REITER'S DISEASE
 
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REITER'S DISEASE

 

DEFINITION:

A seronegative spondyloarthropathy involving entheses with joint and systemic (ophthalmologic, genitouriary, skin, gastrointestinal) manifestations.

EPIDEMIOLOGY:

  • incidence: ?
  • age of onset:
    • rare in patiants <16 years (0.67% of all cases)
  • risk factors:
    • HLA-B27
    • M > F (4:1)
    • infections
      • sexual - chlamydia, mycoplasma
      • gastrointestinal - yersinia, shigella, salmonella, campylobacter
  • target joints:
    • major: peripheral - large lower extremities
    • minor: axial - sacroiliitis

PATHOGENESIS:

1. Background

  • In children, 79% of those with Reiter's Disease are post-dysenteric and 21% are post-venereal. Although rare in children, the tetrad of clinical features (conjunctivitis, urethritis, polyarthritis, skin lesions) tend to develop 3-4 weeks after exposure to the risk factor.

CLINICAL FEATURES:

1. Arthritis

1. Axial Joints

  • 1. Sacroiliitis
    • unilateral at onset
    • less commonly affected than peripheral joints

    • 2. Peripheral Joints

  • 1. Lower Large Joints
    • polyarthritis (25%) of knees and ankles
    • may affect upper joints as well
    • more commonly affected than axial joints

    • 2. Entheses

    1. Enthesitis

    • of calcaneous and patellae

    3. Systemic Manifestations

    1. Ophthalmologic

    • conjunctivitis (67%), anterior uveitis

    2. Genitourinary

    • urethritis (30%), dysuria, pyuria

    3. Cutaneous

    • balanitis, erythema & ulcers of oral mucosa, keratodermia blennorrhagia

    4. Gastrointestinal

    • dysentery

    5. Musculoskeletal

    • muscle atrophy and weakness

    INVESTIGATIONS:

    1. Serum

    • seronegative - RF and ANA
    • HLA-B27

    2. Imaging Studies

    1. Skeletal X-Rays

    • spine, SI joint
    • peripheral joints
    • entheses

    3. Others

    1. Urinalysis

    • urinary tract infection (UTI)

    2. Synovial Fluid Aspiration

    • Reiter's cells - monocytes with ingested intact PMN

    MANAGEMENT:

    1. Supportive

    • team approach with long-term follow-up
      • Paediatrics, Rheumatology, Ophthalmology, PT
    • treat underlying condition - urinary tract infection or dysentery
    • physiotherapy to increase the range of motion of the peripheral and axial joints
    • enthesitis
      • custom-made insoles
      • ultrasound or transcutaneous nerve stimulation

    2. Medications

    • anti-inflammatory drugs
      • ASA
      • NSAID

     

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