REACTIVE ARTHRITIS (REITER’S SYNDROME)

This syndrome consists of a triad of:

• Seronegative arthritis

• Non-specific urethritis

• Conjunctivitis (or uveitis)

It is sterile synovitis that develops within days or weeks of bacterial dysentery (due to salmonella, shigella, campylobacter) or exposure to sexually transmitted infection (chlamydia or ureaplasma urealyticum).

The male to female ratio is 20:1 and mostly young adults.

Associated with Hla B- 27 in 80% of cases.

CLINICAL FEATURES

The onset is typically acute with simultaneous development of urethritis, conjunctivitis (in 50%) and arthritis involving the large or small joints of the lower limbs 1-3 weeks following venereal infection or enteric fever or dysentery.

Arthritis

The arthritis is typically acute, asymmetrical, lower limb arthritis.

The knee and ankle are the commonest sites.

There may be localized pain and tenderness in the spine due to sacroiliitis (in 20%).

Arthritis is occasionally associated with non-articular inflammatory lesions e.g. plantar fasciitis and Achilles tendonitis. Arthritis may persist for months or years.

Urethritis

This is associated with sterile discharge & mild dysuria.

Conjunctivitis

It is usually mild & bilateral occurring in only one-third of patients.

Systemic features

Fever and weight loss are common.

Carditis or aortic regurgitation may occur.

Investigations

• No specific investigation

RA factor & autoantibodies are negative

• X-ray is of no value in the acute stage but signs of permanent or progressive joint disease maybe
seen in sacroiliac as well as peripheral joints. Synovial fluid is inflammatory but sterile.

Treatment

Generally, self remitting

• NSAIDs

• Aspirate acutely inflamed joints and inject corticosteroids.

-Treat the cause