Reiters Syndrome Reactive Arthritis

Reiter s Syndrome is an inflammatory arthritis that produces pain, swelling, redness and heat in the joints. It is one of a family of arthritic disorders, called spondylarthropathies, affecting the vertebral joints The symptoms of Reiter s disease include fever, weight loss, skin rash, inflammation, ulcerations, and pain. Unlike many autoimmune disorders, Reiter s syndrome usually affects young white men between the ages of 20 and 40. 

Multi System Involvement with Emphasis on Neurologic Symptoms 

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

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

Te use of NSAIDS and other anti-inflammatory therapies are similar to those used in other autoimmune arthritic disorders. Corticosteroid injections for severe pain and inflammation at specific joints are standard therapy. For severe forms of the disease immunomodulating anti-rheumatic drugs such as methotrexate and sulfasalazine are effective. As with other similar disorders, the biologic TNF a inhibitors are currently prescribed for severe Reiter s syndrome. 

MuldSys tern Invol vemen t wd th Emphasis on Neurologic Symptoms 

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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. 

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. 

Crohn s syndrome Reiter s Disease (Reactive arthritis) 1 1 1 1 after enteric infection Increased in young white men but increasing in... 

Arthritis and arthralgia are well-known adverse effects of intravesical BCG instillation as part of therapy of bladder cancer (SED-13, 925). The etiology and the different clinical pictures of BCG immunotherapy have been discussed (51). Considering that mycobacteria are potent stimulators of the immune system and especially of T cells, it is not surprising to observe T cell-mediated aseptic arthritis after BCG therapy. The authors suggested that the site of immune stimulation is critical, since intradermal injection produces a clinical presentation similar to reactive arthritis, and intravesical therapy causes a clinical picture identical to Reiter s syndrome. 

Most cases of food-bome gastrointestinal illness resolve spontaneously. Shigella and Salmonella infections have also been associated with Reiter s syndrome or reactive arthritis. Salmonella may also lead to osteomyelitis and endocarditis. They are also associated with haemolytic uraemic syndrome (HUS) in children. 

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