Wednesday, April 23, 2014

Reiter's Syndrome

Definition

Reiter's syndrome (one form of reactive arthritis) is characterized by a triad of arthritis, nongonococcal urethritis, and conjunctivitis, and by lesions of the skin and mucosal surfaces.

An enteric initiating component has been recognized in some patients.

Description

Reiter's syndrome involves both inflammation within and around the joints, and particularly where ligaments and tendons attach to bones. Reiter's syndrome usually develops following an intestinal or a genital/urinary tract infection and is more likely to occur in individuals who have a particular genetic makeup.

People with Reiter's have arthritis and one or more of the following: urethritis, prostatitis, cervicitis, cystitis, eye problems, or skin sores. Many people have only one episode which goes away, while some people have repeated recurrences of the illness.

Causes

Many people develop Reiter's syndrome 1 to 3 weeks following a mild or severe case of diarrhea which is often, but not always, due to food poisoning. Reiter's syndrome also develops following certain types of infections of the genital/urinary tract. These infections may be transmitted during sexual contact.

Symptoms

Arthritis is the major symptom. It generally appears several weeks or months after other symptoms. People with Reiter's may experience swelling and tenderness of one ankle or knee; pain in the heel of the foot; inflammation and pain of the Achilles tendon (located along the back of the heel); or swollen toes and fingers (often called "sausage digits" because of their shape). Inflammation of the lower back joints can cause back pain and stiffness, which often improves with movement and exercise. Inflammation can also occur around the ribs, which may cause pain in the chest.

Urethritis is a common condition of Reiter's. This involves inflammation of the urethra. It is often, but not always, the first condition of Reiter's syndrome.

Prostatitis, inflammation of the prostate gland in men, often accompanies the urethritis.

Cervicitis involves the inflammation of the cervix. There are no obvious symptoms of this condition, but it may be seen by a physician when doing a pelvic exam.

Cystitis, a bladder or urinary tract infection, may also occur. It may be accompanied by frequent and burning urination and fever.

Eye problems such as conjunctivitis may develop. This results from inflammation of the delicate membrane that lines the inner eyelids. Iritis and uveitis are less common.

Skin sores may appear anywhere on a person's body. Small, painless sores may appear on the head of the penis, roof of the mouth or tongue.

Diagnosis

Diagnosis is based upon the findings of the classic triad of problems.

Treatment

The objective of treatment is to reduce joint pain and inflammation; prevent or decrease the amount of joint damage; and restore the function of damaged joints. Treatment includes medications, rest, joint protection, and special exercises.

The most common drugs used are non-steroidal anti-inflammatory drugs (NSAIDS) such as indomethacin, diclofenac, tolmetin, sulindac or phenylbutazone. In severe cases, folic acid antagonists such as methotrexate may relieve joint inflammation.

In addition to medications, splints may be prescribed to limit movement, as this protects joints. Special exercises are recommended to maintain muscle strength and increase the range of motion.

Urethritis, prostatitis and cervicitis may go away on their own or may need treatment with antibiotics such as tetracycline. Conjunctivitis, iritis, or uveitis are often treated with prescription eye drops. Skin sores may be treated with a prescription cream.

Questions

Is the arthritis a part of Reiter's syndrome?

Will you do any more diagnostic tests?

How can this disorder be treated?

What can be done to cure the infection?

Will you prescribe anti-inflammatory drugs (NSAIDS) to relieve the discomfort?

Will exercise help?