Reither's syndrome

Reactive arthritis (also known as Reiter’s syndrome) can cause a wide range of symptoms. The most common symptoms include:

  • inflammation of the joints (arthritis),
  • inflammation of the eyes (conjunctivitis), and
  • inflammation of the urethra (urethritis).

The urethra is the tube that runs from the bladder through the penis or the vulva, through which urine is passed out of the body.

Reactive arthritis develops as a reaction to an earlier infection, hence its name. The infection is usually either a sexually transmitted infection (STI) such as chlamydia, or an infection of the stomach and intestines such as salmonella. It is not fully understood why the reaction occurs.

How common is reactive arthritis?

Reactive arthritis is not common. There are an estimated 30 to 40 new cases a year in England for every 100,000 people.

Reactive arthritis associated with an STI is much more common in men than in women. Men account for 90% of all cases. Reactive arthritis associated with a stomach infection occurs equally among men and women.

Most cases of reactive arthritis develop in people who are 20 to 40 years old.

Outlook

The outlook for reactive arthritis is reasonably good, and most people’s symptoms will get better within three to 12 months. Some people's symptoms will recur at some point in the future.

There is no cure for reactive arthritis. However, its symptoms can be controlled using non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

The cause of reactive arthritis (Reiter’s syndrome) is not known. A generally accepted theory is that it is linked to an underlying problem with the immune system.

In people with reactive arthritis, the immune system seems to have over-reacted to an infection and has inflamed healthy tissue such as the joints and the eyes.

Conditions that are caused by the immune system attacking healthy tissue are known as autoimmune conditions.

Infection

The two most common types of infections linked to reactive arthritis are:

  • sexually transmitted infections (STIs), and
  • gastrointestinal infections (infections of the stomach and digestive system).

Two STIs that are commonly associated with reactive arthritis are:

  • chlamydia, and
  • gonorrhoea.

Two types of bacteria that are responsible for causing gastrointestinal infections, and are commonly associated with reactive arthritis, are:

  • salmonella, and
  • campylobacter.

Both these bacteria are common causes of food poisoning.

Less commonly, reactive arthritis can develop after a viral infection. Viruses associated with reactive arthritis include:

  • herpes,
  • chickenpox,
  • hepatitis (A, B and C),
  • cytomegalovirus (CMV),
  • the Epstein-Barr virus (EBV), and
  • HIV.

Genetic factors

Research has shown that people with a specific type of gene, known as HLA-B27, have an increased chance of developing reactive arthritis (as well as other autoimmune conditions, such as ankylosing spondylitis, which is a type of arthritis that affects the spine). It is estimated that 5-10% of people in England have the HLA-B27 gene.

An estimated 75% of all cases of reactive arthritis develop in people with the HLA-B27 gene. Also, people with the HLA-B27 gene tend to have more severe symptoms and a greater risk of their symptoms reoccurring.

Exactly how HLA-B27 contributes to the development of reactive arthritis is unclear. Research into the role of HLA-B27 in autoimmune conditions is ongoing.

There is no specific test for reactive arthritis (Reiterís syndrome). However, blood tests and X-rays may be used to rule out other causes of arthritis, and blood tests can confirm whether you have the HLA-B27 gene.

A small sample of fluid may also be removed from an affected joint. The fluid will be tested for the presence of bacteria to rule out infection as a possible cause of your symptoms.

Once other possible causes have been ruled out, a diagnosis of reactive arthritis can usually be made by assessing your symptoms and recent medical history.

The three parts of the body that are most commonly affected by reactive arthritis (Reiter’s syndrome) are:

  • the joints and muscles,
  • the urinary system, and
  • the eyes.

Joints and muscles

Reactive arthritis can cause inflammation of the joints and muscles, which in turn can cause the following symptoms:

  • joint pain and swelling; usually in weight-bearing joints such as the knees, ankles and hips,
  • lower back pain,
  • heel pain,
  • pain and swelling in the ankles, and
  • swelling in the fingers and toes.

The urinary system

Reactive arthritis can cause inflammation of the urethra (urethritis). Symptoms of urethritis include:

  • pain, or a burning sensation during urination (dysuria),
  • needing to urinate frequently or urgently,
  • a discharge of fluid from the penis or vagina and, less commonly,
  • blood in the urine.

The eyes

Reactive arthritis can cause inflammation of the eyes (conjunctivitis). Symptoms of conjunctivitis include:

  • reddening of the eyes,
  • watery eyes,
  • eye pain, and
  • swollen eyelids.

Other symptoms of reactive arthritis

Other symptoms of reactive arthritis include:

  • fatigue,
  • mild fever (a high temperature of 37-38°C or 98.6-101.0°F),
  • mouth ulcers,
  • a skin rash, and
  • thick and crumbly nails. 

There is currently no cure for reactive arthritis (Reiter’s syndrome). But there are a number of effective medications that can help relieve your symptoms while you wait for the condition to clear up.

Health professionals usually prescribe a reactive arthritis medication that they think is powerful enough to control your symptoms, and will only ‘step up’ to more powerful medications as and when needed. This is called a step-wise approach

Non-steroidal anti-inflammatory drugs (NSAIDs)

The first medication for reactive arthritis is usually a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen. NSAIDs are useful for treating reactive arthritis and other types of arthritis because they can help to reduce the level of inflammation.

Corticosteroids

Corticosteroids may be recommended if your symptoms do not respond to NSAIDs, or you are unable to use NSAIDs for health reasons, such as having a stomach ulcer. (NSAIDs can make the symptoms of a stomach ulcer worse.)

Corticosteroids can either be given in tablet form, or by an injection directly into an affected joint.

Disease-modifying anti-rheumatic drugs (DMARDs)

Disease-modifying anti-rheumatic drugs (DMARDs) can be used to treat reactive arthritis if your symptoms do not respond to NSAIDs or corticosteroids. DMARDs can help to protect healthy tissue from the over-reaction of the immune system. They do this by blocking the effects of some of the chemicals that are released by the immune system.

It can take four to six months before the effects of a DMARD are felt. Therefore, it is important to keep taking the medication even if the effects are not noticed at first. You may have to try two or three types of DMARD before finding the one that is most suitable for you.

Self care

In the initial stages of reactive arthritis, it is recommended that you get plenty of rest and avoid using the affected joints.

As symptoms improve, you should begin a gradual programme of exercise that is designed to strengthen the affected muscles and improve the range of movement in the affected joints.

Your GP may be able to recommend a suitable exercise programme for you. Or you may be referred to a physiotherapist for physical therapy.