| Home | Article Database | Resources | Tools & Just for Fun | Search HY |
Questions and Answers About Reiter's Syndrome
This fact sheet contains general information
about Reiter's syndrome. It describes what Reiter's syndrome is and
how it develops. It also explains how Reiter's syndrome is diagnosed
and treated. If you have further questions after reading this fact sheet,
you may wish to discuss them with your doctor.
What Is Reiter's Syndrome?
Reiter's syndrome is a disorder that
causes three seemingly unrelated symptoms: arthritis, redness of the
eyes, and urinary tract signs. Doctors sometimes refer to Reiter's syndrome
as a seronegative spondyloarthropathy because it is one of a group of
disorders that cause inflammation throughout the body, particularly
in parts of the spine and at other joints where tendons attach to bones.
(Examples of other seronegative spondyloarthropathies include psoriatic
arthritis, ankylosing spondylitis, and inflammatory bowel syndrome arthritis.)
Inflammation is a characteristic reaction of tissues to injury or disease
and is marked by four signs: swelling, redness, heat, and pain.
Reiter's syndrome is also referred
to as reactive arthritis, which means that the arthritis occurs as a
"reaction" to an infection that started elsewhere in the body. In many
patients, the infection begins in the genitourinary tract (bladder,
urethra, penis, or vagina). The infection is most commonly passed from
one person to another by sexual intercourse. This form of the disorder
is sometimes called genitourinary or urogenital Reiter's syndrome. Another
form of the disorder, called enteric or gastrointestinal Reiter's syndrome,
develops when a person eats food or handles substances that are tainted
When a preceding infection is recognized,
symptoms of Reiter's syndrome appear about 1 to 3 weeks after the infection.
Chlamydia trachomatis is the bacteria most often associated with
Reiter's syndrome acquired through sexual contact. Several different
bacteria are associated with Reiter's syndrome acquired through the
digestive tract, including Salmonella, Shigella, Yersinia,
and Campylobacter. People may become infected with these bacteria
after eating or handling improperly prepared food, such as meats that
are not stored at the correct temperature.
Doctors do not know exactly why some people exposed to these bacteria
develop the disorder and others do not, but they have identified a genetic
factor (HLA-B27) that increases a person's chance of developing Reiter's
syndrome. About 80 percent of people with Reiter's syndrome are HLA-B27
positive. Only 6 percent of people who do not have the syndrome have
the HLA-B27 gene.
Reiter's syndrome is not contagious;
that is, a person with the disorder cannot pass it to somebody else.
However, the bacteria that can trigger it can be passed from one person
to another, although not all people infected with the bacteria will
develop Reiter's syndrome. Rather, it is likely that people who develop
the disease have inherited a trait that makes them susceptible.
Men between the ages of 20 and 40 are
most likely to develop Reiter's syndrome. It is the most common type
of arthritis affecting young men. Among men under age 50, about 3.5
per 100,000 develop Reiter's syndrome each year. Three percent of all
men with a sexually transmitted disease develop Reiter's syndrome. Women
can also develop the disorder, though less often than men, with features
that are often milder and more subtle.
the Symptoms of Reiter's Syndrome?
The symptoms can affect many different
parts of the body, but most typically affect the urogenital tract, the
joints, and the eyes. Less common symptoms are mouth ulcers, skin rashes,
and heart-valve problems. The signs may be so mild that patients do
not notice them. They usually come and go over a period of several weeks
to several months.
Urogenital Tract Symptoms
Reiter's syndrome often affects the
urogenital tract, including the prostate, urethra, and penis in men
and the fallopian tubes, uterus, and vagina in women. Men may notice
an increased need to urinate, a burning sensation when urinating, and
a discharge from the penis. Some men with Reiter's syndrome develop
prostatitis, inflammation of the prostate gland. Symptoms of prostatitis
can include fever, chills, increased need to urinate, and a burning
sensation when urinating.
Women with Reiter's syndrome also develop
signs in the urogenital tract, such as inflammation of the cervix (cervicitis)
or inflammation of the urethra (urethritis), which can cause a burning
sensation during urination. In addition, some women also develop salpingitis
(inflammation of the fallopian tubes) or vulvovaginitis (inflammation
of the vulva and vagina). These conditions may or may not cause any
Joint Symptoms or Arthritis
The arthritis associated with Reiter's
syndrome typically affects the knees, ankles, and feet, causing pain
and swelling. Wrists, fingers, and other joints are less often affected.
Patients with Reiter's syndrome commonly develop inflammation where
the tendon attaches to the bone, a condition called enthesopathy. Enthesopathy
may result in heel pain and the shortening and thickening of fingers
and toes. Some people with Reiter's syndrome also develop heel spurs,
bony growths in the heel that cause chronic or long-lasting foot pain.
Arthritis in Reiter's syndrome can
also affect the joints in the back and cause spondylitis (inflammation
of the vertebrae in the spinal column) or sacroiliitis (sa-kro-il-e-i-tes),
inflammation of the joints in the lower back that connect the spine
to the pelvis. People with Reiter's syndrome who have the HLA-B27 gene
have a greater chance of developing sacroiliitis and spondylitis.
Conjunctivitis, an inflammation of
the mucous membrane that covers the eyeball and eyelid, develops in
about 50 percent of people with urogenital Reiter's syndrome and 75
percent of people with enteric Reiter's syndrome. A few people may develop
uveitis, an inflammation of the inner eye. Conjunctivitis and uveitis
can cause redness of the eyes, eye pain and irritation, and blurred
vision. Eye involvement typically occurs early in the course of Reiter's
syndrome, and symptoms may come and go.
About 20 to 40 percent of men with
Reiter's syndrome develop small, shallow, painless sores or lesions,
called balanitis circinata, on the end of the penis. A small percentage
of men and women develop rashes of small hard nodules on the soles of
the feet, and less often on the palms of the hands or elsewhere. These
rashes are called keratoderma blennorrhagica. In addition, some people
with Reiter's syndrome develop mouth ulcers that come and go. In some
cases, these ulcers are painless and go unnoticed.
About 10 percent of people with Reiter's
syndrome, usually those with prolonged disease, develop heart problems
including aortic regurgitation (leakage of blood from the aorta into
the heart chamber) and pericarditis (inflammation of the membrane that
covers and protects the heart).
Reiter's Syndrome Diagnosed?
Diagnosing Reiter's syndrome is often
difficult because there is no specific test to confirm that a person
has it. When a patient reports symptoms, the doctor must examine him
or her carefully and rule out other causes of arthritis.
The doctor will take the patient's
complete medical history, noting current symptoms as well as any previous
diseases, problems, and infections. Because the symptoms of Reiter's
syndrome can be vague, it is sometimes useful for the patient to keep
a log of the symptoms that occur, when they occur, and for how long.
It is especially important to report any flulike symptoms, such as fever,
vomiting, or diarrhea, even if they were mild, because they may be associated
with the initial bacterial infection.
The doctor may use various blood tests
to help rule out other conditions and confirm a suspected diagnosis
of Reiter's syndrome. Tests may be done to determine the presence of
rheumatoid factor or antinuclear antibodies. Results of these tests
are abnormal in patients with other types of arthritis such as rheumatoid
arthritis or lupus, but they typically are normal in patients with Reiter's
syndrome. Doctors may determine the erythrocyte sedimentation rate,
or sed rate, which is the rate at which red blood cells settle at the
bottom of a test tube of blood. An elevated sed rate indicates inflammation
somewhere in the body. Typically, people with rheumatic diseases, including
Reiter's syndrome, have an elevated sed rate. In some patients with
suspected Reiter's syndrome, the doctor may do a blood test to determine
the presence or absence of HLA-B27.
The doctor is also likely to perform
tests for infections that might be associated with Reiter's syndrome.
Patients are generally tested for a Chlamydia infection because
recent studies have shown that early treatment in Chlamydia-induced
Reiter's syndrome may ameliorate the course of the disease. In many
people with Reiter's syndrome, there is no clear evidence of infection
at the time they are seen, although antibodies may be detected in the
blood, indicating that an infection was present in the past. The doctor
may test samples of cells taken from the patient's throat as well as
the urethra in men or cervix in women. Urine and stool samples may also
be tested. The synovial fluid (the fluid that lubricates the joints)
or the membrane (synovium) that lines the joint may be removed from
the joint affected by arthritis. Studies of the fluid or the synovium
can help the doctor make certain there is no infection in the joint.
Doctors sometimes use X rays to help
establish a diagnosis of Reiter's syndrome and rule out other causes
of arthritis. Common findings on X rays of patients with Reiter's syndrome
include spondylitis, sacroiliitis, swelling of soft tissues, damage
to cartilage or bone margins of the joint, and bone deposits where the
tendon attaches to the bone.
of Doctor Treats Reiter's Syndrome?
A patient probably will see different
doctors because Reiter's syndrome affects different parts of the body.
It may be helpful to the doctors and the patient for one doctor to manage
the complete treatment plan. This doctor can coordinate treatments and
monitor the side effects from the various medicines the patient may
take. A rheumatologist (doctor specializing in arthritis) often manages
a patient's treatment and treats the joint disease. The following specialists
treat other features that affect different parts of the body.
- Ophthalmologist—treats eye
- Gynecologist—treats urogenital
symptoms in women.
- Urologist—treats urogenital
symptoms in men.
- Dermatologist—treats skin
- Orthopaedist—performs surgery
on severely damaged joints.
- Physiatrist—supervises exercise
Reiter's Syndrome Treated?
Although there is no cure for Reiter's
syndrome, treatments that effectively relieve the symptoms are available.
Many symptoms may even disappear for long periods of time. The doctor
is likely to use one or more of the following treatments:
- Bed rest—Short periods of
bed rest are sometimes effective in reducing the pain and inflammation
of arthritis. Lying down can reduce the pressure of the body's weight
on a painful joint and provide relief for some patients.
- Exercise—Even before symptoms
disappear, some strengthening and gentle range-of-motion exercises
will maintain or improve joint function. Strengthening exercises
build up the muscles around the joint to better support it. Isometric
tightening of muscles without moving the joints can be used even
in active, painful disease. Range-of-motion exercises improve movement
and flexibility and reduce stiffness in the affected joint. Before
beginning an exercise program, patients should talk to the doctor,
who can recommend appropriate exercises.
- Nonsteroidal anti-inflammatory
drugs (NSAID's)—This type of medicine effectively reduces joint
inflammation and is commonly used to treat patients with Reiter's
syndrome. Some NSAID's, such as aspirin and ibuprofen, are available
without a prescription. Many others require a doctor's prescription.
- Corticosteroid injections—For
people with severe joint inflammation, injections of corticosteroids
directly into the affected joint may effectively reduce inflammation.
Doctors typically use this treatment only after trying to control
arthritis with NSAID's. Corticosteroid injections are most commonly
used for severe knee or ankle inflammation.
- Topical corticosteroids—This
type of medicine can be put directly on the skin lesions associated
with Reiter's syndrome. Topical corticosteroids reduce inflammation
and promote healing.
may be prescribed to eliminate the bacterial infection that triggered
Reiter's syndrome. The specific antibiotic prescribed depends on
the type of bacterial infection that has to be treated. Patients
must carefully follow the doctor's instructions about how much medicine
to take and for how long; if the medicine is not taken correctly,
the infection may not go away. Often, an antibiotic is taken once
or twice a day for 7 to 10 days or longer. Some doctors may recommend
that a person with Reiter's syndrome take antibiotics for a long
period of time (up to 3 months). Current research shows that this
practice usually has no effect on the course of the disease and
is therefore unnecessary. However, in cases when Chlamydia
triggers Reiter's syndrome, prolonged antibiotic treatment is effective
in shortening the length of time that a person has symptoms.
- Immunosuppressive medicines—A
small percentage of patients with Reiter's syndrome have severe
symptoms that cannot be controlled with the treatments described
earlier. For these people, medicine that suppresses the immune system,
such as sulfasalazine or methotrexate, may be effective.
the Prognosis for People Who Have Reiter's Syndrome?
Most people with Reiter's syndrome
recover fully from the initial flare of symptoms and are able to return
to regular activities within 2 to 6 months after the first symptoms
appear. Arthritis may last up to 6 months, although the symptoms are
usually very mild and do not interfere with daily activities. Only 20
percent of people with Reiter's syndrome will have chronic arthritis,
which is usually mild. Some patients experience symptom recurrence.
Studies show that about 15 to 50 percent of patients will develop symptoms
sometime after the initial flare has disappeared. Back pain and arthritis
are the symptoms that most commonly reappear. A small percentage of
patients will have deforming arthritis and severe symptoms that are
difficult to control with treatment.
What Are Researchers Trying To Learn About Reiter's Syndrome?
Researchers continue to investigate
the causes of Reiter's syndrome and study treatments for the condition.
- Researchers are trying to better
understand the relationship of infection to Reiter's syndrome. In
particular, they are trying to determine why an infection triggers
arthritis and why some people who develop infections get Reiter's
syndrome and others do not. Scientists have identified a genetic
link—people who are positive for HLA-B27 are more susceptible to
Reiter's—and are studying why these people are more at risk than
- Researchers are trying to develop
methods to detect the location of the triggering bacteria in the
body. Some scientists suspect that after the bacteria enter the
body, they are transported to the joints, where they can remain
in small amounts indefinitely.
- Researchers are studying new treatments
for Reiter's syndrome; for example, prolonged treatment with antibiotics
or a combination of antibiotics and other drugs such as methotrexate
or sulfasalazine. Several recent studies have shown that prolonged
treatment with antibiotics may reduce the duration of symptoms in
some patients with Reiter's syndrome caused by Chlamydia
Can People Get More Information About Reiter's Syndrome?
Spondylitis Association of America
P.O. Box 5872
Sherman Oaks, CA 91413
World Wide Web address: http://www.spondylitis.org/
This is the main voluntary organization
devoted to all forms of spondylitis, including Reiter's syndrome. The
association publishes patient and professional materials and a newsletter
1330 West Peachtree Street
Atlanta, GA 30309
World Wide Web address: http://www.arthritis.org/
This is the main voluntary organization
devoted to arthritis. The foundation publishes a free pamphlet on Reiter's
syndrome and can also provide physician/clinic referrals.
American College of Rheumatology
60 Executive Park South, Suite 150
Atlanta, GA 30329
World Wide Web address: http://www.rheumatology.org/
This professional organization of rheumatologists,
both physicians and scientists, is dedicated to treating and studying
all forms of arthritis and can also provide a list of rheumatologists
National Arthritis and Musculoskeletal
and Skin Diseases Information Clearinghouse (NAMSIC)
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
World Wide Web address: http://www.niams.nih.gov/
This clearinghouse, a public service
sponsored by the National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS), provides information about various forms
of arthritis and rheumatic disease. The clearinghouse distributes patient
and professional education materials and also refers people to other
sources of information.
The NIAMS gratefully acknowledges
the assistance of John Klippel, M.D., of NIAMS; Daniel Clegg, M.D.,
University of Utah School of Medicine, Salt Lake City; and Ralph Schumacher,
M.D., VA Medical Center, Philadelphia, PA, in the preparation and review
of this fact sheet.
||Special proteins produced
by the body's immune system that recognize and help fight infectious
agents, such as bacteria, and other foreign substances that invade
that are often present in people who have connective tissue diseases
or other autoimmune disorders.
||Literally means joint
inflammation. It is a general term for more than 100 conditions
known as rheumatic diseases. These diseases affect not only the
joints but also other parts of the body, including important supporting
structures such as muscles, tendons, and ligaments, as well as some
||Any group of single-celled
micro-organisms that live in soil, water, and organic matter or
in the bodies of plants, animals, and humans. Some types of bacteria
cause illness when they enter the body.
|| Small, shallow, painless
sore on the penis.
||Inflammation of the
mucous membrane that covers the eyeball and eyelid.
hormones that are made naturally in the body or synthetically (man-made)
for use as drugs. They are also called glucocorticoids. The most
commonly prescribed drug of this type is prednisone.
|| A term related to
the intestines and the digestion of food.
the tendon attaches to the bone. This symptom is unique to the seronegative
|| A blood test that
measures the speed at which red blood cells settle sedimentation
at the bottom of a test tube. A high rate signals possible inflammatory
disease. Also referred to as the "sed" rate or "ESR."
||Organs related to
the digestion of food, including the stomach and the intestines.
||A genetic marker that
may be found in the blood of patients with certain forms of arthritis
such as ankylosing spondylitis and Reiter's syndrome.
||Medicines that decrease
the immune response and may relieve some symptoms of severe Reiter's
||A characteristic reaction
of tissues to injury or disease. It is marked by four signs: swelling,
redness, heat, and pain.
||Red patches that usually
appear on the bottom of the foot. The area may look like excessively
||An abbreviation for
nonsteroidal anti-inflammatory drug. NSAID's do not contain corticosteroids
and are used to reduce pain and inflammation. Aspirin and ibuprofen
are two types of NSAID's, but there are many others.
|Range of motion:
||A measurement of the
extent to which a joint can go through all of its normal movements.
||A systemic illness
caused by an infection. The most common symptom is joint inflammation.
||A chronic inflammatory
disease that causes pain, stiffness, swelling, and loss of function
in the joints. The primary target of rheumatoid arthritis is the
synovium, or joint lining. This tissue, which normally is smooth
and shiny, becomes inflamed, painful, and swollen. The disease can
also cause inflammation in the blood vessels and the outer lining
of the heart and lungs.
|| A special kind of
antibody often found in people with some types of rheumatic diseases,
but usually not Reiter's syndrome.
||Inflammation of the
||The part of the spine
that connects it to the pelvis.
||A category of diseases
with several similarities, including the presence of HLA-B27 in
the blood, enthesopathy, sacroiliitis, and systemic symptoms. Examples
include Reiter's syndrome, psoriatic arthritis, ankylosing spondylitis,
and inflammatory bowel syndrome arthritis.
||Inflammation of the
||The fluid that lubricates
the joints and reduces friction during movement.
||Inflammation of the
urethra, the canal that carries urine away from the bladder and,
in males, also carries semen.
||Organs related to
the production and excretion of urine and to reproduction.
||Inflammation of the
inner eye, which includes the iris, the ciliary body that holds
the lens of the eye; and the choroid plexus, a network of blood
vessels surrounding the eyeball.
Information provided by:
The National Institute of Arthritis
and Musculoskeletal and Skin Diseases (NIAMS), a part of the National
Institutes of Health (NIH), leads the Federal medical research
effort in arthritis and musculoskeletal and skin diseases. The
NIAMS supports research and research training throughout the United
States, as well as on the NIH campus in Bethesda, MD, and disseminates
health and research information. The National Arthritis and Musculoskeletal
and Skin Diseases Information Clearinghouse (NAMSIC) is a public
service sponsored by the NIAMS that provides health information
and information sources. Additional information can be found on
the NIAMS Web site at http://www.niams.nih.gov/.
Publication Date: April 1999