Reiter’s Syndrome

Reiter’s syndrome, or reactive arthritis, is an autoimmune inflammatory disease that affects the joints, urethra, eyes, and, in some cases, the skin and mucous membranes. It belongs to the group of seronegative spondyloarthropathies, meaning autoimmune inflammatory diseases without the presence of rheumatoid factor in the blood.

This is a rare and complex condition, as symptoms may appear at widely spaced intervals, making diagnosis challenging.

Symptoms

The symptoms of Reiter’s syndrome appear gradually. The most common ones include:

Urinary tract symptoms:

• Urethritis: inflammation of the urethra.
• Urethral discharge.
• Pain or difficulty urinating.
• Prostatitis: inflammation of the prostate.
• Cervicitis: inflammation of the cervix.
• Increased urinary frequency.

Conjunctivitis: inflammation of the transparent membrane between the eyelid and the eyeball. It causes redness, itching, and eye discharge.

Joint symptoms: they typically affect more than one joint and only one side of the body.

• Joint pain and stiffness, mainly in the hips, knees, ankles, feet, or lower back.
• Enthesitis: inflammation of tendons and ligaments at their insertion points on the bone. It primarily affects the Achilles tendon.
• Dactylitis: swelling of the fingers or toes.

Mucocutaneous symptoms: similar to psoriasis.

• Red, scaly plaques or papules on the skin, mainly on the soles of the feet and palms of the hands. This rash is painless.
• Ulcers or lesions on the oral mucosa, tongue, palate, lips, or glans.
• Occasionally, nail lesions: redness, swelling, thickening, darkening, pustules, or nail detachment.

Causes

The exact cause of reactive arthritis is unknown, but it usually develops after a gastrointestinal or urogenital infection due to an excessive immune response. Therefore, a clear association has been established between Reiter’s syndrome and specific Gram-negative bacteria:

• Bacteria causing gastrointestinal infections: Salmonella enteritidis, Salmonella typhimurium, Shigella flexneri, Yersinia enterocolitica, Campylobacter jejuni, and Escherichia coli. Infection occurs through the consumption of contaminated food.
• Bacteria causing urogenital infections: Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma fermentans, Mycoplasma genitalium, and Ureaplasma urealyticum. Infection is sexually transmitted.

Additionally, reactive arthritis has a genetic component: people carrying the HLA-B27 antigen have a predisposition to developing the disease.

Risk Factors

The likelihood of developing Reiter’s syndrome increases in the following cases:

• Age: it commonly appears in adults between 20 and 30 years old.
• Sex: cases triggered by urogenital infections are more common in men.
• Family history.
• Unprotected sexual activity.
• Consumption of contaminated food.

Complications

Although in most cases the disease resolves within a year, it is common for joint or eye symptoms to recur years later. Uveitis, an eye inflammation that can lead to blindness, may occur. In rare cases, internal organs such as the heart, lungs, or kidneys may be affected, causing severe complications such as arrhythmias, pericarditis, aortic insufficiency, valvular disease, pneumonia, pleural effusion, or glomerulonephritis. Cases of neuropathy and neurological sequelae, including behavioral changes, have also been reported.

Prevention

Preventive measures can be taken to reduce the risk of Reiter’s syndrome by avoiding associated infections:

• Always use condoms during sexual activity.
• Store food at the proper temperature.
• Cook food thoroughly.
• Wash hands before eating or cooking.

What Specialist Treats Reiter’s Syndrome?

Reiter’s syndrome is diagnosed and treated in the rheumatology department.