Reiter’s syndrome

ROP Retinopathy of prematurity ROS Reactive oxygen species R-PIA R-(l-methyl-I-phenyltheyl)-adenosine RPMI 1640 Roswell Park Memorial Institute 1640 medium RS Reiter s syndrome RSV Rous sarcoma virus RTE Rabbit tubular epithelium RTE-a-5 Rat tubular epithelium ant n a-5... 

Complications Epididymitis, Reiter s syndrome (rare) Pelvic inflammatory disease and associated complications (i.e., ectopic pregnancy, infertility) Reiter s syndrome (rare)... 

The sahcylates are useful in the treatment of minor musculoskeletal disorders such as bursitis, synovitis, tendinitis, myositis, and myalgia. They may also be used to relieve fever and headache. They can be used in the treatment of inflammatory disease, such as acute rheumatic fever, rheumatoid arthritis, osteoarthritis, and certain rheumatoid variants, such as ankylosing spondylitis, Reiter s syndrome, and psoriatic arthritis. However, other NS AIDS are usually favored for the treatment of these chronic conditions because of their lower incidence of GI side effects. Aspirin is used in the treatment and prophylaxis of myocardial infarction and ischemic stroke. 

Psoriasis can occur in association with chronic juvenile arthritis as well as Reiter s syndrome. Some investigators have demonstrated a significant increase in prevalence in patients with human immunodeficiency virus infection.The pathogenesis of this relationship is imclear, but an immune recognition event may occm related to the HLA-B27 antigen. A large, retrospective, population-based study found that psoriatic arthritis is mild, imcom-mon, and not associated with a significant increase in mortality. 

Most disorders in this group do not present with significant ocular involvement. However, SEE, periarteritis nodosa, Reiter s syndrome (reactive arthritis), juvenile RA, and, in some instances, RA can be clinically identified by their ophthalmic presentation at an early stage in the disease. There is evidence that early treatment can reduce morbidity and have a positive impact on the course of these disorders. 

Figure 25-31 Blennorrhagica in Reiter s syndrome. (Courtesy William Wallace, O.D.)...

Nonspecific laboratory findings in patients with Reiter s syndrome include an increase in peripheral blood leukocytosis and an elevated sedimentation rate. Radiographic abnormalities are typical of RA. 

Management of the ocular aspects of Reiter s syndrome is directed toward control of inflammation.The uveitis can be fairly severe and resistant to therapy. In most instances such topical steroids as 1% prednisolone acetate or 0.1% dexamethasone are recommended. Dosage is variable but in severe cases should be administered initially every 1 to 2 hours and accompanied by such cycloplegic agents as 5% homatropine or 0.25% scopolamine two to three times daily. Aggressive treatment reduces formation of synechiae and subsequent secondary glaucoma. In patients who have severe uveitis, either sub-Tenon s capsule or oral steroids may be used in conjimction with topical management. 

The conjvinctivitis associated with Reiter s syndrome is usually mild and transient.A topical aminoglycoside, erythromycin, or a combination agent such as trimethoprim-polymyxin B (Polytrim) may be used to treat more severe conjimctivitis. 

Gender Overall, uveitis does not tend to favor either gender however, certain predisposing conditions may have a predilection for males or females. For example, HIA-B27-associated uveitis (e.g., ankylosing spondylitis, Reiter s syndrome) is encoimtered more commonly in males (3 1), whereas uveitis of JIA shows a distinct female preponderance (5 1). 

Reiter s syndrome ESR Sacroiliac and Internist, urologist. Cultures (conjimctival. 

Reiter s syndrome may affect the skin, eyes, bladder, genitalia and mucous membranes throughout the body so that it can initially share characterisdcs similar to many other autoimmune diseases. 

The exact cause is unknowm, but there appears to be a generic link. About 75% of those wdth the tendency to develop Reiter s syndrome have the same gene marker, HLA-B27, described in the previous description of alky losing spondylitis. There is also an environmental or infectious component. Reiter s disease can develop in at risk individuals followdng an infection in the intestines, genital or urinary tract. Bacteria implicated as potential causes of Reiter s syndrome include Chlamydia,... 

Those patients who develop psoriatic arthritis with spinal involvement are most likely to test positive for the HLA-B27 genetic marker also implicated in alky losing spondylitis and Reiter s syndrome. 

The most common types of arthritis in the UK are osteoarthritis (UK prevalence 23%) and rheumatoid arthritis (1%). The less common t3 es of inflammatory arthritis include juvenile idiopathic arthritis spondylarthritis (ankylosing spondylitis, Reiter s syndrome, psoriatic arthritis, arthritis associated with inflammatory bowel disecise) and reactive arthritis associated with infection. Joint pains (arthralgia) are common in many other diseases, for example the connective tissue diseases (systemic lupus erythematosus, scleroderma), endocrine conditions (hypo-and h5 erthyroidism) and malignancies, but in these, joint inflammation and damage do not usually occur. 

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