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Information for Doctors

Sports-Medicine Kalyan-Dombivali
Reiter's Syndrome.
Information
Etiology
Clinical picture
Common mucocutaneous features of reactive arthritis
Musculoskeletal Manifestations of reactive arthritis
Treatment
Comparison of ankylosing spondylities and related disorders

Classically it consists of a traid of

  • Urethritis
  • Arthritis
  • Conjuctivitis

Conjuctivitis is absent in about 60% of cases. Other associated features include

  • Mouth and genital ulceration        Present in 10% of cases
  • Keratoderma blennorrhagica       Present in 10% of cases     

Etiology:

The disease is more common in sexually active age group "(between 20 to 50 years) and it develops from urethritis. It may also be associated with dysentery. The dysentery type may be seen in children and women, in whom venereal (sexually transmitted) type is uncommon.

Clinical picture:

Acute onset arthritis with marked effusion involving ankle, knee and uncommonly other joints. In 40% of cases SI joint may be involved. (Ankylosing spondylitis type). The disease may mimick RA (Rheumatoid arthritis type) with erosive arthritic changes. It is self limiting disease lasting from 3 wks. to up to 2 years. Sometimes it may lead to severe destruction of joint and joint deformities.

Common mucocutaneous features of reactive arthritis:

  1. Keratoderma blenorrhagicum: Palms, soles, penis
  2. Circinate balanitis: penis
  3. Oral ulcerations: Tongue, palate
  4. Nail changes: no pits, onycholysis and yellow colour

Musculoskeletal Manifestations of reactive arthritis:

  1. Asymmetric oligoarthritis of lower extremities
  2. Sausage digits (dactylitis)
  3. Enthesitis -Achillies heel ("Lover's heel")
  4. Spondylitis / Sacroilitis in 20-40% cases (asymmetric)

Treatment:

Aim: To include an early remission and prevent serious joint disease with deformity.

Methods:

  • Rest
  • Splintage
  • NSAIDS
  • Antibiotics (Tetracyclin / Dexacyclin) for cure of urethritis (it does not have effect on rest of disease process).
Surgery: Synoviectomy, reconstructive arthroplasties.

Comparison of ankylosing spondylities and related disorders

Refer to table : Click here