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Jyotirmoyee Patnaik
Kanak Manjari Institute of pharmaceutical Sciences.
Rourkela, Orissa

Reactive arthritis, formerly referred to as Reiter's syndrome, is a form of arthritis that affects the joints, eyes, urethra and skin. The disease is recognized by various symptoms in different organs of the body that may or may not appear at the same time. Also one form of reactive arthritis is characterized by a triad of arthritis, nongonococcal urethritis, and conjunctivitis, and by lesions of the skin and mucosal surfaces.


Reactive arthritis
 is classified as an autoimmune condition that develops in response to an infection in another part of the body (cross-reactivity). Coming into contact with bacteria and developing an infection can trigger the disease. By the time the patient presents with symptoms, often the "trigger" infection has been cured or is in remission in chronic cases, thus making determination of the initial cause difficult.

The clinical pattern of reactive arthritis commonly consists of an inflammation of fewer than five joints which often includes the knee or sacroiliac joint. The arthritis may be "additive" (more joints become inflamed in addition to the primarily affected one) or "migratory" (new joints become inflamed after the initially inflamed site has already improved).

The arthritis often is coupled with other characteristic symptoms; this is called Reiter's syndrome or Reiter's arthritis. The manifestations of Reiter's Syndrome include the following triad of symptoms: an inflammatory arthritis of large joints, inflammation of the eyes in the form of conjunctivitis or uveitis, and urethritis in men or cervicitis in women. Patients can also present with mucocutaneous lesions, as well as psoriasis-like skin lesions such as circinate balanitis, and keratoderma blennorrhagicum. Enthesitis can involve the Achilles tendon resulting in heel pain. Not all affected persons have all the manifestations.

Reactive arthritis is an RF-seronegative, HLA-B27-linked arthritis often precipitated by genitourinary or gastrointestinal infections. The most common triggers are intestinal infections (with Salmonella, Shigella or Campylobacter) and sexually transmitted infections (with Chlamydia trachomatis or Neisseria gonorrheae).

It most commonly strikes individuals aged 20–40 years of age, is more common in men than in women, and more common in white than in black people. This is owing to the high frequency of the HLA-B27 gene in the white population. Patients with HIV have an increased risk of developing Reactive arthritis as well.

A large number of cases during World Wars I and II focused attention on the triad of arthritis, urethritis, and conjunctivitis (often with additional mucocutaneous lesions) which at that time was also referred to as "Fiessenger-Leroy-Reiter syndrome". These eponyms are now of historic interest only.

Urinary symptoms will appear within days or weeks of an infection. These symptoms may include:

  • Burning when urinating.
  • Fluid leaking from the urethra (discharge).
  • Problems starting or continuing a urine stream.
  • Needing to urinate more often than normal.
  • A low fever, along with eye discharges, burning, or redness (conjunctivitis or "pink eye") can develop over the next several weeks.
  • Joint pain and stiffness also begins during this time period. The arthritis may be mild or severe.

* Arthritis symptoms may include:

· Heel pain or pain in the Achilles tendon

· Pain in the hip, knee, ankle, and low back

· Pain that only one side of the body or more than one joint

A number of reasons have been implicated as the causes of Reiter’s syndrome-

· A bout of gastrointestinal or genital infection generally precedes reactive arthritis. A past history of food poisoning is also believed to be a cause.

· Re -exposure to the offending organism is also likely to trigger the disease in some. Infection with bacteria Chlamydia trachomatis, Salmonella spp, Campylobacter spp, Yersinia spp, have been commonly implicated.

· The mechanism involving the trigering of the disease is unknown. In 344 cases occurring in Finland after an epidemic of Flexner’s dysentery, two thirds of the cases of Reiter’s was a continuation of the dysentery.

· Reiter’s disease is considered to be an autoimmune disorder initiated by the infecting organism.

· A genetic predisposition to the autoimmune phenomenon is also a possibility. The cause of reactive arthritis is still unknown, but research suggests the disease is caused, in part, by a genetic predisposition.

· Approximately 75% of those with the condition have a positive blood test for the genetic marker HLA-B27.

To provide symptomatic relief by using various medications such as analgesics, Non steroidal anti-inflammatory drugs (NSAIDs), immunosuppressants, and steroids.

To completely eradicate the underlying source of infection by using antibiotics. Usage of Doxycycline or tetracycline in the case of Chlamydia infection is very common rarely, drugs that are used to treat rheumatoid arthritis such as - Etanercept, Infliximab, or Adalimumab may be used. Occasionally drugs to suppress the immune system, such as sulfasalazine maybe used.

Use of Potassium citrate solutions to relieve urinary symptoms Joint pain may also be helped by using - Glucosamine (500 mg three times a day) and chondroitin sulfate (800 - 1,200 mg per day, divided in 2 - 4 doses).

Multi-vitamin and especially Vitamin C (1,000 - 3,000 mg a day), vitamin E (400 - 800 IU a day), beta-carotene (25,000 IU per day), selenium (200 mcg a day) may also help.

In those whose disease is mild, it is a temporary condition. In the severely affected it can lead to an array of complications such as vision loss and debilitating arthritis.

It has a higher morbidity in men compared to women. It also has higher morbidity in those who harbor inflammation but who do not respond to treatment.

* Mayo Staff (March 5, 2011). "Reactive Arthritis (Reiter's Syndrome)". Mayo Clinic. Retrieved May 16, 2011
* Primer on the Rheumatic Diseases, By John H. Klippel, page 218
* Rheumatology in Practice, By J. A. Pereira da Silva, Anthony D. Woolf page 5.9
* H. Hunter Handsfield (2001). Color atlas and synopsis of sexually transmitted diseases, Volume 236. McGraw-Hill Professional.
* Ruddy, Shaun (2001). Kelley's Textbook of Rheumatology, 6th Ed. W. B. Saunders. pp. 1055–1064
* Sampaio-Barros PD, Bortoluzzo AB, Conde RA, Costallat LT, Samara AM, Bértolo MB (June 2010). "Undifferentiated spondyloarthritis: a long term follows up". The Journal of Rheumatology (The Journal of Rheumatology) 37(6): 1195–1199.
* Geirsson AJ, Eyjolfsdottir H, Bjornsdottir G, Kristjansson K, Gudbjornsson B (May 2010). "Prevalence and clinical characteristics of ankylosing spondylitis in Iceland - a nationwide study". Clinical and experimental rheumatology (Clinical and Experimental Rheumatology) 28 (3): 333–40.



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