Understanding Reactive Arthritis (Reiter's Disease)
Reactive arthritis, historically known as Reiter's disease, is a form of inflammatory arthritis triggered by an infection elsewhere in the body. The condition is a type of autoimmune response, where the immune system, after fighting off a bacterial infection, mistakenly attacks the body's own tissues, leading to inflammation. This reaction most commonly follows infections from bacteria like Chlamydia trachomatis (sexually transmitted) or Salmonella and Shigella (foodborne).
Symptoms typically manifest several weeks after the initial infection has resolved. While many people's symptoms are temporary, lasting between three and 12 months, some may experience chronic or recurring issues. This condition is more prevalent in men between the ages of 20 and 40, and those with a specific genetic marker, HLA-B27, may be more susceptible to severe or chronic cases.
The Classic Triad of Symptoms
Reactive arthritis is often characterized by a classic triad of symptoms: arthritis (joint inflammation), conjunctivitis (eye inflammation), and urethritis (urinary tract inflammation). While this full triad may not be present in every patient, these three areas are the most commonly affected. The mnemonic “Can’t pee, can’t see, can’t climb a tree” is sometimes used to describe this classic presentation, highlighting the urinary, ocular, and musculoskeletal symptoms.
Joint-Related Symptoms (Arthritis)
- Asymmetric Oligoarthritis: This refers to inflammatory arthritis affecting a few joints (typically fewer than six) in an uneven pattern. The knees, ankles, and feet are most frequently involved.
- Enthesitis: Inflammation at the site where tendons and ligaments attach to bone is a common feature. This often presents as heel pain from plantar fasciitis or Achilles tendinitis.
- Dactylitis: In some cases, toes or fingers may swell entirely, resembling a sausage. This condition is also known as “sausage digits”.
- Sacroiliitis and Spondylitis: Inflammation can occur in the sacroiliac joints (where the spine and pelvis meet) and, less commonly, in the spine itself, leading to low back pain and stiffness, particularly in the morning.
Eye-Related Symptoms (Conjunctivitis)
- Redness and Irritation: Eye inflammation is a hallmark of reactive arthritis and can manifest as red, painful, and irritated eyes.
- Vision Problems: Patients may experience blurred vision due to inflammation of the mucous membrane covering the eyeball and inner eyelid.
- Uveitis: In more severe cases, inflammation of the inner eye (uveitis) can occur, which requires prompt medical attention to prevent permanent vision loss.
Urinary and Genital Symptoms (Urethritis)
- Painful Urination: Inflammation of the urethra can cause a burning sensation during urination and an increased frequency or urgency.
- Discharge: A discharge from the penis or vagina may also be present.
- Genital Ulcers and Rashes: Men may experience inflammation of the glans penis (circinate balanitis), while women may develop cervicitis or vulvovaginitis.
Other Systemic Symptoms
Beyond the classic triad, patients may experience other symptoms throughout the body, including:
- Skin and Mucosal Lesions: Skin rashes, particularly on the palms and soles (known as keratoderma blennorrhagicum), resembling psoriasis, can appear. Painless mouth sores are also common.
- Fatigue and Fever: A low-grade fever and general feeling of tiredness or malaise can accompany the other symptoms.
- Nail Changes: Some individuals may notice changes in their nails, such as thickening or detachment (onycholysis).
Chronic vs. Self-Limiting Courses
Most people who develop reactive arthritis will have symptoms that eventually resolve on their own, often within a few months to a year. However, a significant minority—around 15% to 30%—may experience chronic symptoms or recurrent flare-ups. A chronic course is more likely in individuals who test positive for the HLA-B27 gene. Chronic disease can lead to persistent joint pain, fatigue, and other long-term complications.
Reactive Arthritis vs. Other Conditions
Distinguishing reactive arthritis from other types of inflammatory conditions is crucial for proper diagnosis and treatment. While symptoms may overlap, the cause and treatment approaches can differ significantly.
| Feature | Reactive Arthritis (Reiter's Disease) | Psoriatic Arthritis | Rheumatoid Arthritis (RA) |
|---|---|---|---|
| Cause | Triggered by a bacterial infection (e.g., Chlamydia, Salmonella) | Immune system attacks the joints and skin; linked to psoriasis | Immune system attacks the synovium (joint lining) |
| Onset | Acute, following a genitourinary or gastrointestinal infection | Can develop slowly or rapidly; associated with psoriasis | Gradual onset; symmetrical joint involvement |
| Symptom Triad | Classic triad of arthritis, urethritis, and conjunctivitis | Psoriatic plaques, nail changes, dactylitis | Symmetrical joint pain, stiffness, and swelling |
| Affected Joints | Primarily knees, ankles, feet; typically asymmetric | Often involves distal joints (fingers, toes); can be asymmetric | Symmetrical involvement of smaller joints (hands, wrists) |
| Skin Involvement | Keratoderma blennorrhagica, mouth sores | Psoriatic plaques on the skin and scalp | Rheumatoid nodules are possible, but skin rash is not typical |
Diagnosis and Management
Diagnosing reactive arthritis can be challenging since there is no single definitive test. A doctor will typically consider a combination of a patient's recent history of infection and physical symptoms. Blood tests can help rule out other conditions and check for the HLA-B27 gene, while fluid from an affected joint may be analyzed. Treatment focuses on managing symptoms with nonsteroidal anti-inflammatory drugs (NSAIDs), and in some cases, disease-modifying antirheumatic drugs (DMARDs) or steroid injections may be necessary. For more information, the National Institute of Arthritis and Musculoskeletal and Skin Diseases offers resources on reactive arthritis.
Conclusion
While the name Reiter's disease is now outdated, the condition, reactive arthritis, remains a significant health concern for those affected. The primary symptoms revolve around a classic triad of joint inflammation, eye inflammation, and urinary tract issues, appearing weeks after an infection. Understanding these signs is key for early diagnosis and appropriate management. Although most cases are self-limiting, some can become chronic, emphasizing the importance of ongoing medical care. Always consult a healthcare professional for an accurate diagnosis and personalized treatment plan if you suspect you have reactive arthritis.
