Reiter’s syndrome, Reiter syndrome, or reactive arthritis is a type of arthritis that afflicts people who have a certain bacterial infection. The actual infection occurs in the person’s genitals, urinary tract or in their intestines. The condition is not in itself contagious, though the bacteria can be spread. Reiter’s syndrome has no cure as of 2018, but it often resolves within two to six months. Indeed, often by the time the symptoms of arthritis arrive, the bacterial infection is over.
The bacteria most likely to cause Reiter’s syndrome are Shigella, Campylobacter, Ureaplasma urealyticum, Yersinia, Salmonella or Chlamydia. The bacterial infection is often the result of food poisoning or has been sexually transmitted. Shigella is most often the bacteria that triggers the arthritis after food poisoning, while Chlamydia is the triggering virus in the case of an STI.
Reiter’s syndrome usually affects young men between 20 and 40. Women tend to have milder symptoms if they are affected. It is more common in Caucasians than black people. This is because the syndrome is linked to the HLA-B27 gene, which is found more often in whites than in people of color. Researchers do not know how the bacteria and the gene interact to cause Reiter’s syndrome. The condition is sometimes one of the first signs that the patient has contracted HIV.
Symptoms usually develop about one to three weeks after the person has contracted the triggering bacteria, but the incubation times can vary. Signs and symptoms are:
1. Joint pain
The arthritis of Reiter’s syndrome usually involves the knees, feet, ankles, heels and lower spine. Researchers believe that the joint pain is caused by synovitis, which happens when the synovial membrane is inflamed. The synovial membrane lines joints that move, like the knee. These joints are lubricated with synovial fluid. When the patient suffers from synovitis, the joint not only hurts but swells up because of the accumulation of the synovial fluid.
Since Reiter’s syndrome usually does not last a long time, the synovitis does not necessarily cause damage to the joints the way osteoarthritis does. However, if the synovitis lasts a long time, the joints may start to degenerate.
2. Stiffness
Stiffness is also a symptom of the synovitis of Reiter’s syndrome. It is caused by the inflammation of the synovial membrane and often worse in the morning. Patients with Reiter’s syndrome may describe the phenomenon as an achey joint that is hard to move. The discomfort may get better as the day goes on. This is in contrast to osteoarthritis, where stiffness tends to get worse the more the joint is moved because the joint and the cartilage that is cushioning it are deteriorating.
3. Lower back pain
Lower back pain is another sign of inflammation of the joints in the lumbar, or lower back. Reiter’s syndrome patients suffer from a particular type of lower back pain called spondylitis. Spondylitis means “inflammation of the vertebrae.” Interestingly, it is also related to conditions in the eyes, genitals and skin.
Another source of lower back pain is called sacroiliitis and occurs at the place where the spine is connected to the pelvis. This is an area of fused bone called the sacrum. The pain of sacroiliitis not only involves the lower back but spreads into the buttocks and may shoot down the patient’s legs. It may even affect their feet. Standing for a long time, running, standing on one leg or climbing stairs worsens the pain.
4. Pain during urination
As reactive arthritis sets up inflammation in the joints, it also causes inflammation in the urinary tract. Pain during urination is caused by inflammation in the urethra, or urethritis. This is the tube that directs urine from the kidneys out of the body.
The pain of urethritis can be severe and is often accompanied by a discharge, swelling and itching of the genitals, a frequent urge to urinate even when the bladder is nearly empty and blood or even seminal fluid in the urine. Men can develop an inflammation of their prostate gland called prostatitis, while women can develop an inflammation of their cervix called cervicitis. The type of urethritis that accompanies Reiter’s syndrome is not infectious.
5. Swelling
Common areas of the swelling of Reiter’s syndrome are the fingers and toes. When this happens the condition is called dactylitis. Dactylitis can make fingers and toes look like sausages. The fingers may be so swollen that they cannot make a fist or easily pick up objects. The digits are painful and feel warm to the touch. As with everything else with reactive arthritis, the inflammation is not symmetrical as it would be in a disease such as rheumatoid arthritis. The fingers of the left hand or foot can be affected while those of the right are not. Other areas of swelling are the elbows, heels, knees and genitals.
6. Eye redness
Eye redness is conjunctivitis. Again, it is part of Reiter’s syndrome’s overall inflammation of the body. In this case, the inflammation attacks the conjunctiva of the eye. This is the transparent membrane that covers the white part of the patient’s eye and the insides of their eyelids. The eye is painful and feels like it has grit in it. The white part is red, which gives the condition the name “pink eye.” There is a discharge from the eye that may be yellow, green or clear, and the patient may wake up with such a crust on their eyelashes that they can’t open their eye. The eyelids swell, and the patient is sensitive to bright light.
7. Fever
Fever comes with an acute onset of Reiter’s syndrome, which means this symptom occurs when the disorder comes on suddenly. It is an abnormally high bodily temperature. Medical experts believe fever helps to fight infection, even though by the time the person has symptoms of Reiter’s syndrome the infection has usually passed. An adult with Reiter’s syndrome is considered feverish if their body temperature is over 99 degrees or 99.5 degrees Fahrenheit.
8. Inflamed tendons
Even the tendons that connect the muscles to the bones suffer from inflammation in reactive arthritis. This is called enthesopathy or enthesitis. It is also connected to the HLA-B27 gene that plays a role in Reiter’s syndrome. It is not just tendinitis but refers specifically to the point where the tendon connects to the bone. The symptoms are pain, stiffness and swelling around the joint. If the patient has reactive arthritis for a long time, the body may lay down calcium at the spot and cause bone spurs. Having enthesitis for a prolonged period also causes tendons and ligaments, which connect bones to each other, to become less supple. This results in even more pain when the patient tries to move their joint.
9. Skin rash
Reiter’s syndrome causes unsightly skin rashes such as keratoderma blennorrhagicum. This is a rash that is found on the palms of the hands and the soles the feet and spreads up the legs to the trunk and the scalp. In men it can affect the scrotum. If the patient gets this condition, it usually appears about one to two months after the first symptoms of the arthritis. The lesions of keratoderma blennorrhagicum resemble psoriasis and appear as bumps, pustules, blisters or scaly patches. The patient can also suffer red, scaly lesions on their face, mouth ulcers, head rash and a rash called circinate balanitis, which is a rash on the head of the penis.
