Reiter's Syndrome

I have a follow-up appointment with the Rheumatology Dept at the U. of Florida soon, and I would appreciate if you could give me some insight on the tests and symptoms I have had so that I can be better prepared when I have my appointment.

I was diagnosed with Reiter's Syndrome nearly 3 years ago.  I am a 40 year old male. So far no bacteria has been found to identify a causitive agent.  I do have chronic epididymitis, urethrits, and tender prostate, but my Urologist does not feel this is from a bacteria.

I do get recurrent conjuctivitis due to dry eyes, but this has been much better since I had a Dacryocystorhinostomy in 1997.

I also have stomach involvement with mid to lower right side pain and often have severe cramping and diarrhea with low-grade fevers.  I have attributed this always to IBS.

My arthritis pain is in my right hip, lower back and neck.  I often am waken with my spine feeling like it is compressing and hot.  I waske up often with stiffness which lasts around 2 hours and then eases.  Also my achilles tendon on my right foot has been effected and I have lost the ability to stand up on my toes.  Fatigue is also a problem at times.

My labs have been negative for HLA-B27 and ANA.  I have a Sed Rate of 3, C reactive protein of 3.8, Rheumatoid Factor of 8.0 and mild transaminase elevation.

U of Florida was quite certain I have Reiter's and am early stage Ankylosing Spondylitis due to underlying Crohn's.  After my last visit, however, my Gastroenterologist did an ultra sound, CT Scan of the Abdomen, and Small Bowel Follow through to check for IBD.  Everthing was unremarkable except both the CT and Ultra Sound showed Fatty Liver and some mild changes due to recent gallbladder surgery.  I am a non-drinker despite the Fatty Liver findings.

I have had a colonoscopy and an EGD recently.  Everything is fine except the EGD revealed mixed chronic and acute inflammation of the small intestine.  Fecal samples were normal.  My Gastroenterologist said the inflammation is probably due to GERD, not Crohn's

Also, my x-rays reveal sclerosing of the right SI joint and MRI showed slight disk bulging and degeneration in my lower back

U of Florida wants to start me on Methotrexate since I am not responding to the NSAID's.

I am still confused about the relationship of Crohn's and Arthritis.  Is it possible to have Crohn's without it showing on x-rays?

I appreciate any insight you may have or questions you feel I should ask the Rheumatologists at U of Florida.

[Kevin Pho, MD]

Ulcerative colitis and regional enteritis (Crohn's disease) are the most frequently encountered types of idiopathic inflammatory bowel disease that are associated with arthritis or spondylitis.   Arthritis may affect the spine, sacroiliac joints, appendicular joints, or a combination of these articulations. Peripheral arthritis may be acute and remitting (Type I), or be a more chronic problem or have frequent relapses (Type II).

Spondylitis occurs in 1 to 26 percent of patients with IBD. Males are more frequently affected than females. Patients typically complain of prolonged stiffness in the back and/or buttocks in the morning or after rest.

There are cases where Crohn's disease can be difficult to diagnose, especally if it focuses on the small bowel.  Colonoscopy with the intubation of the terminal ileum as well as upper GI series with small bowel follow-through are typically used for diagnosis.  In cases where Crohn's disease is suspected, but cannot be shown with the traditional test, capsule endoscopy can be considered.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Peppercorn.  Clinical manifestations and diagnosis of Crohn's disease.  UptoDate, 2004.

Schur.  Arthritis associated with gastrointestinal disease.  UptoDate, 2004.

[rahdey46]

A related discussion, Reiter's vs neck and Shoulder involvement was started.