$Unique_ID{BRK04171} $Pretitle{} $Title{Reiter's Syndrome} $Subject{Reiter's Syndrome Blennorrheal Idiopathic Arthritis Arthritis Urethritica Venereal Arthritis Conjunctivourethrosynovial Syndrome Feissinger-Leroy-Reiter Syndrome Polyarthritis Enterica Ruhr's Syndrome Urethro-Oculo-Articular Syndrome Waelsch's Syndrome } $Volume{} $Log{} Copyright (C) 1986 National Organization for Rare Disorders, Inc. 105: Reiter's Syndrome ** IMPORTANT ** It is possible that the main title of the article (Reiter's Syndrome) is not the name you expected. Please check the SYNONYM listing to find the synonyms and disorder subdivisions covered by this article. Synonyms Blennorrheal Idiopathic Arthritis Arthritis Urethritica Venereal Arthritis Conjunctivourethrosynovial Syndrome Feissinger-Leroy-Reiter Syndrome Polyarthritis Enterica Ruhr's Syndrome Urethro-Oculo-Articular Syndrome Waelsch's Syndrome General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your personal physician and/or the agencies listed in the "Resources" section. Reiter's syndrome is characterized by inflammation of the joints, urethra, and conjunctiva of the eye, and by lesions of the skin and mucosal surfaces. Symptoms do not necessarily appear simultaneously; they may alternate, and there may be spontaneous remissions and recurrences. The syndrome rarely disables its victims. It appears to result from abnormal immune response in association with exposure (usually sexual) to an infectious agent. It affects primarily men between the ages of 20 and 40 years. Symptoms Onset of Reiter's Syndrome is between 20 and 40 years of age. Urethritis is usually the first symptom to appear, often after a sexual encounter. Urethral symptoms may be so mild initially that they seem unremarkable until later symptoms suggest the diagnosis. More often, though, urination may be painful, there may be blood in the urine, and there may be a purulent discharge. Later genitourinary symptoms can include inflammation of the prostrate gland and/or seminal vesicles (but very seldom the epididymis or the testes), and of the bladder (cystitis). Cystitis may cause increased urinary frequency, pain, blood tinged urine, and in severe or prolonged cases, obstruction of the ureters, the passages leading from the kidneys to the bladder. Other symptoms appear within 4 days to 4 weeks of the onset of urethritis. Arthritis usually has a sudden onset, affecting more than one joint. It is asymmetrical; joints of the legs and feet are involved most often; the hips and shoulders are almost never affected. Joints are warm, reddish, and painful. Although episodes of arthritis usually last at least 2 to 4 months, symptoms begin to subside within 2 to 6 weeks. Spontaneous remission often occurs within the first year, but some attacks last several years. In such cases, the involved joints may be permanently damaged. Tendons may also become inflamed. Conjunctivitis normally last only a few days, and seldom longer than a month, although it commonly recurs. It is mild and affects both eyes. The eyes burn, itch, and may discharge a viscous mucous. Occasionally, the uvea, a layer of the eye that includes the iris and choroid, also becomes inflamed, with possible symptoms of increased sensitivity to light, glaucoma, cataracts, and blindness in severe cases. Similarly, the cornea may be involved (keratitis) with pain and irritability of the eye, tearing, increased light sensitivity, and the sensation that something is present in the eye. Lesions of the skin and mucous linings occur on the penis (especially the glans), palms of the hands, soles of the feet, and in the mouth, urethra, and bladder. They cause little pain, and disappear quickly. Initially, they resemble small blisters, which then become eroded and reddish. Keratoderma blennorrhagica refers to lesions of the skin, as opposed to those of the mucosae; these lesions are scaly and crusty, eventually peeling off. They are found primarily on the hands, trunk, and arms. Mucocutaneous lesions leave no scars. The fingernails are often thick, opaque, and brittle, with dead skin accumulated underneath. Rarely, patients develop heart abnormalities including an incompetent aortic valve. Nervous system abnormalities may include inflammation of nerves, meningitis, paralysis, and psychosis. Laboratory findings include elevated levels of white blood cells in the blood and synovial fluids, and, frequently, the presence of an unusual cell marker, HLA-B27 antigen. Causes Reiter's syndrome usually makes its appearance after sexual exposure, although occasionally it follows an episode of acute diarrhea due to unknown causes. This, and the fact that many patients have an unusual cell marker (see section on Symptoms), suggests that the syndrome results from infection of genetically susceptible individuals with some infectious agent, probably shigella, or chlamydia or similar organisms. Affected Population Reiter's Syndrome predominantly affects men between the ages of 20 and 40 years. Related Disorders Arthritis with simultaneous urethritis due to gonorrhea may mimic some symptoms of Reiter's syndrome. Behcet's syndrome has similar symptoms of oral and genital ulcers and eye inflammation, and often arthritis, but the lesions are different from those in Reiter's syndrome. Therapies: Standard Treatment for Reiter's Syndrome is symptomatic. Antiinflammatory drugs such as aspirin, indomethacin, or phenylbutazone usually provide relief of arthritis. In severe cases, folic acid antagonists such as methotrexate, which act as immunosuppressants but can have serious side effects, may relieve symptoms. Corticosteroids are ineffective in this disorder. Urethritis may respond to tetracycline. Physical therapy may be useful during recovery from arthritis. Therapies: Investigational This disease entry is based upon medical information available through March 1987. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Reiter's Syndrome, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 The National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse Box AMS Bethesda, MD 20892 (301) 495-4484 References Petersdorf, Robert, G., et al, editors, Harrison's Principles of Internal Medicine, tenth edition, pp. 1989-90. McGraw-Hill, New York: 1983.