-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