Reiter’s Syndrome aka Reactive Arthritis
The term Reiter’s syndrome has fallen out of vogue, and it is more commonly known as reactive arthritis. Arthritis is an inflammation of the joints and reactive means that it is caused by (is a reaction to) an infection that occurs not in the joints, but elsewhere in the body. There are three characteristic symptoms of reactive arthritis, though they don’t necessarily all occur in the same individual; they are - arthritis, inflammation of the eye, and inflammation of the urethra.
Infections that can trigger reactive arthritis include: -
Infection of the gut - the most common bacteria involved are Campylobacter, Yersinia, and Shigella. The condition may develop after a person has eaten food contaminated with the bacteria.
Infection of the urethra - the most common bacterium involved is Chlamydia.
Viral infections - those that cause a sore throat can sometimes trigger reactive arthritis.
HIV infections - can trigger reactive arthritis in some people with the virus.
The symptoms of reactive arthritis will usually develop two to four weeks after the infection, and in many cases that’s after the cause of the infection has been dispatched by antibiotics or it has simply just run its own course.
The Discovery of Reiter’s Syndrome
Reiter’s syndrome was discovered in 1916 by German physician Hans Conrad Julius Reiter (1881-1969). He reported that a German lieutenant was admitted to hospital and presented with high fever and bloody diarrhoea. He also developed urethritis, arthritis, and conjunctivitis. At the time Reiter was a military physician in the Balkans serving in the 1st Hungarian Army. He was later a controversial figure because he conducted medical experiments in Nazi concentration camps and was involved in the Nazi Racial Hygiene Program. Reiter was an enthusiastic participant in euthanasia and forced sterilization programs.
After the Nazis were defeated he was arrested, tried at Nuremberg and convicted of war crimes. Because of his evil past, and appalled at his war crimes, a group of doctors started a campaign in the 1970s to have the term Reiter’s syndrome abolished in favour of reactive arthritis.
Reiter’s Syndrome and Genetics
There is a pre-disposing genetic factor called HLA-B27. HLA stands for human leukocyte antigen and it is a class of protein usually found on the surface of cells. They are present in high concentrations in white blood cells and their function is to “present” antigens to T and B cells.
HLA-B27 has been found in 50-70% of patients with reactive arthritis, although how it causes the problems is still something of a mystery. One theory is that it interferes with the way the body eliminates infectious organisms.
Reiter’s Syndrome Treatments
There are a number of treatments for people with reactive arthritis including: -
- Nonsteroidal anti-inflammatory drugs (NSAIDs) - prescription and non-prescription. An example of the latter is aspirin.
- Steroid injections - into affected joints.
- Corticosteroids - injected directly into the joints of severely affected patients.
- Antibiotics - to deal with the infection that triggered reactive arthritis.
- Topical corticosteroids - to treat the skin lesions that afflict some people with reactive arthritis.
- Eye drops - to treat inflammation of the eye.