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Onset usually 10-30 days after enteritic or urethritic infection.
Classic symptom triad ("can`t see, cant`t pee, can`t climb a tree"):
- Urethritis: Usually onset with acute, nonspecific, purulent to bloody discharge, pain on urination. In dysenteric form first secondary urethritis.
- Conjunctivitis: Usually occurring bilaterally in varying degrees.
- Arthritis: Oligoarthritis, especially of the lower extremities, e.g. knee and ankle joints. Often symmetrical, alternating affection with swollen, warm, painful joints. Less commonly, the costosternal joints are also affected. Arthritis of Reiter's disease is quite slow to heal.
- Integument(25% of Reiter's patients have skin symptoms): In particular, there are exudative, psoriasiform skin lesions, especially symmetrical on palmae and plantae(keratoderma blenorrhagicum), erythemato-squamous foci, especially on capillitium and in the umbilical region.
- Mucous membrane: redness, erythematous macules and papules, erosions, hemorrhages, exfoliatio areata linguae.
- Genitourinary: balanitis parakeratotica circinata, chronic prostatitis, cystitis, pyelonephritis.
- Eyes: eyelid and corneal edema, keratitis, iritis, iridocyclitis, uveitis.
- Joints: tendinitis, fasciitis, synoviitis, sacroileitis, ankylosing spondylitis.
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Balanitis: Therapy of balanitis parakeratotica circinata with drying measures such as lotio alba and application of gauze compresses. In addition, application of glucocorticoid-containing creams/lotions such as 0.25% prednicarbate cream(e.g. Dermatop cream), 0.1% methylprednisolone cream (e.g. Advantan) or 0.5% hydrocortisone cream R121.
Keratoderma blenorrhagicum or/and psoriasiform skin lesions: Medium-strength glucocorticoids such as 0.1% triamcinolone cream R259 or 0.1% mometasone furoate (e.g. Ecural fat cream/ointment), in combination with calcipotriol-containing externals (e.g. Psorcutan ointment) 2 times/day.
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Arthritides: Non-steroidal anti-inflammatory drugs such as acetylsalicylic acid 2-4 g/day (e.g. Aspirin Tbl.), especially also indometacin (e.g. Ammuno) 75-150 mg/day, diclofenac (e.g. Voltaren) 75-150 mg/day, ibuprofen (e.g. Ibuprofen-ratiopharm) 600-1200 mg/day. If necessary, also use systemic glucocorticoids, e.g. prednisolone (e.g. Decortin H Tbl.) initially 100 mg/day, reduction to lowest possible maintenance dose. If necessary, also combination therapy with azathioprine (e.g. Imurek 50), starting with 100 mg/day. Reduction depending on the acute nature and course of the disease.
After exhaustion of these possibilities in severe disease methotrexate (e.g. Methotrexat Lederle) 1 time/week 7,5-15 mg p.o. (is preferable to long-term peroral administration of glucocorticoids). An attempt at therapy is also possible with retinoids such as acitretin (Neotigason) 30-50 mg/day (in women only under strict anticonception)!
Good therapeutic success is achieved with the use of TNF-alpha antagonists . They are now considered to be the first-choice therapeutic agents.
Rheumatological and ophthalmological consultation.
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LiteratureThis section has been translated automatically.
- Catteral RD (1983) Clinical aspects of Reiter's disease. Br J Rheumatol 22: 151
- Edirisinghe DN et al (2002) Reiter's syndrome and keratoderma blennorrhagica on glans penis--is this unusual? Int J STD AIDS 13: 133-134
- Fiessinger N, Leroy E (1916) Contribution à l'étude d'une épidemie de dysenterie dans la somme. Bull Soc méd Hòp (Paris) 40: 2030.
- Fox R, Calin A, Gerber R, Gibson D (1979) The chronicity of symptoms and disability in Reiter's syndrome: an analysis of 131 consecutive patients. Ann Intern Med 91: 190
- García-Kutzbach A et al (2018) Reactive arthritis: update 2018. Clin Rheumatol 37:869-874.
- Gaylis N (2003) Infliximab in the treatment of an HIV positive patient with Reiter's syndrome. J Rheumatol 30: 407-411.
- Kiss S, Letko E et al (2003) Long-term progression, prognosis, and treatment of patients with recurrent ocular manifestations of Reiter's syndrome. Ophthalmology 110: 1764-1769
- Lotery HE et al (2003) Ulcerative vulvitis in atypical Reiter's syndrome. J Am Acad Dermatol 48: 613-616.
- Rahman MU, Schumacher HR, Hudson AP (1992) Recurrent arthritis in Reiter's syndrome: a function of inapparent chlamydial infection of the synovium? Sem Arthr Rheum 21: 259-266
- Reiter H (1916) On a hitherto unrecognized spirochete infection (spirochaetosis arthritica). Dtsch med Wschr 42: 1535
- Schneider JM et al (2003) Reiter's syndrome. Cutis 71: 198-200
- Wollina U et al (1999) Nail changes in rheumatic disease. Dermatologist 50: 549-555
- Wu IB et al (2008) Reiter`s syndrome: the classic triad and more. J Am Acad Dermatol 59: 113-121.
Incoming links (19)Aa-type amyloidosis; Ankylosing spondylitis; Balanitis parakeratotica circinata; Conjunctivitis; Dermatitis-arthritis syndromes; Eye diseases, skin changes; Fiessinger-leroy reiter disease; Fiessinger-leroy syndrome; Hydrocortisone cream hydrophilic 0.25/0.5 or 1% (nrf 11.36.); Immune reconstruction syndrome; ... Show all
Outgoing links (46)Acetylsalicylic acid; Acitretin; Analgesics; Ankylosing spondylitis; Anonychie acquired; Antibiotics; Azathioprine; Balanitis parakeratotica circinata; Calcipotriol; Chlamydiaceae; ... Show all
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