Reiter's syndrome
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Introduction
Ref[4] equates Reiter's syndrome with reactive arthritis.
Etiology
- Chlamydia trachomatis recovered from urethra in 70% of untreated men
- Salmonella, Shigella, Campylobacter can produce identical syndrome
- hypersensitivity to bacterial antigens
Genetics
HLA-B27 is positive in 80% of patients
Clinical manifestations
-..........-
- arthritis ......|
- conjunctivitis..| classic triad
- urethritis .....|
- buccal/palatal ulcerations (generally painless)
- balanitis
- cervicitis in women
- sacroiliitis is a strong confirmatory sign, but may not be present
- arthritis is asymmetric, average of 5-6 joints involved, heal & Achilles tendon commonly involved
- keratoderma blennorrhagicum (indistinguishable from psoriasis)
- asymmetric joint involvement
- toes
- large joints of lower extremities
- erosions or scales on penis
- iritis (acute anterior uveitis)
- disease is characteristically episodic
Laboratory
- increased erythrocyte sedimentation rate (ESR)
- rheumatoid factor (RF) is negative
- tests for Chlamydia
- HLA-B27 genotyping
Differential diagnosis
- Behcet syndrome: genital ulcers, not urethritis, not infectious
Management
- pharmaceutical agents
- doxycycline, tetracycline or erythromycin for treatment of Chlamydia
- NSAIDS 1st line: indomethacin[5]
- glucocorticoid joint injections
- DMARDS if NSAID ineffective
- sulfazalazine may be agent of choice[4]
- methotrexate, start with 7.5 mg PO QD
- TNF-alpha inhibitor
- prognosis
- disease remains episodically active in 75% of patients
- disability is a frequent outcome
More general terms
References
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1057
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 865
- ↑ Guide to Physical Examination & History Taking, 6th edition, Bates B, JB Lippincott, Philadelphia, 1995, pg 57
- ↑ 4.0 4.1 4.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 18. American College of Physicians, Philadelphia 1998, 2012, 2018
- ↑ 5.0 5.1 NEJM Knowledge+ Question of the Week. Oct 29, 2019 https://knowledgeplus.nejm.org/question-of-week/703/
- ↑ Hannu T. Reactive arthritis. Best Pract Res Clin Rheumatol 2011 Nov 22; 25:347. PMID: https://www.ncbi.nlm.nih.gov/pubmed/ 22100285
- ↑ Carter JD, Hudson AP. The evolving story of Chlamydia-induced reactive arthritis. Curr Opin Rheumatol 2010 May 7; 22:424 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20445454
- ↑ University of Maryland Medical Center Reiter syndrome http://umm.edu/health/medical/altmed/condition/reiter-syndrome