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...

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.

Name

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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