'A differential diagnosis revealed that the rash on the bottom of this individual’s feet, known as keratoderma blennorrhagica, was due to Reiter's syndrome, not a syphilitic infection as was initially suspected' - CDC/ Dr. M. F. Rein
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Reiter's Syndrome

Reactive arthritis (Reiter syndrome) is the combination of three seemingly unlinked symptoms—an inflammatory arthritis of large joints, inflammation of the eyes (conjunctivitis and uveitis) and urethritis. more...

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It is named after Hans Reiter, a German military physician, who in 1916 described the disease in a World War I soldier who had recovered from a bout of diarrhea.

Reiter's is a seronegative, HLA-B27-linked spondyloarthropathy (autoimmune damage to the cartilages of joints) often precipitated by genitourinary or gastrointestinal infections. It is more common in men than in women and more common in white men than in black men. People with HIV have an increased risk of developing Reiter's as well.

It is set off by a preceding infection, the most common of which would be a genital infection with Chlamydia trachomatis. Other bacteria known to cause Reiter's are gonococcus, Ureaplasma urealyticum, Salmonella, Shigella, Yersinia, and Campylobacter. A bout of food poisoning or a gastrointestinal infection may also set off Reiter's (those last four bacteria mentioned are enteric bacteria). Reactive Arthritis usually manifests about 1-3 weeks after a known infection.


Hans Reiter during World War Two committed inhumane experimentation on Jews and other prisoners in the nazi concentration camps, and there is some debate amongst those with the syndrome on whether the disease should be named after the physician. Reiter was also a member of the Nazi SS. He supported involuntary sterilization and euthanasia, and in later interrogations he admitted to “recording the numerical count” of those victims. Reiter designed a study to inject experimental typhus vaccine into concentration camp prisoners at Buchenwald. Several hundred people died as a result of this experiment.

Due to strong opposition to Reiter's actions as a Nazi, in 1977 a group of doctors began a campaign to encourage the use of the name reactive arthritis rather than the Reiter eponym. A 2005 analysis in the Journal of the American Academy of Dermatology found that the campaign has been effective. In a sample from medical journals, use of the eponym dropped from 57% in 1998 to 34% in 2003. The report concluded that the term will eventually be eliminated as a modern name for the disease.

Other names for the disease include arthritis urethritica, venereal arthritis, and polyarteritis enterica.

Signs and symptoms

Symptoms generally appear within 1-3 weeks but can range from 4-35 days from onset of inciting episode of disease.

The classical presentation is that the first symptom experienced is a urinary symptom such as burning pain on urination (dysuria) or an increased need to urinate (polyuria or frequency). Other urogenital problems may arise such as prostatitis in men, and cervicitis, salpingitis and/or vulvovaginitis in women.

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Reiter's syndrome
From Gale Encyclopedia of Medicine, 4/6/01 by Rebecca J. Frey


Reiter's syndrome (RS), which is also known as arthritis urethritica, venereal arthritis, reactive arthritis, and polyarteritis enterica, is a form of arthritis that affects the eyes, urethra, and skin, as well as the joints. It was first described by Hans Reiter, a German physician, during World War I.


Reiter's syndrome is marked by a cluster of symptoms in different organ systems of the body that may or may not appear simultaneously. The disease may be acute or chronic, with spontaneous remissions or recurrences.

RS primarily affects sexually active males between ages 20-40, particularly males who are HIV positive. Most women and children who develop RS acquire the disease in its intestinal form.

Causes & symptoms

The cause of Reiter's syndrome was unknown as of early 1998, but scientists think the disease results from a combination of genetic vulnerability and various disease agents. Over 80% of Caucasian patients and 50-60% of African Americans test positive for HLA-B27, which suggests that the disease has a genetic component. In sexually active males, most cases of RS follow infection with Chlamydia trachomatis or Ureaplasma urealyticum. Other patients develop the symptoms following gastrointestinal infection with Shigella, Salmonella, Yersinia, or Campylobacter bacteria.

The initial symptoms of RS are inflammation either of the urethra or the intestines, followed by acute arthritis 4-28 days later. The arthritis usually affects the fingers, toes, and weight-bearing joints in the legs. Other symptoms include:

  • Inflammation of the urethra, with painful urination and a discharge from the penis
  • Mouth ulcers
  • Inflammation of the eye
  • Keratoderma blennorrhagica. These are patches of scaly skin on the palms, soles, trunk, or scalp of RS patients.


Patient history

Diagnosis of Reiter's syndrome can be complicated by the fact that different symptoms often occur several weeks apart. The patient does not usually draw a connection between the arthritis and previous sexual activity. The doctor is likely to consider Reiter's syndrome when the patient's arthritis occurs together with or shortly following inflammation of the eye and the genitourinary tract lasting a month or longer.

Laboratory tests

There is no specific test for diagnosing RS, but the physician may have the urethral discharge cultured to rule out gonorrhea. Blood tests of RS patients are typically positive for the HLA-B27 genetic marker, with an elevated white blood cell (WBC) count and an increased sedimentation rate of red blood cells. The patient may also be mildly anemic.

Diagnostic imaging

X rays do not usually reveal any abnormalities unless the patient has had recurrent episodes of the disease. Joints that have been repeatedly inflamed may show eroded areas, signs of osteoporosis, or bony spurs when x rayed.


There is no specific treatment for RS. Joint inflammation is usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs.) Skin eruptions and eye inflammation can be treated with corticosteroids. Gold treatments may be given for eroded bone.

Patients with chronic arthritis are also given physical therapy and advised to exercise regularly.


The prognosis varies. Most patients recover in three to four months, but about 50% have recurrences for several years. Some patients develop complications that include inflammation of the heart muscle, stiffening inflammation of the vertebrae, glaucoma, eventual blindness, deformities of the feet, or accumulation of fluid in the lungs.


In males, Reiter's syndrome can be prevented by sexual abstinence or the use of condoms.

Key Terms

Having a sudden onset and lasting a short time.
Of long duration.
Keratoderma blennorrhagica
The medical name for the patches of scaly skin that occur on the arms, legs, and trunk of RS patients.
Reactive arthritis
Another name for Reiter's syndrome.

Further Reading

For Your Information


  • Hellman, David B. "Arthritis & Musculoskeletal Disorders." In Current Medical Diagnosis & Treatment 1998, edited by Lawrence M. Tierney, Jr., et al. Stamford, CT: Appleton & Lange, 1998.
  • Lawson, William, and Anthony J. Reino. "Neoplastic and Non-neoplastic Lesions of the Oral Mucosa." In Current Diagnosis 9, edited by Rex B. Conn, et al. Philadelphia: W. B. Saunders Company, 1997.
  • Magalini, Sergio I., et al. Dictionary of Medical Syndromes. Philadelphia: J. B. Lippincott Company, 1990.
  • "Musculoskeletal and Connective Tissue Disorders: Reiter's Syndrome (RS)." In The Merck Manual of Diagnosis and Therapy, edited by Robert Berkow, et al. Rahway, NJ: Merck Research Laboratories, 1992.
  • "Reiter Syndrome." In Physicians' Guide to Rare Diseases, edited by Jess G. Thoene. Montvale, NJ: Dowden Publishing Company, Inc., 1995.
  • "Reiter's Syndrome." In Professional Guide to Diseases, edited by Stanley Loeb et al. Springhouse, PA: Springhouse Corporation, 1991.
  • Theodosakis, Jason, et al. The Arthritis Cure. New York: St. Martin's Paperbacks, 1997.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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