Reiter’s syndrome is a condition of unproven cause. It is one of the most frequent causes of arthritis in young men. It is often considered venereal disease although venereal transmission has never been proven. Recent studies indicate that a Chlamydia infection may be one of the causes of the disease. Genetic factors also play a role since HLA-B27 occurs in most patients. Ninety percent of the patients are male.
Clinical Presentation and Diagnosis
Classically Reiter’s syndrome presents with three distinct symptoms. These conditions are burning with urination with a discharge (urethritis), arthritis and eye infection. Usually urethritis precedes the symptoms of arthritis, which frequently presents as a red swollen toe or heel pain.
There may also be characteristic skin lesions that may form on the palms of the hands and the bottom of the feet. These skin lesions may occur without urethritis or eye infection.
The joint disease associated with Reiter’s syndrome is usually of sudden onset that may involve a single joint or multiple joints. The lower extremities are most often affected. Pain in the heel is common. Small joints in the hands and feet may also be involved.
Diagnosis is made based upon the clinical presentation of the patient and can be quite difficult. There are no specific blood tests for making the diagnosis. Blood test are more useful in excluding other conditions such as rheumatoid arthritis. In later stages of the disease x-ray finds may be useful.
The course of the initial onset of disease usually subsides spontaneously after several weeks. Reoccurrence of arthritis may occur over several decades. The overall prognosis, however, is good, and extensive disability and deformity rarely occur.
The major goal of treatment is the relief of inflammation. This often requires the use of oral steroids or cortisone injections. Splinting or the use of removable casts may be useful in treating the lower extremity arthritis that frequently occurs.