Internal Medicine

Reiter syndrome

Frequency distribution
prophylaxis
history

Synonyms: Reactive arthritis, Reiter's disease, urethral polyarthritis, urethro-conjunctivo-synovial syndrome

definition

The Reiter syndrome describes a inflammatory joint diseasethat after as a second illness Inflammation of the gastrointestinal tract or des Genitourinary tract (Urinary tract) can occur. Reiter's syndrome actually comprises three or four main symptoms and is considered a special form of reactive arthritis.

causes

Before it becomes one Reiter syndrome comes, the patient initially has one bacterial infection. This infection can, for example, be a Urinary tract infection (Urethritis) which either by Neisseria gonorrhea or a non-gonorrhoeic urinary tract infection Chlamydia trachomatis, Mycoplasma or Ureaplasma be. But also a Gastrointestinal infection by Yersinia, Salmonella, Shigella (so-called Ruhr), Campylobacter jejuni or Enteritis pathogen be the previous illness.

In addition, in 60-80% of cases a genetic predisposition present. This means that the affected patients have a change in an antigenic trait. These patients are HLA-B27 positive. In the normal population, this gene is actually only expressed in 8%.

It can occur after a bacterial infection of the gastrointestinal or urinary tract after 2 - 6 weeks then come to a reactive disease with Reiter's syndrome.

diagnosis

For a diagnosis, a anamnese with targeted questioning after a previous one Urinary tract infection or des Gastrointestinal tract carried out.

Furthermore, the typical symptoms (Equestrian triad) leading to a diagnosis of Reiter's syndrome.

Likewise, a Laboratory examination be made. Here, inflammation parameters such as an increased Sedimentation rate (BSG) and an increased CRP value (C-reactive protein) detected. But these are very unspecific.

It can be a genetic examination be initiated, after a HLA-B27 Evidence is sought. In 80% of the cases this is positive.

It is usually difficult to detect the pathogen, as the acute infection was usually a few weeks ago and there are no more germs in the urine (if you have a urinary tract infection) or chair (with a gastrointestinal infection) Find. In individual cases and depending on the germ, this can possibly still be proven with certain methods.

In the serological diagnostics the course of an infection can also be determined retrospectively. Here will be IgA- and IgG antibodies detected in the blood. Such parallel titer courses suggest an existing infection, but are not found in all cases or can be detected in the blood.

Frequency distribution

2-3 % of patients who previously had certain gastrointestinal infections or urinary tract infections show Reiter's syndrome afterwards. The gender distribution is given between men and women 1: 1, 3: 1 or 20: 1, depending on the literature. Reiter's syndrome occurs mainly in the life span between the 20 to 40 years of age on.

Symptoms

In the case of Reiter's syndrome, the so-called Equestrian triad described. Possibly this can be caused by another symptom Rider triad be completed.

The equestrian triad include one arthritis, inflammation of the lining of the ureter (Urethritis) and a Conjunctivitis (Conjunctivitis) or Iritis:

A arthritis describes a acute inflammation of one or more joints. This usually occurs asymmetrically, i.e. not on the same side. Arthritis in Reiter's syndrome preferably affects the lower extremity, that is, the knee- or Ankle joints.
The Urethritis describes the Inflammation of the urethra. It makes itself noticeable through an itching and through Painful urination. A discharge or reddening of the urethra orifice may also be noticed.
The Conjunctivitis is the Conjunctivitis of the eyes. It makes itself felt that the Eyes reddened are. A foreign body sensation is described in the eye and the eyes make more water.
A Iritis would be a Inflammation of the iris of the eye (iris). Again, the eye appears reddened, and compared to conjunctivitis, one develops Photosensitivity, Pain and blurred vision.

The so-called rider triad also counts Reiter's dermatosis: This dermatosis means a Erythema, one Reddening of the skinwhich is similar to a psoriasis (psoriasis) on the mucous membrane of the male reproductive organ occurs as well Oral mucosal lesions. Furthermore, changes occur in this dermatosis Palms and soles on, so-called Keratoma blenorrhagicumwhich deals with pus-filled vesicles to make noticable. It can lead to further Skin changes all over the body that resemble psoriasis in their image.

During Reiter's syndrome, in addition to the typical Reiter triad, it can also be closed Concomitant symptoms come. These are variable and include fever, one inflammatory changes in the joints of the lower spine (Sacroiliitis), painful Inflammation of the tendon attachments (Enthesopathies) or rarer ones Inflammation of internal organs like that Heart (Carditis) or des Pulmonary membrane (pleurisy).

therapy

The Therapy of Reiter's Syndrome depends on the infection situation and the germ. If the infection is still acute, various can be Antibiotic treatments be indexed. This is not the case if no pathogen can currently be detected.

At a proven urinary tract infection by Chlamydia or Ureaplasma come the Antibiotics Doxycycline or macrolides like Erythromycin or Clarithromycin in question. Antibiotic therapy is recommended, especially in the case of an infection by chlamydia, as this germ can persist in the body. It is important that with a Chlamydial infection always the partner because of a renewed risk of infection co-treated must become!

Even in the case of an acute proven Gonorrhea (Gonorrhea) or a gastrointestinal infection is a pathogen-friendly Antibiotic therapy recommended.

If infections are no longer detectable, you can too Treat symptomatically. So come with one acute arthritis non-steroidal anti-inflammatory drugs for use. Likewise here should be anti-inflammatory with a so-called Application of cold (Cryotherapy) be worked. Both therapies help against the symptoms of arthritis.

It comes to severe disease coursesthat affects several different joints, or becomes severe Inflammation of the inner eye (Iridocyclitis) therapy should come with Glucocorticosteroids (Cortisol) can be started.

Reiter's syndrome persists and one occurs chronic course is the gift of Sulfasalazine indexed. This also has a further anti-inflammatory effect.

prophylaxis

As the only one prophylaxis for the occurrence of Reiter's syndrome the effort is worth one Prevent infection of the urinary tract or the gastrointestinal tract. If an infection does occur, it should treated as quickly as possible become.

forecast

A complete healing after 12 months is at 80% of the falls. A disease with only individual symptoms has a more favorable prognosis than a fully developed Reiter syndrome. Patient with positive HLA-B27 or with one severe disease course can tend to the disease chronic runs.