Spondyloarthropathies (spawn-dill-oh-ahr-THRAH-puh-thees) are a group of inflammatory joint conditions that share certain clinical features and predisposing genetic factors. These conditions include psoriatic arthritis, ankylosing spondylitis, reactive arthritis (Reiter’s syndrome), inflammatory-bowel-associated spondyloarthropathies (Crohn’s disease, ulcerative colitis, etc.), and others.
Reiter’s syndrome is a spondyloarthropathy characterized by the clinical triad of non-gonococcal urethritis, conjunctivitis, and arthritis. Not all of these features may be present, however.
Reiter’s syndrome is most often associated with genitourinary or gastrointestinal infections—Chlamydia trachomatis, Shigella, Salmonella, Yersinia, Mycoplasma, Ureaplasma, and Campylobacter are the most frequently found organisms.
People who possess the HLA-B27 genotype are at a much higher risk of developing reactive arthritis than others. This genetic makeup probably confers immune hyper-reactivity to infection by these microbes, predisposing individuals to an autoimmune response that damages joints and other tissues.
Although people with Reiter’s syndrome usually have evidence of bacterial antigens in their joint fluid, the organisms cannot be cultured from within the joints. This characteristic distinguishes reactive arthritis from septic arthritis, in which infectious organisms can be recovered and cultured from joint fluid.
Signs and Symptoms of Reiter’s Syndrome (Reactive Arthritis)
- Arthritis: May involve one joint or several; usually asymmetric. Generally begins 1 – 4 weeks after infection, and preferentially affects lower extremities. Can be transient, lasting three to four months, but about half of patients have recurrent or prolonged symptoms lasting years.
- Conjunctivitis (“pinkeye”): Occurs in up to 50% of patients with reactive arthritis, and can develop any time during the disease course. Uveitis—an inflammation of the iris and vascular layer of the eye—may also occur, causing pain, blurred vision, and light sensitivity.
- Urethritis (inflammation of the urethra): Usually more mild than that caused by gonococcal infection (gonorrhea), but may be associated with bloody urine or prostatitis in men or cervicitis in women.
- Fever: Up to 102º F (38.8º C)
- Weight loss
- Fatigue
- Enthesitis (inflammation of tendinous insertions): Achilles tendinitis, plantar fasciitis, painful and swollen fingers (“sausage digits”).
- Back pain
- Lesions of skin and mucous membranes: Painless oral ulcers; splitting and separation of finger- and toenails; circinate balanitis (a painless reddening of the glans penis); keratoderma blennorhagicum (a classic finding in Reiter’s, these lesions begin as small blisters on the palms or soles and progress to form patches of flaky skin or firm, tender lumps.
- Rare: Cardiovascular complications (valvular insufficiency, conduction disturbances with abnormal rhythms, inflammation of the aorta); kidney failure; nervous system disorders.
Treatment for Reiter’s Syndrome (Reactive Arthritis)
- Although reactive arthritis is triggered by bacterial infections, treatment with antibiotics has not proven effective at reducing the symptoms or duration of arthritic symptoms. Antibiotics are administered in accordance with guidelines for treating the underlying infection.
- Non-steroidal anti-inflammatory drugs (NSAIDs) are indicated for controlling pain and fever.
- If NSAIDs do not control symptoms, sulfasalazine, azathioprine, or methotrexate—drugs used to treat other autoimmune conditions—may be used.
- Local injection of corticosteroids for enthesitis or joint pain may be useful, but systemic corticosteroids (e.g., prednisone) have no proven value.
- Physical therapy may help to maintain joint mobility during recovery or for those patients with chronic arthritis.
- Skin and mucous membrane lesions and conjunctivitis usually don’t require specific treatment, although emollients, moisturizers, or topical anesthetics could be helpful.
- Uveitis is treated with eye drops that reduce inflammation and control pupil dilation.
Preventing Reiter’s Syndrome (Reactive Arthritis)
Many of the bacteria that contribute to reactive arthritis are acquired through contact with contaminated water or foods. Basic hygienic practices will go far to prevent infection with these organisms.
Avoiding unprotected sex will markedly reduce one’s risk for acquiring sexually-transmitted infections that can lead to reactive arthritis.
(From Kataria R and Brent L. Spondyloarthropathies. Am Fam Phys. 2004;69(12):2853-60 and The Merck Manual, 18th Edition. Spondyloarthropathies: Reactive arthritis. 2006:292-94)
