In Reiter's syndrome, there is severe joint pain.
SynonymsReactive arthritis, Reiter's disease, polyarthritis urethrica, urethro-conjunctivo-synovial syndrome
The Reiter's syndrome describes a inflammatory joint disease, as a second disease after Inflammation of the gastrointestinal tract or of the Genitourinary tract (Urinary tract) can occur. Actually, Reiter's syndrome includes three or four main symptoms and is considered a special form of the reactive arthritis.
Before it comes to a Reiter's syndrome the patient first has a bacterial infection. This infection can be Urinary tract infection (Urethritis), which can be caused by either Neisseria gonorrhea has been triggered, or a non-gonorrheal urinary tract infection due to Chlamydia trachomatis, Mycoplasma or Ureaplasma its. Equally, however, a gastrointestinal infection through Yersinia, Salmonella, Shigella (so-called dysentery), Campylobacter jejuni or Enteritiserreger be the previous disease.
In addition, in 60 – 80 % of the cases an genetic predisposition present. This means that the affected patients have a change in an antigenic characteristic. These patients are HLA-B27 positive. In the normal population this gene is actually expressed in only 8%.
After a bacterial infection of the gastrointestinal tract or the urinary tract, it can be after 2 – 6 weeks then come to a reactive disease with Reiter's syndrome.
For a diagnosis first of all a Medical history with specific questioning after a previous Urinary tract infection or of the gastrointestinal tract carried out.
Furthermore, the typical symptoms (Reiter's triad) can lead to a diagnosis of Reiter's syndrome.
Likewise an Laboratory examination be made. Here, mostly inflammation parameters like an increased erythrocyte sedimentation rate (BSG) and an increased CRP level (C-reactive protein) detected. But these are very unspecific.
It can be genetic examination be initiated, during which, after a HLA-B27 detection is sought. In 80% of the cases it is positive.
Detection of the pathogen is usually difficult, since the acute infection usually occurred a few weeks ago and thus no germs can be found in urine (with a urinary tract infection) or stool (in case of a gastrointestinal infection) find. In individual cases and depending on the germ, this can possibly still be detected with certain methods.
In the serological diagnostics can determine the course of an infection even afterwards. Here IgA– and IgG antibodies detected in the blood. Such parallel titer courses would indicate an existing infection, but are not to be found in all cases or to be detected in the blood.
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2-3 % of patients who had previously certain gastrointestinal or urinary tract infections show Reiter's syndrome afterwards. The gender distribution is reported to be 1:1, 3:1, or 20:1 between males to females, depending on the literature. The Reiter's syndrome occurs mainly in the life span between the 20. up to 40. year of life on.
In the case of Reiter's syndrome, the so-called Reiter's triad described. Possibly, these can be added to the Rider triad be completed.
The Reiter's triad includes a arthritis, inflammation of the ureteral mucosa (urethritis) and a Conjunctivitis (Conjunctivitis) respectively iritis:
– A arthritis describes a acute inflammation of one or more joints. This usually occurs asymmetrically, i.e. not sideways. Arthritis in Reiter's syndrome preferentially affects the lower extremity, ie Knee– or ankle joints. – The urethritis describes the Inflammation of the urethra. It becomes noticeable through itching and through pain during urination. Also a discharge or redness of the urethral orifice can be noticed. – The Conjunctivitis is the conjunctivitis of the eyes. It is noticeable by the Eyes reddened are. A foreign body sensation in the eye is described and the eyes water more often. – A iritis would be a Inflammation of the iris of the eye (Iris). Here, too, the eye appears reddened, and compared with conjunctivitis, there is Sensitivity to light, Pain and blurred vision.
The Reiter triad also includes the so-called antibiotic Reiter's dermatosis: This dermatosis is understood to be a Erythema, a Skin redness, which is similar to a psoriasis (Psoriasis) at the mucous membrane of the male sexual organ occurs as well as lesions of the oral mucosa. Furthermore, in this dermatosis changes occur in palms and soles of the feet to the eye, so called keratoma blenorrhagicum, which can be explained with pus-filled blisters noticeable. It can lead to further Skin changes all over the body which resemble in their picture a psoriasis.
During Reiter's syndrome, in addition to the typical Reiter's triad, it can also accompanying symptoms come. These are variable and include fever, a inflammatory changes in the joints of the lower spine (sacroiliitis), painful Inflammations of the tendon attachments (Enthesiopathies) or also rarer Inflammation of internal organs like the Heart (Carditis) or of the Pulmonary pleura (Pleurisy).
Antibiotics are used for therapy.
The Therapy of Reiter's syndrome depends on the infection situation and germ. If the infection is still acute, various medications can be used Antibiotic treatments may be indicated. This is not the case if no pathogen can be detected at present.
In the case of proven urinary tract infection through Chlamydia or Ureaplasma come the antibiotics Doxycycline or macrolides as Erythromycin or Clarithromycin in question. Especially in case of infection by chlamydia, antibiotic therapy is recommended, since this germ can persist in the body. It is important to chlamydial infection always the Partner because of a renewed risk of infection co-therapy must be!
Also in the case of an acute proven Gonorrhea (gonorrhoea) or a gastrointestinal infection, a pathogen-specific treatment is started Antibiotic therapy recommended.
If no more infections are detectable, one can also use symptom-oriented therapy. This is the way to go in the case of acute arthritis non-steroidal anti-inflammatory drugs To the application. anti-inflammatory therapy should also be used here with a so-called cold application (Cryotherapy) are worked. Both therapies help against the symptoms of arthritis.
If it comes to more severe courses of the disease, in which several different joints are affected, or there is severe Inflammation of the inner eye (Iridocyclitis) comes, therapy should be glucocorticosteroids (Cortisol) can be started.
If Reiter's syndrome persists and there is a chronic course is the administration of Sulfasalazine indicated. This also has an anti-inflammatory effect once again.
As the only Prophylaxis for the occurrence of a Reiter's syndrome is the effort of a prevent infection of the urinary tract or gastrointestinal tract. If an infection does occur, this should be treated as soon as possible become.
A complete healing after 12 months is used with 80% of the cases to see. A more favorable prognosis has a disease with only single symptoms in comparison to a fully developed Reiter's syndrome. patients with positive HLA-B27 or with a severe course of the disease may be prone to the disease chronic runs. Reiter's syndrome was first identified in 1961 by the Berlin bacteriologist. hygienist Hans Reiter (1881 – 1969) described.
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