Reiter’s disease is an inflammatory disease of the joints. The conjunctiva on the eye and urethra are also affected. Reiter’s disease develops as a result of a bacterial infection. The disease heals in many cases by itself. For some people, however, it persists for years or even decades. Read all about the causes, symptoms and treatment of Reiter’s disease here.
Reiter’s disease: description
Reiter’s disease (Reiter syndrome, Reiter’s disease) is a special form of “reactive arthritis”. Reactive arthritis is an inflammatory disease of the joints that develops after a bacterial infection (“reactive”). In Reiter’s disease, in addition to the joints, the urethra, the conjunctiva of the eyes and sometimes the skin are also affected.
One to four percent of people who develop a gastrointestinal infection or a urinary tract infection then develop a Reiter’s disease.
After combating the bacterial infection, the immune system falsely continues to react with the remaining proteins of the killed bacteria. Immune cells enter with the protein compounds and cause inflammation in different places in the body. The inflammations usually occur only temporarily. Sometimes, however, a chronic disease develops that affects the joints as well as the spine.
People of all ages can fall ill with Reiter’s disease. White-skinned men between the ages of 20 and 40 are the most affected. In Western countries, the number of new cases is slightly above the global average of about three people per 100,000.
Reiter’s disease: symptoms
In most cases, the symptoms of Reiter’s disease occur about one to two weeks after infection. It will ignite one or more joints. Especially often the knee and ankle joints are affected. They hurt, are reddened and overheated. In some cases, the big toe joint or an entire toe is also affected.
In addition to the joints, tendons and fascia in the body can also become inflamed. The Achilles tendon on the heel is especially common. It hurts especially with movements of the foot. Inflames the tendon plate on the sole of the foot, walking is associated with severe pain. Nocturnal low back pain indicates inflammation of the iliac crest. Some people suffer from common symptoms such as fever, fatigue and weight loss.
Furthermore, conjunctivitis of the eyes often develops. It occurs on one or both sides and in severe cases can even lead to blindness.
Fever and pain when urinating
An inflammation of the urethra manifests itself in frequent urination and pain when urinating. Sometimes pus comes out of the urethra. In women, the bladder, the fallopian tubes or the uterus can also inflame. Then there is the danger of becoming infertile.
skin lesions
Reiter’s disease can lead to different skin changes. Often they occur on the foreskin of the penis. The result is small, roundish redness with whitish rim.
Other frequently affected skin areas in Reiter’s syndrome are the soles of the hands and soles, as well as the nails. The skin lesions may be similar to psoriasis, as reddened nodules or skin keratinization. The oral mucosa is also partially affected.
Especially under the soles of the feet and in the palm of the hand, brownish discoloration may form. In the course of a few days, these areas of the skin thicken and develop crusty, sometimes bumpy elevations. In these bubbles or bumps, liquid can accumulate. If the bubbles burst, a brownish crust develops on the skin.
Often there is an increased salivation and deposits on the tongue. Over the course of several days, a so-called map tongue develops from the deposits, alternating brownish or white spots with still normal-looking spots.
Half of the patients also have mild kidney inflammation, whereas more severe kidney disease is rare. There is a risk that the heart muscle will become inflamed. This in turn triggers some cardiac arrhythmias.
Reiter’s disease: causes and risk factors
How exactly the Reiter syndrome arises is unclear. It is an autoimmune disease in which the immune system reacts to bacterial components in the synovial fluid. For example, when the joint membrane comes into contact with the surface proteins of certain bacteria, it responds with an inflammatory response.
Those affected are genetically biased in more than half of the cases. They contain the so-called HLA-B27 molecule in the blood, which is responsible for some rheumatic diseases. White-skinned people are also affected more often.
Reiter’s disease: examinations and diagnosis
An important clue to Reiter’s disease is provided by the medical history. If the joint inflammation after a urinary tract or intestinal infection has occurred, this supports the suspicion of the disease. Sometimes, sufferers report a new sexual partner within the last three months before joint pain. If rheumatic diseases are known in the family, the likelihood of having Reiter syndrome increases as well.
A particularly important indication of the disease is the detection of the HLA-B27 molecule in the blood. Furthermore, it is examined whether the liver and kidney function are limited by the Reiter syndrome.
X-ray examinations of the affected joints and the spinal column sections provide more detailed information about the manifestation of joint damage caused by Reiter’s disease. To ensure the diagnosis, a so-called urinary tract smear must be made. Here you can often detect the disease-causing bacteria. The urine is also used to diagnose Reiter’s syndrome on bacteria, inflammatory cells and kidney damage.
Sometimes an affected joint needs to be punctured to more accurately examine the effusion that forms during inflammation. An ECG and echocardiogram (cardiac ultrasound) should rule out that the autoimmune reaction has also affected the heart.
Reiter’s disease: treatment
The symptoms of joint inflammation can be treated by painkillers and anti-inflammatory agents (non-steroidal anti-inflammatory drugs). Overall, one should try to protect the affected joints. Cooling envelopes and medicinal plants can also help alleviate the symptoms of joint inflammation.
In severe disease processes with a pronounced involvement of the conjunctiva must often be treated with cortisone. In addition, there are other chemotherapeutic agents that are used in severe cases. In very rare cases, surgical procedures such as removal of the synovial membrane (synovectomy) or a joint change (arthroplasty) are necessary.
In chronic Reiter’s disease, so-called long-acting antirheumatic agents (LWAR) must be taken.
Reiter’s disease: Disease course and prognosis
Most of the time the Reiter syndrome heals by itself after three to nine months. The medication can help relieve the symptoms by then. In ten to 20 percent of those affected but develops a chronic disease. The course of the disease becomes more protracted the more joints are affected. In half of the patients, the disease returns after some time (recurrence). Sometimes only a few symptoms such as conjunctivitis occur.
Especially if the HLA-B27 molecule can be detected in the blood, the disease is usually persistent. In exceptional cases, a disease duration of ten to 15 years is possible. Complications arise when the joint inflammation leads to a permanent impairment of joint function to the destruction of the joint.
In the eye, the inflammatory process can spread from the conjunctiva to the iris and adjacent eye structures. Thus, the visual function is permanently impaired. There is a risk that a so-called cataract will develop. In turn, a cataract can lead to blindness.
Frequently, Reiter’s disease is caused by so-called Chlamydia infections. Chlamydia are transmitted during sexual intercourse. With changing sexual partners should therefore be prevented with condoms. People who have ever been affected by Reiter’s disease are at an increased risk of developing the disease symptoms again.