MANUAL MINORS
Reiter’s syndrome, now known as reactive arthritis, is an inflammatory condition that develops as a reaction to an infection in another part of the body, typically gastrointestinal or genitourinary. The characteristic symptoms include asymmetric arthritis, urethritis (inflammation of the urethra), and conjunctivitis.
It primarily affects young men and is associated with the HLA-B27 antigen. The disease typically involves the joints of the lower limbs, such as the knees, ankles, and feet.
Diagnosis
The diagnosis of reactive arthritis is based on clinical presentation, with arthritis appearing 1 to 4 weeks after an intestinal infection (by Salmonella, Shigella, Yersinia, or Campylobacter) or genitourinary infection (most commonly Chlamydia trachomatis).
Findings include asymmetric arthritis in large joints, dactylitis (sausage fingers), enthesitis (inflammation at tendon or ligament insertion sites), and extra-articular symptoms such as conjunctivitis or uveitis. Blood tests may show elevated inflammatory markers (CRP, ESR) and, in some cases, HLA-B27 positivity. Bacteria are not detected in synovial fluid.
Differential Diagnosis
Condition | Distinctive Features |
|---|---|
Septic arthritis | Active infection in the joint, purulent synovial fluid, positive culture, high fever. |
Gonococcal arthritis | Recent sexual infection, tenosynovitis, pustular skin lesions, positive gonococcal culture. |
Gout | Monoarticular arthritis, urate crystals in synovial fluid, acute attacks, typically affects the big toe. |
Ankylosing spondylitis | Primarily affects the spine with sacroiliitis, morning stiffness, no preceding infection. |
Systemic lupus erythematosus | Multisystem involvement, positive serologies (ANA, anti-DNA), skin rashes, no infection history. |
Emergency Management
Emergency treatment for Reiter’s syndrome focuses on managing pain and inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are administered. In cases of severe or persistent arthritis, intra-articular or systemic corticosteroids may be used.
Antibiotics may be indicated if the triggering infection is still active, such as in a Chlamydia infection. Extra-articular symptoms like conjunctivitis are usually treated symptomatically with eye drops.
Definitive Treatment
Long-term treatment includes the continuous use of NSAIDs to control joint symptoms. In patients with persistent or refractory arthritis, disease-modifying antirheumatic drugs (DMARDs) such as sulfasalazine or methotrexate may be employed.
In some cases, biological agents like TNF inhibitors may be required if the disease does not respond to conventional treatment. Treating the initial infection is crucial to prevent recurrence of symptoms. Physiotherapy is also helpful in maintaining joint function and preventing stiffness.
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