Reactive Arthritis/Uveitis Syndrome




© Springer International Publishing AG 2017
George N. Papaliodis (ed.)Uveitis10.1007/978-3-319-09126-6_33


33. Reactive Arthritis/Uveitis Syndrome



George N. Papaliodis 


(1)
Department of Opthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA

 



 

George N. Papaliodis



Keywords
Reactive arthritisReiter’s syndromeConjunctivitisIritisHLA-B27Urethritis



Introduction


Reactive arthritis/uveitis syndrome (also described as Reiter’s syndrome) is an autoimmune condition that develops in response to an infection in other regions of the body (following diarrheal illnesses, cervicitis, urethritis). The original description in the literature included a triad of associated inflammatory events including: (1) arthritis; (2) conjunctivitis; (3) urethritis. Anterior uveitis has been described in 3–12 % of affected patients [1].

In 1916, Hans Conrad Julius Reiter reported a German lieutenant who developed non-gonococcal urethritis, arthritis, and conjunctivitis [2]. Reiter was not the first to describe this syndrome, but his name became affiliated with the condition. In 1977, a campaign to rename the syndrome “reactive arthritis” was initiated as others had described the constellation of findings in the literature prior to Reiter, and Reiter had been convicted at the Nuremberg trials for war crimes as a member of the Nazi party (enthusiastic support of enforced racial sterilization and euthanasia).

The exact incidence and prevalence of the disorder is difficult to establish as the classic triad is only found in approximately 33 % of the patients, and there is often a lag between the development of the infectious illness and the resultant inflammatory events (typically 1–4 weeks later). Additionally, some of the predisposing infectious agents (eg Chlamydia urethritis) may be relatively silent with few if any clinical symptoms. In a US population-based study in Oregon and Minnesota, the incidence of reactive arthritis following documented enteric bacterial infections ranged from 0.6 to 3.1 cases per 100,000 (and varied depending upon the organism) [3].


Clinical Manifestations


The syndrome can affect many organ systems in the body including


  1. 1.


    joints—patients develop a painful, inflammatory, asymmetric oligoarthritis which can involve the phalanges, ankles, hips, sacroiliac joint, and knees

     

  2. 2.


    ligaments and tendons—inflammation at the site of insertion into the bone (aka enthesitis)

     

  3. 3.


    eyes—conjunctivitis, iritis, keratitis, scleritis; Conjunctivitis is found in 58 % of patients with reactive arthritis syndrome and is typically bilateral and mild

     

  4. 4.


    skin—keratoderma blennorrhagica (patches of scaly skin on the palms, soles, trunk, or scalp)

     

  5. 5.
Aug 17, 2017 | Posted by in OPHTHALMOLOGY | Comments Off on Reactive Arthritis/Uveitis Syndrome

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