- See: Spondyloarthropathies
- Discussion:
- involves arthritis of large joints (knees & ankles), uveitis, skin lesions, & urethritis, however only a minority will have classic triad of symptoms;
- conjunctivitis is observed early, usually before or at the onset of arthritis;
- urethritis is usually mild and painless with frequent nonpurulent urethral discharge;
- severity of inciting infection does not correlate w/ intensity of arthritis which tends to appears one or two weeks later;
- viable organisms are not present in the synovium, but bacterial antigens are present & may provide stimulus for persistent synovitis;
- although some pts have only one episode of this illness, majority of pts have recurrent attacks, and some develop AS;
- asymmetric large jonit polyarthritis may result from enteritis caused by salmonella, shigella, campylobacter, or yersinia;
- urogenital infection (Chlamydia trachomatis) may also be involved;
- yersiniosis:
- more likely to have atypical presentation w/ pharyngitis & cervical adenopathy resembling rheumatic fever;
- European varient:
- diarrhea occurs instead of urethritis;
- Shigella, Yersinia, & Salmonella are involved in pathogenesis;
- Clinical Manifestations:
- arthritis of large joints (knees & ankles), uveitis, skin lesions, & urethritis.
- arthritis:
- usually involves several joints at once - more common in the lower extremities (with oligoarthritis, reconsider the diagnosis);
- usually more painful than the arthritis of JRA;
- arthritis lasts less than 6 weeks.
- typically there will be asymmetry of the affected joints;
- spine:
- sacroiliitis & spondylitis may occur;
- enthesopathy:
- pain in the heels or at sites of tendon or ligament insertion;
- hand: dactylitis ("sausage digits");
- diffuse swelling of fingers and/or toes does not occur frequently, but when it does occur, it is very specific for Reiters syndrome;
- skin:
- pts w/ Reiter's syndrome will have pustular lesions on sole of feet (keratoderma blennorrhagicum) which is not found in other forms of arthritis;
- balanitis circinata: painless, erythematous lesion on the glans penis;
- Radiographic Features:
- beaklike nonmarginal syndesmophytes are seen (also w/ Psoriatic arthritis);
- there is a tendency toward exuberant periostitis, particularly in heel.
- calcification of soft tissue
- Labs:
- HLA-B27:
- present in approx 90 % of pts w/ urogenital infection;
- present in > 50% of those w/ enteric infection;
- antibody titers:
- w/ enteric infection, a rising antibody titer may confirm the diagnosis when cultures are negative;
- Treatment:
- early treatment w/ tetracycline may shorten duration of illness in reactive arthritis that follows chlamydial infection;
- relapses can be expected several years after the first episode with recurrence of both articular and non articular symptoms;
- consider work up and treatment of GC joint sepsis
- good initial response to NSAIDS is common but is not always seen (especially if an the syndrome occurred from GC or chlamydia).
Spondyloarthropathies: Reiter's Syndrome. Diagnosis and Clinical Features.