-IBIS-1.5.0-
tx
immune system
Reiter's syndrome
diagnoses

definition and etiology

definition: Arthritis associated with nonbacterial urethritis and conjunctivitis; most patients carry the antigen HLA-B27; The syndrome seems to be a response to infection with shigella or sexually transmitted infections (e.g. chlamydia) in a genetically susceptible host.

signs and symptoms

• nonbacterial urethritis develops 7-14 days after sexual exposure, and low grade fever, conjunctivitis, and arthritis develop over the next few weeks
• urethritis is milder than in gonorrhea
• the arthritis is asymmetric and polyarticular, and generally occurs in the larger joints of the lower extremities and the toes
• the conjunctivitis is usually mild
• small painless superficial ulcers may be seen on the oral mucosa, tongue, and glans penis
• patients may develop hyperkeratotic skin lesions of the palms and soles and around the nails.

lab findings:
• increased ESR parallels clinical course
• increased WBC (10-20,000/mm3), increased granulocytes
• cystitis is non-bacterial
• HLA-B27 in 90% of white patients
• RF may be positive
• joint fluid aspiration shows marked increase in WBC and complement activity

course and prognosis

The initial illness typically resolves in 3-4 months but 50% of patients experience transient recurrences of arthritis or the full syndrome over a period of several years; joint deformity, ankylosis, sacroiliitis, and spondylitis may occur in patients who develop the chronic illness.

differential diagnosis

The diagnosis must include the triad of urethritis, conjunctivitis, and arthritis; it may take several months for all symptoms to manifest, so each must be differentiated as it arises.
For arthritis:
• gonococcal arthritis
• psoriatic arthritis
• ankylosing spondylitis
• septic arthritis
• rheumatoid arthritis


footnotes