Reactive Arthritis (Reiter's Syndrome) and Eye Inflammation
The classic triad of conjunctivitis, urethritis, and arthritis after an infection, plus modern treatment.
Reactive arthritis (Reiter's syndrome) is a type of inflammatory arthritis in the spondyloarthropathy family, which affects the spine and sacroiliac joints. It is usually triggered by a gastrointestinal or genitourinary bacterial infection (Shigella, Salmonella, Chlamydia trachomatis), with joint inflammation appearing one to four weeks later.
The classic triad: conjunctivitis, urethritis or prostatitis, and oligoarticular arthritis. Dactylitis ('sausage digits') and enthesitis (inflammation where tendons attach to bone) can occur here and in psoriatic arthritis. The arthritis is often asymmetric and affects only a few joints.
Other features include skin lesions on the palms and soles (keratoderma blennorrhagicum) that can resemble pustular psoriasis, and an inflammatory lesion on the shaft of the male genital called circinate balanitis. Eye inflammation is common, so I often collaborate with an ophthalmologist. Conjunctivitis is the most common ocular sign, followed by uveitis.
Treatment includes NSAIDs like ibuprofen or naproxen, antibiotic therapy for chlamydial infection, and sulfasalazine. The disease is more common in men, but cases occur in women and children as well. Prognosis varies widely; roughly 15 to 20% of patients develop chronic sequelae, and treatment can be more difficult in HIV-positive patients.
Dr. Maggie Cadet, MD