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Monday, September 28, 2020

Reiter’s syndrome – reactive arthritis

Reiter’s syndrome was named after a German military doctor Hans Reiter who was the first to observe and describe these changes- combination of three symptoms is characteristic for this condition – urethritis, conjunctivitis, and arthritis. Urethritis (inflammation of urethral tube) is usually the first sign, but is not a consequence of sex disease, even though symptoms include burning, pain while urinating, and thick yellow discharge.  Sometimes inflammation spreads to glans penis mucosa (balantis circinata).

Conjunctivitis is usually acute and recurring, but can also go unnoticed.

Arthritis usually presents itself few weeks after urethritis. It can affect a single large joint (usually ankle or knee), and last for a few weeks, but can also present itself like polyarthritis, even similarly to rheumatoid arthritis. Skin can change on hands and soles of the feet, with hyperceratosis and peeling (keratoderma blenorrhagica), which is aesthetically ugly and can affect the patient’s social life. All mentioned changes are mostly short-term. Arthritis can repeat itself several times in a period of few months, even years, but it also passes. In a small number of patients disease becomes chronic and develops into a progressive polyarthritis similar to rheumatoid arthritis which leads to heavy paralysis.

The cause of this illness lies in some infective germs, especially Chlamydia. They are not in the inflamed joint, but the inflammation of the joint develops as a reaction to infection, so nowadays we speak of reactive arthritis. The presence of HLA-system B27 antigens also plays an important role. Like every arthritis, Reiter’s syndrome patients might experience affection of sacroiliac joints and spine, with ankylosing changes like in ankylosing spondylitis.

Reiter’s disease is not very common. It affects younger men, and is sometimes preceded by diarrhea and dysentery.

Prognosis is usually benign. Only 3% of patients develop spinal ankylosis, and around 30% develop chronic peripheral arthritis. Treatment involves non-steroid anti-inflammatory drugs, while mucosa inflammation demands local therapy (eye drops, urological disinfectants, and increased hygiene).
Lately antibiotics are prescribed in the beginning acute stadium. Physical procedures involve treating arthritis , which is the most important treatment. In acute phase kryotherapy and kinesiotherapy are performed locally, along with electrotherapeutical procedures.

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