REITER'S SYNDROME

WHAT IS REITER'S SYNDROME?

Reiter's syndrome is a form of arthritis and rheumatic disease. 
Arthritis literally means inflammation of the joints. Inflammation 
causes swelling, redness, pain, warmth, or stiffness. There are over 100 
different kinds of arthritis which belong to a larger group of diseases 
called "rheumatic diseases." These diseases include not only arthritis, 
but also conditions which cause aches and pains in tissues near or 
around the joints, such as the ligaments, tendons, and muscles. Reiter's 
syndrome involves both inflammation within and around the joints, and 
particularly where ligaments and tendons attach to bones. The 
inflammation is also "systemic," meaning it occurs in many places 
throughout the body The term "syndrome" means that several different 
conditions occur within the course of the illness.

WHAT HAPPENS IN REITER'S SYNDROME?

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 make-up. (See section on the 
causes of Reiter's syndrome.) People with Reiter's syndrome have 
arthritis and one or more of the following conditions: urethritis, 
prostatitis, cervicitis, cystitis, eye problems, or skin sores. (See 
next section for a more detailed description.)

Many people have only one episode of Reiter's syndrome which goes away 
and does not return, while some people have repeated occurrences of the 
illness. Unfortunately the cause of the inflammation in Reiter's 
syndrome is unknown, so there is no cure yet. Nonetheless, we are 
learning more about it and people who have it can be helped.

WHAT ARE THE SYMPTOMS OF REITER'S SYNDROME?

Arthritis is the major symptom of Reiter's syndrome. It generally
appears several weeks or months after other symptoms. It involves 
inflammation of the joints, as well as the ligaments, tendons, and 
muscles sur- rounding the joints. 
People with Reiter's syndrome 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. 
Many people will have only one attack of arthritis which lasts several 
months or up to one year. Some people will have repeated attacks 
(flares), followed by periods that are symptom-free (remissions). A very 
few people may have persistent arthritis for an indefinite period of 
time. 
Urethritis (U-reeth-RY-tis) is a common condition of Reiter's syndrome.
It involves the inflammation of the urethra (the small tube through 
which urine passes to the outside from the bladder). It is often, but 
not always, the first condition of Reiter's syndrome. Sometimes, the 
symptoms of urethritis may be so mild that most men and women are 
unaware they have it. However; some men may experience frequent 
urination; mild pain when they pass urine; fever; or slight discharge 
from the penis. 
Prostatitis (PRAH-state-I-tis), inflammation of the prostate gland in
men, often occurs along with urethritis. It may be accompanied by 
frequent urination, dull aching pain in the pelvic region, or fever. 
Cervicitis involves the inflammation of the cervix, the neck-like
region of a woman's uterus. There are no obvious symptoms of this 
condition, but it may be seen by a physician when doing a pelvic 
examination or a PAP smear 
Cystitis, a bladder or urinary tract infection may also occur. It may
be accompanied by frequent and burning urination and fever. 

Eye Problems.

Conjunctivitis (con-JUNK-tiv-I-tis), commonly known as "pink eye," may 
occur. It results from the inflammation of the delicate membrane 
(conjunctiva) that lines the inner eyelids. The symptoms of 
conjunctivitis are red, irritated eyes, with a slight burning sensation. 
Sometimes, the eyelids stick together in the morning. Conjunctivitis is 
usually a mild eye condition. 
Iritis (I-ry-tis) and uveitis (U-vee-I-tis) are less common, but more 
serious eye problems. Iritis is the inflammation of the iris (the 
colored membrane of the eye). Uveitis is the inflammation of the iris 
and other inner layers of the eye. Both these conditions can cause the 
eyes to become red and painful, with blurred vision. Individuals 
experiencing any of these symptoms should see an ophthalmologist (eye 
specialist) as soon as possible for diagnosis and treatment. If 
untreated, iritis and uveitis can lead to blindness.

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. These 
are hardly noticeable and will disappear in a few days or weeks. 
A more noticeable type of skin sore may occur on the soles of the feet 
and the palms of the hands, and sometimes on other parts of the body 
This particular type of skin sore usually develops 4-6 weeks after other 
symptoms occur. The sores first appear as red-purple clusters which 
develop into thick, crusty sores that may cover the entire soles and 
palms. They generally heal on their own within 6-12 weeks, but may 
require treatment with a prescription cream. If no other symptoms are 
detected during the medical examination, these sores can easily be 
mistaken for psoriasis (a specialized form of skin disease).

WHAT CAUSES REITER'S SYNDROME?

The exact cause of Reiter's syndrome is unknown. It has been linked with 
intestinal or genital/urinary tract infections in combination with a 
genetic tendency to get the disease.

Infections

Many people develop Reiter's syndrome 1-3 weeks following a mild or 
severe case of diarrhea, which is often, but not always due to food 
poisoning (dysentery). The diarrhea usually goes away on its own or with 
appropriate treatment. Reiter's syndrome also develops following certain 
types of bacterial infections of the genital/urinary tract. These 
infections may in some instances, be transmitted during sexual contact. 
The reasons why these types of infections trigger the development of 
Reiter's syndrome is unknown. In fact, a few people develop Reiter's 
syndrome with no obvious evidence of prior infection.

Genetic Markers

Most people with Reiter's syndrome have a specific genetic factor or 
marker called "HLA-B27." This genetic marker can be passed on from one 
generation to the next. Thus, the tendency to develop Reiter's syndrome 
is hereditary However; having HLA- B27 does not mean a person will 
necessarily get Reiter's syndrome. It means that an individual has a 
greater chance of developing it. Only seven percent of the population 
has HLA-B27. Of that group, only twenty percent are at risk of getting 
Reiter's syndrome. A few individuals who develop Reiter's syndrome do 
not have HLA- B27.

WHO GETS REITER'S SYNDROME?

Reiter's syndrome occurs in people in all countries, but is more common 
in white men and women between the ages of 20 to 40. More men than women 
are diagnosed with Reiter's syndrome. It is possible, but uncommon for 
children and older people to get it. Because it is associated with a 
genetic marker; Reiter's syndrome tends to run in families.

HOW IS REITER'S SYNDROME DIAGNOSED?

Like many other forms of arthritis, there are no specific laboratory 
tests for Reiter's syndrome. Therefore, the diagnosis depends on the 
evaluation of the overall pattern of symptoms, medical history and 
physical examination. Inform the doctor about any intestinal, 
genital/urinary or eye conditions which may have occurred prior to the 
appearance of joint pain and inflammation.

Blood tests may be performed to rule out other forms of arthritis or to 
determine the presence of a recent infection. A small amount of fluid 
may be removed from an inflamed joint and analyzed in the laboratory 
Testing for the genetic marker HLA-B27 may or may not be necessary to 
confirm the diagnosis.

WHAT IS THE TREATMENT FOR REITER'S SYNDROME?

Treatment for managing arthritis includes:

- medications 
- rest
-joint protection 
-special exercises. 

This arthritis treatment program is designed to reduce joint pain and 
inflammation; prevent or decrease the amount of joint damage; and 
restore the function of damaged joints.

The most common drugs used to treat arthritis are called "nonsteroidal 
anti-inflammatory drugs (NSAIDs)." These medications reduce the pain as 
well as the inflammation in the joints. Most people respond well to 
NSAID treatment. However; there are several different NSAIDs and one 
that works for one person may not help another. Therefore, many people 
may need a trial period, during which medications are changed, until 
they and their doctor decide which one is most effective. For persistent 
arthritis, other medications may be used.

In addition to medications, splints may be prescribed to limit movement, 
as this protects joints and reduces pain and tissue damage. Special 
exercises, taught by a physical therapist, are generally recommended to 
maintain muscle strength and increase range of motion. Rest is 
recommended to reduce stress on inflamed joints.

For most people, this treatment program will allow them to carry out 
their day-to- day activities with less discomfort. More information 
about arthritis medications, exercise, and joint protection is available 
through the Arthritis Foundation's self- help course. Contact your local 
chapter to find out how you can register for a class.

Urethritis, prostatitis, and cervicitis, may go away on their own or may 
need treatment with antibiotics. Cystitis is generally treated with 
antibiotics. Sometimes, a spouse is also treated with antibiotics to 
prevent spouses from re-infecting each other. Keep in mind, however; 
that Reiter's syndrome itself cannot be transmitted from one person to 
another. Conjonctivitis generally goes away on its own in a day or two, 
but if persistent, can be treated with prescription eye drops. Iritis or 
uveitis are generally treated with eye drops prescribed by an 
ophthalmologist. Dark glasses should be worn during treatment because 
these eye drops dilate the pupils of the eye, making them sensitive to 
bright lights and the sun. Individuals who have these more serious eye 
conditions should have regular check-ups with the ophthalmologist to 
determine whether the medication is effective and to detect any 
additional problems. Skin sores may be treated with a prescription 
cream.

COPING WITH REITER'S SYNDROME

Living and coping with an illness that lasts more than a few weeks, 
regardless of its severity is a challenge for most people. If you have 
Reiter's syndrome, know that there are many ways to adjust and be able 
to cope with its symptoms and discomforts. Try to be optimistic because 
most people eventually get well.

It is normal to experience feelings of depression, anger; blame, denial, 
and frustration when you first discover you have a chronic illness. 
However; accepting your illness will help you cope with it more 
effectively Acceptance often takes time and support. Discussing your 
illness with a family member; a friend, or your doctor can help you 
adjust more easily Some people benefit from discussing their concerns 
and frustrations with a professional counselor or occupational 
therapist. Perhaps your doctor can refer you.

Meeting with others who have arthritis to discuss problems, ask 
questions, share concerns, and find solutions can also be helpful. 
Consider joining an arthritis support group or arthritis club in your 
area. Call your local chapter of the Arthritis Foundation for more 
information about these and other services.

As with any chronic illness for which there is no proven remedy or cure, 
there may be a tendency to lose faith in the prescribed treatment. This 
often leads to "doctor- shopping" in an attempt to find a cure or more 
satisfactory treatment. Before changing doctors, learn all you can about 
your illness and its treatment. Discuss your frustrations with your 
doctor so that you can work together to find the treatment that is best 
for you.