diarrhea, or develop a heart murmur. Symptoms may last for several weeks to six months and some individuals with RS have periodic attacks of symptoms.Possible Causes
The exact cause of RS is unknown, however the condition seems to be triggered by a bacterial infection of the intestines, genitals, or urinary tract. There may also be a genetic component to RS as evidenced by the fact that individuals with proteins called HLA-B27 are more likely to develop the condition. HLA (human leukocyte antigens) are proteins found in cells that are used by the immune system to differentiate foreign and non-foreign tissues in the body (please see the second 1 Up Health reference for more information). However, not all people with this protein develop RS and this syndrome can occur in those who do not have HLA-B27.Diagnosis
Diagnosis of RS is based on the presence of two or more of the above symptoms on physical exam (see also “Physical” section of eMedicine reference). Additionally, X-rays of the joints can be performed to detect or confirm the presence of arthritis. Your doctor may want to obtain some joint fluid to make sure there is no active infection causing the arthritis. Blood tests may be done to assess the severity of the current attack and set the course of treatment. A test for HLA-B27 can be used to identify a genetic tendency to develop the condition. An ophthalmologist will diagnose the extent of eye inflammation. Your doctor may also want to test for Chlamydia, a common bacterial trigger of Reiter’s Syndrome.Treatment
If there is an infection, the patient is treated with antibiotics to wipe out the bacteria. The arthritis can be treated with pain relievers like NSAIDS (anti-inflammatory medication) to reduce inflammatory symptoms (redness, heat, and swelling). Corticosteroids can be injected into individual joints to relieve persistent, more severe inflammation in those joints and to prevent permanent joint stiffness. Physical therapy is also helpful in relieving pain and maintaining mobility of the affected joints. Surgery to repair damaged tissues inside the joint may be needed in severe, chronic cases. Skin lesions and conjunctivitis usually go away without treatment. Therapies that suppress the immune system are considered only for those with a severe case of the condition due to their toxic side effects.Prognosis
Symptoms usually disappear within six months, although recurrent episodes of arthritis occur in up to half of affected individuals and chronic arthritis occurs in up to 30 % of affected individuals. Children who first develop symptoms before age 16, who have hip arthritis, who need more than just NSAIDS to relieve their symptoms, and who have lower back involvement are associated with a poorer prognosis. Regular clinic visits and physical therapy can help control the severity of Reiter’s Syndrome and hopefully improve the quality of life.Connect with other parents
In the spirit of community and support, Madisons Foundation offers the unique service of connecting parents of children with rare diseases. If you would like to be connected to other parents of children with this disease, please fill out this brief form.Weblinks
1 Up Health
Contains easy-to-understand information about RS and many other conditions.
1 Up Health
Contains information about HLA-B27 and its link to RS.
Arthritis Foundation
about RS and links for more information about arthritis.
Medline Plus
A complex, well written article on RS with nice definitions of medical ternms.
Reiter's Syndrome Hub
A great list of websites all with useful information about Reiter's Syndrome including support for those affected and links to ongoing research.