Reiter’s syndrome (RS) is defined by an episode of peripheral arthritis of more than 1 month’s duration occurring in association with urethritis and/or cervicitis and frequently accompanied by keratoderma blennorrhagicum, circinate balanitis, conjunctivitis, and stomatitis. The classic triad is arthritis, urethritis, and conjunctivitis.
Causes of Reiter’s Syndrome
RS appears linked to two factors: genetic factors, i.e., HLA-B27 in up to 75% of affected caucasians (8% incidence in unaffected caucasians) and enteric pathogens such as salmonella enteritidis, S.typhimurium, S. heidelberg; Yersinia enterocolitica, Y. pseudotuberculosis; Campylobacter fetus; Shigella flexneri. Two patterns are observed: 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.
Symptoms of Reiter’s Syndrome
People of all races, age and sex can get Reiter syndrome, however, it is more common in young males. It is the most common form of arthritis affecting men between 20-40 years old. Common symptoms are:-
- Small, painless ulcers in the mouth, tongue, and glans penis.
- Skin redness or inflammation
- Burning or stinging on urination.
- Inflammation of the eye.
- Skin lesions on the palms and soles that may resemble psoriasis.
- Keratoderma blennorrhagica, these are patches of scaly skin on the palms, soles, trunk, or scalp of RS patients.
Diagnosis
Diagnosis is based upon the findings of the classic triad of problems.
Treatment
Prior Infection Role of antibiotic therapy unproven in altering course of postvenereal RS.
Cutaneous Manifestations Similar to management of psoriasis. Balanitis: low-potency glucocorticoids. Palmar/plantar: potent glucocorticoid preparations, which are more effective under plastic occlusion. Extensive or refractory disease: phototherapy and PUVA.
Prevention of Articular Inflammation/Joint Deformity Rest, nonsteroidal anti-inflammatory agents. Occasionally, phenylbutazone is indicated. In HIV-infected individuals, zidovudine may ameliorate RS.
Methotrexate, Etretinate Effective in treatment of arthritis and cutaneous manifestations.
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