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Reiter’s disease – a disease of a rheumatic nature with simultaneous or sequential lesions of the urethra, prostate, joints and mucous membranes of the eyes. Violations in the work of the immune system, provoked by a genitourinary or intestinal infection, underlie the disease. Reiter’s syndrome has a tendency to frequent relapses, often becoming chronic.
According to statistics, the disease in 80% of cases develops in males, in the age range from 20 to 40 years. Reiter’s symptom is rarely diagnosed in women and children.
The disease goes through two successive stages – infectious, when the pathogen is in the genitourinary system or in the intestines, and immunopathological, expressed in an immune complex reaction with damage to the conjunctiva and joints.
Reiter’s disease symptoms
Symptoms of Reiter’s disease are expressed in a specific lesion of the organs of vision, the urogenital tract, joints and skin.
Focusing on the clinical picture in more detail, the following symptoms can be noted:
The onset of the disease is characterized by the manifestation of urethritis, cystitis or prostatitis. Often a person first suffers enterocolitis, or a sexual infection. During urethritis, the patient suffers from the corresponding dysuric disorders: mucous contents are separated from the urinary canal in small quantities, itching and burning appear during emptying of the bladder. Worried about the feeling of discomfort in the area of the external urethra and its hyperemia. Sometimes the onset of the disease is erased, which is observed in 30% of patients, and an inflammatory reaction can be detected only after examining a smear to increase the number of leukocytes in it.
The next symptom characteristic of Reiter’s disease is damage to the organs of vision. Most often, patients develop conjunctivitis, although iridocyclitis, uveitis, iritis, retinitis, keratitis, and retrobulbar neuritis are not excluded. It is possible that the patient will not notice the symptoms of conjunctivitis, since it often occurs in a latent form and passes quickly enough.
4-6 weeks after the urogenital infection, reactive arthritis develops, which becomes the defining symptom of Reiter’s disease. The joints are involved in the pathological process asymmetrically, in the lower extremities the joints of the interphalangeal, ankle, knee joints are affected. Pain has a maximum intensity in the morning and at night, the skin over the site of inflammation acquires a red tint, there is an effusion inside the joint cavity. When the big toe is involved in the process of inflammation, pseudo-gouty symptoms develop.
The process of inflammation proceeds sequentially, starting from the distal small joints and ending with large joints located closer to the body.
Edema is characteristic of urogenic arthritis, while the fingers take on a shape resembling sausages and become purple-bluish in color.
Calcaneal bursitis, tendinitis, rapid formation of a heel spur – all of these diseases can act as additional signs of Reiter’s disease.
Some patients complain of pain in the spine, followed by the development of sarcoileitis.
The defeat of the skin and mucous membranes occurs according to various sources in 30-50% of cases. So, ulcers are formed in the mouth by the type of stomatitis, inflammation of the tongue by the type of glossitis is possible. In men, the addition of balanoposthitis and balanitis is likely. Eruptions on the skin look like red papules, erythematous spots, or hyperemic areas with hyperkeratosis. The palms and feet are prone to cracking and peeling.
Damage to the cardiovascular system (myocarditis, myocardial dystrophy), pulmonary system (pneumonia, pleurisy), kidneys (amyloidosis, nephritis), nervous system (polyneuritis) is not excluded.
Often there is an increase in inguinal lymph nodes. On palpation, they remain painless. Reiter’s syndrome may be accompanied by a prolonged increase in body temperature to subfebrile levels.
Causes of Reiter’s disease
The causes of Reiter’s disease can be identified as follows:
Most often, the disease develops as a result of infection of the body with gram-negative bacteria (chlamydia). These are the smallest intracellular parasites, which, in the presence of a favorable environment for them, begin to actively multiply, leading to chronic infection. Chlamydia are sexually transmitted and in 60% of cases are the cause of urethritis in men. A household route of infection is also possible, when chlamydia are found in the conjunctiva, in the synovial membrane of the joints, in the epithelium of the urethra. At the same time, women are often carriers of chlamydia, and they themselves may not suffer from the disease of urethritis. Once in the body, chlamydia form a focus of inflammation and from it spread through the tissues, causing an autoallergic reaction. The nature of the course of the disease depends on the degree of its severity.
Salmonella, shigella, which remain in the body after suffering enterocolitis, can provoke Reiter’s syndrome.
There is evidence of participation in the manifestation of the disease ureoplasma.
The disease itself is not inherited, but there may be a genetic predisposition to it. Moreover, the antigen-marker is detected in 95% of patients with Reiner’s syndrome.
If the disease lasts more than 1 year, then it is transferred to the category of chronic. There is a sporadic form of Reiter’s disease, which manifests itself after a genitourinary infection, and an epidemic form, which develops after an intestinal infection.
Diagnosis of Reiter’s disease
If there is a suspicion of Reiter’s syndrome, then the patient may be referred for a consultation with a venereologist, rheumatologist, urologist, ophthalmologist. Women are advised to undergo a gynecological examination.
To confirm the diagnosis appoint:
Blood chemistry.
General blood analysis.
Urine samples: according to Addison-Kakovsky, according to Nechiporenko, a three-glass sample.
Cytological scraping of the urethra.
Cytological scraping of the cervix.
The study of the secret of the prostate according to Romanovsky-Giemsa.
Performing PCR with isolation of pathogen DNA.
Performing ELISA and other serological tests to determine the antibodies of chlamydia and other sources of infection.
Isolation of the HLA 27 antigen, which is specific for Reiter’s symptom.
Joint puncture with synovial fluid sampling.
X-ray examination of the joints.
It is important to take an anamnesis, establish a connection between a previous urogenital or intestinal infection, identify symptoms of conjunctivitis, skin rashes.
Treatment of Reiter’s disease
Treatment of Reiter’s disease should be aimed at treating the infection itself with antibacterial drugs and eliminating inflammation in the joints. Therapy of only articular manifestations, as well as the use of cephalosporins and penicillins, will lead to a protracted chronic process.
Antibiotics are prescribed in maximum maximum doses. The duration of their admission is from a month to 6 weeks. The beginning of therapy is reduced to the infusion method of administering drugs, followed by the transition to oral administration. It is recommended to change antibacterial agents in groups every 2 to 2,5 weeks.
The drugs of choice are those from the groups of tetracyclines, macrolides and fluoroquinols. Of the tetracyclines, intravenous doxycycline and oral doxycycline monohydrate are recommended.
From the fluoroquinol group, Ciprofloxacin, Ofloxacin, Lomefloxacin are recommended.
From the group of macrolide antibiotics, it is possible to use Erythromycin, Azithromycin, Josamycin, Clarithromycin, Roxithromycin.
For the correction of immune disorders, it is possible to use the immunomodulators Thymogen, Timalin, adaptogens, drugs aimed at the production of interferon (Neovir, Cycloferon).
In parallel, antimycotics, vitamins, hepatoprotectors are prescribed. If the patient suffers from elevated body temperature, then desensitizing therapy with antihistamines is indicated.
To relieve inflammation in the joints allows the use of NSAIDs, hormonal drugs, cytostatics. Of non-steroidal anti-inflammatory drugs, Diclofenac, Ketoprofen, Naproxen, Piroxicam, Meloxicam are more often prescribed, drugs are taken for a long time, changing the drug every 10 days.
Glucocorticoids can only be used during an exacerbation of the disease, if it has a severe course. Initially, high doses of prednisolone, methylprednisolone, or betamethasone are administered, followed by rapid dose reduction and switching to NSAIDs. In case of recurrence of the disease, pulse therapy with Methylprednisolone is recommended for up to 5 days.
As the inflammatory process subsides, patients are recommended to undergo physiological procedures: phonophoresis, UHF, magnetotherapy, laser therapy.
If there is a significant joint effusion, then a puncture with glucocorticosteroids and evacuation of the joint fluid is indicated. For introduction into the joint, long-acting drugs are used, such as: Diprospan, Depo-medrol.
Local treatment is reduced to the application of ointments with analgesic and anti-inflammatory effect.
All extragenital foci of infection, if any, should be sanitized in a timely manner. This applies to sinusitis, cholecystitis, respiratory infections, etc. No less important is the treatment of urogenital inflammation, the prostate gland.
If the patient has minor psychological disorders, is quick-tempered, irritable, then he is shown taking mild sedatives, for example, Valerian Tinctures.
The exercise therapy complex begins to be performed immediately after the diagnosis is made. As the inflammation in the joints fades, the load increases. With increasing muscle weakness and atrophy, therapeutic massage is required.
An ophthalmologist should monitor patients with Reiter’s disease on a regular basis. To eliminate conjunctivitis, the use of antibacterial ointments – erythromyin or tetracycline – is indicated.
Skin rashes are treated depending on their manifestations.
It is important that both sexual partners receive antibiotic therapy, even if one of them has no signs of the disease.
The prognosis of the course of the disease is most often favorable. In most patients, it is possible to achieve a stable remission, but an exacerbation of the disease is not excluded later. This can happen even after many years. In 25% of patients, the disease becomes chronic and leads to persistent dysfunction of the joints, atrophy of muscle tissue, and the formation of flat feet. Therefore, in order to prevent the disease, the development of intestinal and urogenital infections should be prevented, and if they are detected, they should be treated in a timely manner under the supervision of a specialist.