This fact sheet contains general information about Reiters syndrome. It describes what Reiters syndrome is and how it develops. It also explains how Reiters syndrome is diagnosed and treated. If you have further questions after reading this fact sheet, you may wish to discuss them with your doctor.

What Is Reiters Syndrome?

Reiters syndrome is a disorder that causes three seemingly unrelated symptoms: arthritis, redness of the eyes, and urinary tract signs. Doctors sometimes refer to Reiters syndrome as a seronegative spondyloarthropathy because it is one of a group of disorders that cause inflammation throughout the body, particularly in parts of the spine and at other joints where tendons attach to bones. (Examples of other seronegative spondyloarthropathies include psoriatic arthritis, ankylosing spondylitis, and inflammatory bowel syndrome arthritis.) Inflammation is a characteristic reaction of tissues to injury or disease and is marked by four signs: swelling, redness, heat, and pain.

Reiters syndrome is also referred to as reactive arthritis, which means that the arthritis occurs as a reaction to an infection that started elsewhere in the body. In many patients, the infection begins in the genitourinary tract (bladder, urethra, penis, or vagina). The infection is most commonly passed from one person to another by sexual intercourse. This form of the disorder is sometimes called genitourinary or urogenital Reiters syndrome. Another form of the disorder, called enteric or gastrointestinal Reiters syndrome, develops when a person eats food or handles substances that are tainted with bacteria.

What Causes Reiters Syndrome?

When a preceding infection is recognized, symptoms of Reiters syndrome appear about 1 to 3 weeks after the infection. Chlamydia trachomatis is the bacteria most often associated with Reiters syndrome acquired through sexual contact. Several different bacteria are associated with Reiters syndrome acquired through the digestive tract, including Salmonella, Shigella, Yersinia, and Campylobacter. People may become infected with these bacteria after eating or handling improperly prepared food, such as meats that are not stored at the correct temperature.

 Doctors do not know exactly why some people exposed to these bacteria develop the disorder and others do not, but they have identified a genetic factor (HLAB27) that increases a persons chance of developing Reiters syndrome. About 80 percent of people with Reiters syndrome are HLAB27 positive. Only 6 percent of people who do not have the syndrome have the HLAB27 gene.

Is Reiters Syndrome Contagious?

Reiters syndrome is not contagious; that is, a person with the disorder cannot pass it to somebody else. However, the bacteria that can trigger it can be passed from one person to another, although not all people infected with the bacteria will develop Reiters syndrome. Rather, it is likely that people who develop the disease have inherited a trait that makes them susceptible.

Who Gets Reiters Syndrome?

Men between the ages of 20 and 40 are most likely to develop Reiters syndrome. It is the most common type of arthritis affecting young men. Among men under age 50, about 3.5 per 100,000 develop Reiters syndrome each year. Three percent of all men with a sexually transmitted disease develop Reiters syndrome. Women can also develop the disorder, though less often than men, with features that are often milder and more subtle.

What Are the Symptoms of Reiters Syndrome?

The symptoms can affect many different parts of the body, but most typically affect the urogenital tract, the joints, and the eyes. Less common symptoms are mouth ulcers, skin rashes, and heart-valve problems. The signs may be so mild that patients do not notice them. They usually come and go over a period of several weeks to several months.

Urogenital Tract Symptoms

Reiters syndrome often affects the urogenital tract, including the prostate, urethra, and penis in men and the fallopian tubes, uterus, and vagina in women. Men may notice an increased need to urinate, a burning sensation when urinating, and a discharge from the penis. Some men with Reiters syndrome develop prostatitis, inflammation of the prostate gland. Symptoms of prostatitis can include fever, chills, increased need to urinate, and a burning sensation when urinating.

Women with Reiters syndrome also develop signs in the urogenital tract, such as inflammation of the cervix (cervicitis) or inflammation of the urethra (urethritis), which can cause a burning sensation during urination. In addition, some women also develop salpingitis (inflammation of the fallopian tubes) or vulvovaginitis (inflammation of the vulva and vagina). These conditions may or may not cause any symptoms.

Joint Symptoms or Arthritis

The arthritis associated with Reiters syndrome typically affects the knees, ankles, and feet, causing pain and swelling. Wrists, fingers, and other joints are less often affected. Patients with Reiters syndrome commonly develop inflammation where the tendon attaches to the bone, a condition called enthesopathy. Enthesopathy may result in heel pain and the shortening and thickening of fingers and toes. Some people with Reiters syndrome also develop heel spurs, bony growths in the heel that cause chronic or long-lasting foot pain.

Arthritis in Reiters syndrome can also affect the joints in the back and cause spondylitis (inflammation of the vertebrae in the spinal column) or sacroiliitis (sa-kro-il-e-i-tes), inflammation of the joints in the lower back that connect the spine to the pelvis. People with Reiters syndrome who have the HLAB27 gene have a greater chance of developing sacroiliitis and spondylitis.

Eye Involvement

Conjunctivitis, an inflammation of the mucous membrane that covers the eyeball and eyelid, develops in about 50 percent of people with urogenital Reiters syndrome and 75 percent of people with enteric Reiters syndrome. A few people may develop uveitis, an inflammation of the inner eye. Conjunctivitis and uveitis can cause redness of the eyes, eye pain and irritation, and blurred vision. Eye involvement typically occurs early in the course of Reiters syndrome, and symptoms may come and go.

Other Symptoms

About 20 to 40 percent of men with Reiters syndrome develop small, shallow, painless sores or lesions, called balanitis circinata, on the end of the penis. A small percentage of men and women develop rashes of small hard nodules on the soles of the feet, and less often on the palms of the hands or elsewhere. These rashes are called keratoderma blennorrhagica. In addition, some people with Reiters syndrome develop mouth ulcers that come and go. In some cases, these ulcers are painless and go unnoticed.

About 10 percent of people with Reiters syndrome, usually those with prolonged disease, develop heart problems including aortic regurgitation (leakage of blood from the aorta into the heart chamber) and pericarditis (inflammation of the membrane that covers and protects the heart).

How Is Reiters Syndrome Diagnosed?

Diagnosing Reiters syndrome is often difficult because there is no specific test to confirm that a person has it. When a patient reports symptoms, the doctor must examine him or her carefully and rule out other causes of arthritis.

The doctor will take the patients complete medical history, noting current symptoms as well as any previous diseases, problems, and infections. Because the symptoms of Reiters syndrome can be vague, it is sometimes useful for the patient to keep a log of the symptoms that occur, when they occur, and for how long. It is especially important to report any flulike symptoms, such as fever, vomiting, or diarrhea, even if they were mild, because they may be associated with the initial bacterial infection.

The doctor may use various blood tests to help rule out other conditions and confirm a suspected diagnosis of Reiters syndrome. Tests may be done to determine the presence of rheumatoid factor or antinuclear antibodies. Results of these tests are abnormal in patients with other types of arthritis such as rheumatoid arthritis or lupus, but they typically are normal in patients with Reiters syndrome. Doctors may determine the erythrocyte sedimentation rate, or sed rate, which is the rate at which red blood cells settle at the bottom of a test tube of blood. An elevated sed rate indicates inflammation somewhere in the body. Typically, people with rheumatic diseases, including Reiters syndrome, have an elevated sed rate. In some patients with suspected Reiters syndrome, the doctor may do a blood test to determine the presence or absence of HLAB27.

The doctor is also likely to perform tests for infections that might be associated with Reiters syndrome. Patients are generally tested for a Chlamydia infection because recent studies have shown that early treatment in Chlamydia-induced Reiters syndrome may ameliorate the course of the disease. In many people with Reiters syndrome, there is no clear evidence of infection at the time they are seen, although antibodies may be detected in the blood, indicating that an infection was present in the past. The doctor may test samples of cells taken from the patients throat as well as the urethra in men or cervix in women. Urine and stool samples may also be tested. The synovial fluid (the fluid that lubricates the joints) or the membrane (synovium) that lines the joint may be removed from the joint affected by arthritis. Studies of the fluid or the synovium can help the doctor make certain there is no infection in the joint.

Doctors sometimes use X rays to help establish a diagnosis of Reiters syndrome and rule out other causes of arthritis. Common findings on X rays of patients with Reiters syndrome include spondylitis, sacroiliitis, swelling of soft tissues, damage to cartilage or bone margins of the joint, and bone deposits where the tendon attaches to the bone.

What Type of Doctor Treats Reiters Syndrome?

A patient probably will see different doctors because Reiters syndrome affects different parts of the body. It may be helpful to the doctors and the patient for one doctor to manage the complete treatment plan. This doctor can coordinate treatments and monitor the side effects from the various medicines the patient may take. A rheumatologist (doctor specializing in arthritis) often manages a patients treatment and treats the joint disease. The following specialists treat other features that affect different parts of the body.

  • Ophthalmologisttreats eye disease.

  • Gynecologisttreats urogenital symptoms in women.

  • Urologisttreats urogenital symptoms in men.

  • Dermatologisttreats skin symptoms.

  • Orthopaedistperforms surgery on severely damaged joints.

  • Physiatristsupervises exercise regimens.

How Is Reiters Syndrome Treated?

Although there is no cure for Reiters syndrome, treatments that effectively relieve the symptoms are available. Many symptoms may even disappear for long periods of time. The doctor is likely to use one or more of the following treatments:

  • Bed restShort periods of bed rest are sometimes effective in reducing the pain and inflammation of arthritis. Lying down can reduce the pressure of the bodys weight on a painful joint and provide relief for some patients.

  • ExerciseEven before symptoms disappear, some strengthening and gentle range-of-motion exercises will maintain or improve joint function. Strengthening exercises build up the muscles around the joint to better support it. Isometric tightening of muscles without moving the joints can be used even in active, painful disease. Range-of-motion exercises improve movement and flexibility and reduce stiffness in the affected joint. Before beginning an exercise program, patients should talk to the doctor, who can recommend appropriate exercises.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)This type of medicine effectively reduces joint inflammation and is commonly used to treat patients with Reiters syndrome. Some NSAIDs, such as aspirin and ibuprofen, are available without a prescription. Many others require a doctors prescription.

  • Corticosteroid injectionsFor people with severe joint inflammation, injections of corticosteroids directly into the affected joint may effectively reduce inflammation. Doctors typically use this treatment only after trying to control arthritis with NSAIDs. Corticosteroid injections are most commonly used for severe knee or ankle inflammation.

  • Topical corticosteroidsThis type of medicine can be put directly on the skin lesions associated with Reiters syndrome. Topical corticosteroids reduce inflammation and promote healing.

  • AntibioticsAntibiotics may be prescribed to eliminate the bacterial infection that triggered Reiters syndrome. The specific antibiotic prescribed depends on the type of bacterial infection that has to be treated. Patients must carefully follow the doctors instructions about how much medicine to take and for how long; if the medicine is not taken correctly, the infection may not go away. Often, an antibiotic is taken once or twice a day for 7 to 10 days or longer. Some doctors may recommend that a person with Reiters syndrome take antibiotics for a long period of time (up to 3 months). Current research shows that this practice usually has no effect on the course of the disease and is therefore unnecessary. However, in cases when Chlamydia triggers Reiters syndrome, prolonged antibiotic treatment is effective in shortening the length of time that a person has symptoms.

  • Immunosuppressive medicinesA small percentage of patients with Reiters syndrome have severe symptoms that cannot be controlled with the treatments described earlier. For these people, medicine that suppresses the immune system, such as sulfasalazine or methotrexate, may be effective.

What Is the Prognosis for People Who Have Reiters Syndrome?

Most people with Reiters syndrome recover fully from the initial flare of symptoms and are able to return to regular activities within 2 to 6 months after the first symptoms appear. Arthritis may last up to 6 months, although the symptoms are usually very mild and do not interfere with daily activities. Only 20 percent of people with Reiters syndrome will have chronic arthritis, which is usually mild. Some patients experience symptom recurrence. Studies show that about 15 to 50 percent of patients will develop symptoms sometime after the initial flare has disappeared. Back pain and arthritis are the symptoms that most commonly reappear. A small percentage of patients will have deforming arthritis and severe symptoms that are difficult to control with treatment.

What Are Researchers Trying To Learn About Reiters Syndrome?

Researchers continue to investigate the causes of Reiters syndrome and study treatments for the condition. For example:

  • Researchers are trying to better understand the relationship of infection to Reiters syndrome. In particular, they are trying to determine why an infection triggers arthritis and why some people who develop infections get Reiters syndrome and others do not. Scientists have identified a genetic linkpeople who are positive for HLAB27 are more susceptible to Reitersand are studying why these people are more at risk than others.

  • Researchers are trying to develop methods to detect the location of the triggering bacteria in the body. Some scientists suspect that after the bacteria enter the body, they are transported to the joints, where they can remain in small amounts indefinitely.

  • Researchers are studying new treatments for Reiters syndrome; for example, prolonged treatment with antibiotics or a combination of antibiotics and other drugs such as methotrexate or sulfasalazine. Several recent studies have shown that prolonged treatment with antibiotics may reduce the duration of symptoms in some patients with Reiters syndrome caused by Chlamydia infection.

Where Can People Get More Information About Reiters Syndrome?

  • Spondylitis Association of America
    P.O. Box 5872
    Sherman Oaks, CA 91413
    818/9811616
    800/7778189
    World Wide Web address: http://www.spondylitis.org/

This is the main voluntary organization devoted to all forms of spondylitis, including Reiters syndrome. The association publishes patient and professional materials and a newsletter for members.

  • Arthritis Foundation
    1330 West Peachtree Street
    Atlanta, GA 30309
    404/8727100
    800/2837800
    World Wide Web address: http://www.arthritis.org/

This is the main voluntary organization devoted to arthritis. The foundation publishes a free pamphlet on Reiters syndrome and can also provide physician/clinic referrals.

  • American College of Rheumatology
    60 Executive Park South, Suite 150
    Atlanta, GA 30329
    404/6333777
    World Wide Web address: http://www.rheumatology.org/

This professional organization of rheumatologists, both physicians and scientists, is dedicated to treating and studying all forms of arthritis and can also provide a list of rheumatologists by State.

  • National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse (NAMSIC)
    National Institutes of Health
    1 AMS Circle
    Bethesda, MD 208923675
    301/4954484
    Fax: 301/7186366
    TTY: 301/5652966
    World Wide Web address: http://www.nih.gov/niams/

This clearinghouse, a public service sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), provides information about various forms of arthritis and rheumatic disease. The clearinghouse distributes patient and professional education materials and also refers people to other sources of information.

Acknowledgments

The NIAMS gratefully acknowledges the assistance of John Klippel, M.D., of NIAMS; Daniel Clegg, M.D., University of Utah School of Medicine, Salt Lake City; and Ralph Schumacher, M.D., VA Medical Center, Philadelphia, PA, in the preparation and review of this fact sheet.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the National Institutes of Health (NIH), leads the Federal medical research effort in arthritis and musculoskeletal and skin diseases. The NIAMS supports research and research training throughout the United States, as well as on the NIH campus in Bethesda, MD, and disseminates health and research information. The National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse (NAMSIC) is a public service sponsored by the NIAMS that provides health information and information sources. Additional information can be found on the NIAMS Web site at http://www.nih.gov/niams/.

REITERS SYNDROME
Key Words

Antibodies: Special proteins produced by the bodys immune system that recognize and help fight infectious agents, such as bacteria, and other foreign substances that invade the body.
Antinuclear antibodies: Abnormal antibodies that are often present in people who have connective tissue diseases or other autoimmune disorders.
Arthritis: Literally means joint inflammation. It is a general term for more than 100 conditions known as rheumatic diseases. These diseases affect not only the joints but also other parts of the body, including important supporting structures such as muscles, tendons, and ligaments, as well as some internal organs.
Bacteria: Any group of single-celled micro-organisms that live in soil, water, and organic matter or in the bodies of plants, animals, and humans. Some types of bacteria cause illness when they enter the body.
Balanitis circinata: Small, shallow, painless sore on the penis.
Conjunctivitis: Inflammation of the mucous membrane that covers the eyeball and eyelid.
Corticosteroids: Potent anti-inflammatory hormones that are made naturally in the body or synthetically (man-made) for use as drugs. They are also called glucocorticoids. The most commonly prescribed drug of this type is prednisone.
Enteric: A term related to the intestines and the digestion of food.
Enthesopathy: Inflammation where the tendon attaches to the bone. This symptom is unique to the seronegative spondyloarthropathies.
Erythrocyte sedimentation rate: A blood test that measures the speed at which red blood cells settle sedimentation at the bottom of a test tube. A high rate signals possible inflammatory disease. Also referred to as the sed rate or ESR.
Gastrointestinal tract: Organs related to the digestion of food, including the stomach and the intestines.
HLAB27: A genetic marker that may be found in the blood of patients with certain forms of arthritis such as ankylosing spondylitis and Reiters syndrome.
Immuno-suppressive drugs: Medicines that decrease the immune response and may relieve some symptoms of severe Reiters syndrome.
Inflammation: A characteristic reaction of tissues to injury or disease. It is marked by four signs: swelling, redness, heat, and pain.
Keratoderma blennorrhagica: Red patches that usually appear on the bottom of the foot. The area may look like excessively dry skin.
NSAID: An abbreviation for nonsteroidal anti-inflammatory drug. NSAIDs do not contain corticosteroids and are used to reduce pain and inflammation. Aspirin and ibuprofen are two types of NSAIDs, but there are many others.
Range of motion: A measurement of the extent to which a joint can go through all of its normal movements.
Reactive arthritis: A systemic illness caused by an infection. The most common symptom is joint inflammation.
Rheumatoid arthritis: A chronic inflammatory disease that causes pain, stiffness, swelling, and loss of function in the joints. The primary target of rheumatoid arthritis is the synovium, or joint lining. This tissue, which normally is smooth and shiny, becomes inflamed, painful, and swollen. The disease can also cause inflammation in the blood vessels and the outer lining of the heart and lungs.
Rheumatoid factor: A special kind of antibody often found in people with some types of rheumatic diseases, but usually not Reiters syndrome.
Sacroiliitis: Inflammation of the sacrum.
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