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Reiter's syndrome causes, diagnosis and treatment

This article is to discuss Reiter's syndrome regarding its definition, aetiology, clinical picture (symptoms and signs), diagnostic investigations and treatment approach.

Definition and Causes of Reiter's syndrome

It is an inflammatory arthritis which is usually associated with sexually acquired infection e.g non specific urethritis in males, non specific cervicitis in females. Also it may follow an acute attack of gastrointestinal infection.
 A variety of organisms can be the trigger (see below) so Reiter's syndrome may follows sexually acquired infection or gastrointestinal infection).
- Arthrogenic bacteria causing Reactive arthritis .
• Salmonella , Yersinia and Shigella .
• Chlamydia causing urethritis.

How to diagnose Reiter's syndrome ?

Clinical picture
• The onset is typically acute with development of urtheritis, conjunctivitis and arthritis.
• Sex : Male > Female with ratio of 15-1
• Age:  20 - 40 years
• Asymmetric arthritis : big joint of L.L. (knee, ankles, and feet).
• Planter faciitis and achilles tendenitis ==>  painful heel syndrome.
• Sacroilitis and spondylitis may occur
• Eye :  conjunctivitis, uveitis.
• Skin - keratoderma ===>  yellow brown papules with desquamating margins on the soles and plasms. Circinate balanitis (ulcers on glans penis), present in 20-50% of patients.
• Heart : A.I. - pericarditis.
• Neurological  :  meningoencephalitis and neuropathy.
• Buccal ulceration (tongue, palate, buccal mucosa and lips), they are painless.
Investigations
ESR ,CRP : +++
• HLA B27 is present in 80% of patients
• Anemia. (normocytic, normochromic) 
• Sterile pyuria.
• X-ray showing soft tissue swelling, narrowing of joint spaces with or without sacroiliitis.

Treatment of Reiter's syndrome

• Rest..
• NSAIDs  : for arthritis.
• Steroid (not for arthritis), it is used for:
              - Achilles tendenitis (local injection.)
              - Eye (topical)
• Systemic corticosteroids are rarely required.
• Methotrexate, azathioprine or sulphasalazin may be used.
• The non-specific urethritis or any infection should be treated with short course of antibiotics e.g tetracycline.
• Anterior uveitis is a medical emergency requiring topical, subconjunctival or systemic steroids.
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Tamer Mobarak

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