What is the syndrome (disease) Reiter, its symptoms, causes, treatment
The causes and mechanism of development of the disease
About a month after undergoing a genitourinary or gastrointestinal infection symptoms of autoimmune damage. The immune defense cells begin to attack the tissues of its own body (especially the joints, eyes).
Why this happens is not known. It is established that the predisposition to develop disease Reiter's is hereditary nature. Higher risk of sick associated with the presence of so-called antigen HLA-B27.
The prevalence of the disease
The incidence of this disease is 3.5 – 5 cases per 100 thousand population (USA statistics). The possibility of developing reactive arthritis after infection of the urinary tract (nonspecific urethritis) is 1-3% after gastrointestinal infection – 1-4%.
Most often the disease affects young men aged 20 to 40 years (80% of all cases). Women suffer reactive arthritis less. In the age group of 40-50 years old men and women suffer reactive arthritis, with almost the same frequency. Obviously, sex differences in the incidence associated with hormonal factors.
In children Reiter's syndrome occurs very rarely, almost all sick children older than 9 years.
Symptoms of Reiter's disease in men and women
The classical course of reactive arthritis in a patient revealed a combination of three processes (Reiter's triad: urethritis (inflammation of urethra), arthritis, conjunctivitis. Sometimes there are added rash.
In a typical scenario (90% of the patients) these symptoms occur in 2-4 weeks after suffering genitourinary (usually chlamydia) or gastrointestinal infections. Approximately 10% of patients do not get sick with any infection before the debut of reactive arthritis.
Reiter syndrome begins acutely, accompanied by General weakness, fever.
Arthritis affects mainly the joints of the feet. It is asymmetric. This means that the inflammation usually develops only the left or only the right. The pathological process captures one or more joints, but not all.
Can hurt and swelling of the knee, ankle, metatarsophalangeal and interphalangeal joints. This greatly hampers movement. Less often a sore lower back. Rarely involves small joints of hands. Often there are muscle pain and tendon pain (especially characterized by pain in the Achilles tendon).
Urethritismanifested frequent urination, urgency to urinate, discharge from the urethra, burning, unpleasant sensations in the genital area. Urethritis is diagnosed in 90% of people with Reiter's syndrome, regardless of disease associated with urogenital infection or infection of the gastrointestinal tract.
Men can develop prostatitis females oophoritis (inflammation of the uterine appendages). Both men and women may develop cystitis (bladder inflammation).
The second most common ocular manifestation of the disease (12-37%) is uveitis (lesion of choroid). Uveitis usually develops in adult patients. In children, ocular symptoms are usually limited to conjunctivitis.
Scleritis, keratitis, glaucoma, optic neuritis optic nerve can also occur but are much rarer.
In patients suffering from Reiter's disease may be mild, severe diarrhea. Endoscopic examination of the colon sometimes reveal pathological changes of the mucous membrane, similar to Crohn's disease.
The rash in this disease resembles psoriatic. The lesions represent papules, nodules, spots. They are located on the feet and palms, genitals, torso, scalp. Sometimes skin manifestations can appear after 1-2 months after the first attack of arthritis.
On the mucous membrane of the mouth and throat can cause stains, erosion, areas of redness. The language may acquire a "geographic" view.
In 20-30% of cases the affected nails. They thicken, zadubrivtsi and can crumble. This process is called onihodistrofiya.
Very rare in the inflammatory autoimmune process involved the lining of the heart (myocardium, pericardium).
Features of Reiter's disease in children
The children often Reiter's disease developing after dysentery. Urethritis can occur in the form of erased and not identified in the survey. Eye symptoms are usually limited to conjunctivitis. Arthritis usually affects multiple joints.
Boys - carriers of HLA-B27, there is a tendency for lesions of the spine. These children have a high probability of development of ankylosing spondylitis. Diagnostic methods
Diagnosis of this disease is clinical, i.e., diagnosis is based on the analysis of complaints and data of objective research.The characteristic history of the disease (identification of a triad of urethritis+arthritis+conjunctivitis a month later, after undergoing a gastrointestinal or genitourinary infection), the presence of symptoms, detected during examination, in a typical case, this is enough for diagnosis.
Laboratory studies are performed to clarify the clinical situation and body treatment, but are not key.
Usually when reactive arthritis must pass the clinical blood analysis, General urine analysis. Also appointed by biochemical tests: C-reactive protein, seromucoid, rheumatoid factor, antistreptolysin-O.
Studies aimed at identifying chlamydial infection. Is the scraping of the urethra for cytologic analysis, identifies antibodies to chlamydia in the blood, occurs, a PCR test that is able to detect fragments of genetic code chlamydia in the human body.
Sometimes for the exclusion or confirmation of an infectious inflammation of a joint is performed artrotsentez (puncture of the joint capsule with the sampling of synovial fluid for analysis).
To determine the antigen HLA-B27 is a genetic test.
Methods of treatment
Causal (directed at the cause) treatment of reactive arthritis does not exist. Therapy is aimed at relief of symptoms.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the main therapeutic group of reactive arthritis.
In addition to NSAIDs in the treatment of inflammation of joints used are the corticosteroids (hormones of the adrenal glands). The ineffectiveness of NSAIDs, and in cases of contraindications to their use are assigned to cytotoxic drugs (e.g. methotrexate). Drugs that bind the tumor necrosis factor (infliximab), can also be effective in the treatment of the disease Reiter.
If the urinary tract chlamydia infection antibiotics are used. Were most commonly prescribed antibiotics the macrolides.
Conjunctivitis in many cases is mild and needs no special treatment. The mainstay of treatment in chlamidia conjunctivitis – appointment of macrolide antibiotics.
Treatment of cutaneous manifestations of Reiter's disease consists in the local application of corticosteroids (hydrocortisone, triamcinolone) and drugs that improve exfoliation (salicylic acid).
For the relief of joint and muscular manifestations of the disease apply physical therapy techniques and therapeuticphysical education.
The need for dietary restrictions.
The likely prognosis and complications
Most often (70% of cases, symptoms are 3-12 months after their appearance. Pink eye usually disappears on its own within 2 weeks. After recovery there is a high probability of relapse (15-50%), especially in carriers of HLA-B27. Reactivation of the disease may cause a new infection or stress. Approximately 30% of patients with Reiter's syndrome becomes chronic.
The complications of the disease include its transition in the chronic form, the development of strictures (persistent narrowing) of the urethra, ankylosing spondylitis (chronic inflammatory lesions of joints and periarticular structures), secondary glaucoma.
About Hans Reuter
From all kinds of diseases the term "Reiter's syndrome" is used most often. However, the term "reactive arthritis" begins to displace. In international practice there is a General trend to renaming of diseases associated with the name of the scientists who described them.
But in this case, the rejection of the use of the name "Reiter's syndrome" also associated with the odium of the rater. Hans Reiter was a German doctor who conducted experiments on prisoners of Buchenwald.