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