Rhumatoid arthritis (arthuritis) and Reiters syndrome

Reiter's syndrome is a rheumatory arthuritis disorder causing three seemingly unrelated symptoms: arthritis, urinary tract signs and redness of the eyes.

	Reiters syndrome

Reiter's syndrome, a reactive arthritis starting in the genitourinary tract and also called seronegative spondyloarthropathy, is one of a few conditions that can cause severe inflammatory problems in the whole body and with special focus on the spinal area and in joints with attachments of bones and tendons.  In the same group, disorders such as ankylosing spondylitis, psoratic arthritis and inflammatory bowel syndrome arthritis are other members. Following the inflammations are typically symptoms such as pain, heat, swelling and sometimes red rashes.

Another name of Reiter's syndrome is reactive arthritus. This is due to the fact that it is a secondary arthritis, it comes from another infection in the body. This other infection can often be found in the region of penis, vagina, urethra or bladder and in this case, the disease is specifically named urogenital Reiter's syndrome. This condition is spread via sexual contact. Another type of Reiter's is the gastrointestinal variety which has its origin in bacteria from food. 

Causes of Reiter's syndrome

Following the original infection, the first signs are symptoms that appears around 2-3 weeks afterwards. The strain of bacteria involved is often Chlamydia trachomatis which is spread during sexual intercourse. This is not the only strain though, Reiter's syndrome can also be caused by digestive bacterias such as salmonella, campylobacter or shigella. Infection from these strains frequently occurs when eating badly prepared food, or when handling such food. It can often be a case of badly stored meat. 

Some people who are in contact with the strains above may develop Reiter's syndrome, while others might not. Science does not know exactly why this is the case, whether there is a genetic predisposition etc. A few things are known though, such as that the genetic code called HLAB27 can increase the risk that you will get infected, or develop Reiter's syndrome. About one in ten of the American population has the HLAB27 gene, but it is also the case that 8 out of 10 Reiter's patients have it.

How contagious is Reiter's syndrome?

Not at all actually. You will not pass over Reiter's syndrome to others if you have it. It is however possible that the trigger, the bacterial strain is passed over if you have it, but it doesn't necessarily mean that the next person will develop Reiter's. Not all people who are affected by these bacterial strains will develop Reiter's, there must also be some other factor present, probably a genetic predisposition or general immune system weakness, or both. 

Diagnosing Reiter's syndrome

Diagnosing Reiter's syndrome can be notoriously difficult. This is due to the fact that there is no certain test that will uniquely confirm this disease. Instead, diagnosis focus on close examination of the patient but also of the symptoms described by the patient, in order to be able to rule out any other possible rumatory arthritis.

Knowing the full medical history is very important. This will include all information on any prior diseases or conditions, especially infections, and all the current signs. Symptoms of Reiter's syndrome are often quite vague and it can thus be important that the patient records them in writing as they occur, even if they are vague. Typical symptoms of interest are anything in resemblance with flu, which might point towards the original bacterial infection. 

In order to rule out any other diseases and to confirm that it is Reiter's syndrome, there are some blood tests that can be used for establishing whether there is a rheumatoid factor or not. The rheumatoid factor means presence of antinuclear antibodies. This is important since these will not be present in a patient who suffers from other types of arthritis such as rheumatoid arthritus, lupus etc. They are however, very significant in pointing out the presence of Reiter's syndrome. Determining the rate of sedimentation of red blood cells (the erythrocyte sedimentation rate) can be helpful as a heightened value here will indicate a rheumatory inflammation which can include Reiter's syndrome.

Testing for Chlamydia can also help since this infection may be connected to Reiter's. Further infections such as in the urethra or cervix, in the throat, can also point towards this condition. The use of stool samples, or urine samples is also helpful. 

When X-raying paitients with Reiter's syndrome, signs of spondylitis, sacrolitis or other damage to the bone margins in the joints, or the cartilage is often found.

How to treat patients with Reiter's syndrome

Using NSAID's (nonsteroidal anti-inflammatory drugs) - These are drugs like ibuprofen or aspirin, but there are also prescription drugs in this broup. They will reduce the inflammation in the joints and can be effective in the treatment of Reiter's patients.

Corticosteroids - For patients with high level of joint inflammation these drugs can be injected straight into the joint where the inflammation resides and this can be a substantial help in reducing the level of inflammation. It is common to try NSAID's first and then go on to use corticosteroids.

Antibiotics - Often used to battle the original infection that triggered Reiter's syndrome. There are many different antibiotics available but the exact type will depend on what strain of bacteria it needs to counter. Antibiotics are normally taken for one or two weeks, but in the case or Reiter's, the patient may have to be on antibiotics for several months.

Topical corticosteroids - These are used, as the name implies, directly on the skin lesions that are typical for Reiter's syndrome.

Immunosuppressive medicines - Some Reiter's patients, a small group, may have symptoms that are difficult to counter with any of the other treatments and in these cases it may be necessary to resort to immunosuppresive drugs such as sulfasalazine or methotrexate.

Summary of treatment options for Reiter's syndrome, a rheumatory arthritis condition. 

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