Related articles: Reiter syndrome
Definition
Reiter's syndrome is an inflammatory arthritis that results from an infectious process initially located in non-articular sites of the body. This condition belongs, in particular, to seronegative spondyloarthropathies, a family of articular diseases characterized by:
- from the involvement of the skeleton (both at the level of the spine and of the peripheral joints and of the insertion points of the tendons to the bone)
- and by the negativity for rheumatoid factor.
As anticipated, Reiter's syndrome is the consequence of an ill-directed response to an extra-articular infection; often, this last process originates in the genitourinary tract (urethritis, cystitis and prostatitis) or gastrointestinal (eg. enteritis with diarrhea). At least in some cases, Reiter's syndrome is associated with the presence of Chlamydia trachomatis in the joint.
The genetic predisposition contributes to the pathogenesis of the disease (many patients are HLA-B27 positive), although the mechanism by which it intervenes is not yet known.
Most common symptoms and signs *
- Asthenia
- Balanite
- Conjunctivitis
- Diarrhea
- Dysuria
- Knee pain
- Pelvic pain
- Articolar pains
- Muscle pains
- Temperature
- Joint swelling
- Backache
- Weight loss
- Urethral leaks, sometimes visible only after squeezing the glans
- Polyuria
- pollakiuria
- Joint stiffness
- Articular noises
- Scales on the skin
- Strangury
- Skin Ulcers
- blisters
Further indications
Reiter's syndrome is characterized by a triad consisting of arthritis, conjunctivitis and urethritis; these manifestations usually occur between the first and third week after initial enteric or genital infections (ie following sexual contact or dysenteric episode).
- The articular involvement is generally asymmetrical and oligoarticular (ie it affects a maximum of 4 joints) or polyarticular; inflammation causes pain, swelling, redness and heat. Arthritis most commonly involves the spine, sacroiliac joints and tendon insertions on the bone; Enthusias, tendinitis and plantar fasciitis are frequent and characteristic. The disease can affect many other parts of the body, including the joints of the lower limbs (knees and feet).
- The urethritis involves pain and discomfort to urination, polyuria and urethral secretions, and may be associated with hemorrhagic cystitis; prostatitis is also frequent in males and infections of the cervix, tubes and / or vulvovaginitis in females.
- Conjunctivitis is the eye injury most commonly associated with Reiter's syndrome and is usually mild, but keratitis and anterior uveitis may also occur. Therefore, symptoms are possible, such as: eye redness and feeling of sand in the eyes, pain, photophobia and tearing.
Reiter's syndrome can also cause hyperkeratotic skin lesions on the palm of the hand, on the sole of the foot and around the nails (blenorrhagic keratoderma). In the pathological process, the mucous membranes of the mouth, tongue and glans, which develop transient and relatively painless ulcers, may also be involved.
Moreover, Reiter's syndrome involves systemic symptoms such as low fever, fatigue, weight loss and low back pain.
Rarely, cardiovascular complications develop (eg aortitis, aortic insufficiency and cardiac conduction defects), pleurisy and symptoms affecting the central or peripheral nervous system.
Diagnosis is based on the recognition of the typical clinical features of Reiter's syndrome (joint inflammation, urethritis or cervicitis, conjunctivitis and other extra-articular signs). Arthritis or muco-cutaneous lesions of the chronic form may simulate those of psoriatic arthritis, ankylosing spondylitis or Behçet's syndrome.
The treatment of Reiter's Syndrome is intended to eradicate the triggering infection (by administering antibiotics; eg tetracycline in the presence of confirmed C. trachomatis ) and to relieve symptoms with analgesics, steroids and immunosuppressants associated with rest and specific exercises.
Reiter's syndrome generally resolves within 3 or 4 months, although patients may experience transient or prolonged episodes of arthritis or other manifestations associated with the condition for several years. In some cases, chronic or recurrent forms can cause deformity, ankylosis, sacroiliitis or spondylitis.
