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Updated: Jun 17 2021

Reiter's Syndrome

  • summary
    • Reiter's Syndrome is a seronegative spondyloarthropathy, often caused by an underlying infection, that typically presents with urethritis, ocular conjunctivitis, uveitis, and/or arthritis. 
    • Diagnosis is made clinically based on history, symptoms, and ophthalmologic exam.
    • Treatment is usually antibiotics, symptomatic treatment, and observation.
  • Epidemiology
    • Incidence
      • rare
    • Demographics
      • occurs most commonly in young man (<40 years of age)
      • rarely occurs in children, but sometimes appears in adolescents
    • Anatomic location
      • arthritis
        • may be unilateral or bilateral
        • may affect one or multiple joints
  • Etiology
    • Diagnostic criteria
      • urethritis
      • conjunctivitis or uveitis
      • arthritis
    • Pathophysiology
      • associated infections
        • mycoplasma
        • yersinia
        • salmonella
        • shigella
        • chlamydia
        • campylobacter
    • Genetics
      • may be genetic component making certain individuals more susceptible
  • Presentation
    • Symptoms
      • urinary discomfort or pain
        • usually appears within days or weeks of infection
      • inflammation or dryness of the eye
      • joint pain
        • may develop within weeks of initial infection and urinary symptoms
      • other non-specific pain symptoms including
        • heel pain (Achilles tendon pain)
        • low back pain
    • Physical exam
      • nongonococcal urethritis
      • conjunctivitis or uveitis
      • arthritis
      • skin lesions on palms/soles
        • may resemble psoriasis
        • genital skin lesions
      • low-grade fever
  • Imaging
    • Radiographs
      • may identify arthritis of the joints
  • Studies
    • Diagnosis is based primarily on symptoms and presentation
    • Labs
      • HLA-B27 positive in 75% of cases
      • CRP elevated
      • ESR elevated
    • Urinalysis
      • may identify signs of active infection
  • Treatment
    • Nonoperative
      • antibiotics, symptomatic treatment, observation
        • indications
          • standard of treatment in most cases
        • medications
          • direct antibiotics at underlying infection
            • azithromycin and doxycycline indicated for Chlamydia
          • NSAIDs for pain and inflammation
      • systemic steroids
        • indications
          • severe or recalcitrant cases
  • Complications
    • Aortic insufficiency
    • Arrhythmia
  • Prognosis
    • Most cases resolve within weeks, but can last up to months
    • Recurrence occurs in up to half of cases over period of several years
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