Reiter syndrome

Signs and Symptoms

• Arthritis. Includes pain, swelling, stiffness, and redness of joints, usually the hips, knees, ankles, spine, and feet.
• Conjunctivitis, inflammation of the eye. Usually brief and mild.
• Iritis, inflammation of the iris of the eye. Less common but needs immediate medical treatment to avoid eye damage.
• Uveitis, inflammation of the inner eye. Less common but needs immediate medical treatment to avoid eye damage.
• Urinary tract infection. Pain or burning during urination and frequent urge to urinate. May include inflammation of the prostate or cervix. Men may have pus drainage from penis.
• Painless, shallow ulcers on the penis.
• Pus-filled sores on soles, palms, and penis. May also include mouth sores.
• Rashes of small nodules on the soles of the feet, and, less often, on the palms of the hands or elsewhere.
• Heart problems, affecting about 10% of people who have Reiter syndrome.

What Causes It?

Reiter syndrome is caused by a bacterial infection. Researchers do not know exactly why some people develop Reiter syndrome after an infection while others do not, although they think that genetics may play a role. The following factors may raise your risk for Reiter syndrome.

• HLA-B27 gene. About 80% of people with Reiter syndrome have the HLA-B27 gene. Only 6% of people who do not have the syndrome have the HLA-B27 gene.
• Bacterial triggers, such as salmonella, shigella, Yersinia, and Campylobacter.
• Sexually transmitted disease (STD) triggers, such as chlamydia.
• White males, ages of 20 to 50, are at higher risk. Women tend to have milder symptoms.

What to Expect at Your Doctor's Office

Tell your doctor about any stomach problems or sexually transmitted diseases (STDs) you have had recently. While there is no test for Reiter syndrome, you may be tested for chlamydia. The doctor may test samples of cells from your throat as well as the urethra in men or the cervix in women. Urine and stool samples may also be tested. You may need to have a blood test to rule out other diseases and to see if you have the HLA-B27 gene.

Your doctor may refer you to a rheumatologist, a specialist who treats arthritis. Although Reiter syndrome is an easily managed disease, it is often missed, especially among young, otherwise healthy people who may not have the classic symptoms.

Treatment Options

Drug Therapies

• Antibiotics. If you still have the bacterial infection that triggered Reiter syndrome.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs lower inflammation. These drugs include ibuprofen (Advil, Motrin), naproxen (Aleve), and prescription drugs.
• Corticosteroids. May be injected into painful joints to reduce inflammation.
• Drugs that suppress the immune system, such as sulfasalazine or methotrexate, may be given in more serious cases.
• Tumor necrosis factor (TNF) inhibitors. These drugs block a protein that causes inflammation in the body. They may be used in more severe cases and are also used to treat rheumatoid arthritis (RA). TNF inhibitors include etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira).

Your doctor may also prescribe drugs to treat specific symptoms, such as steroid eye drops for eye inflammation.

Complementary and Alternative Therapies

Although no complementary and alternative therapies (CAM) have been shown to help Reiter syndrome specifically, some may help reduce inflammation and support your immune system. Some CAM therapies can interact with medications, and some may make underlying medical problems worse. Work with your physician and make sure all of your providers know about any CAM therapies you are considering using.

• Eat fewer foods that are high in saturated fat, like red meat and fried foods, and limit alcohol. These foods may make inflammation worse. Eat more fatty fish (like salmon), nuts, and flaxseed, which can help reduce the amount of inflammatory chemicals your body produces. Eat more fruits and vegetables, which have disease-fighting antioxidants.
• Shark cartilage or chondroitin sulfate may help provide pain relief over time, although it has been studied only in osteoarthritis. DO NOT take shark cartilage if you have diabetes. If you take calcium supplements, talk to your doctor before taking shark cartilage. Chondroitin sulfate may interfere with blood-thinning medications (anticoagulants), and increase the risk of bleeding. It can also potentially aggravate asthma symptoms.
• Omega-3 fatty acids help reduce inflammation and are good for your heart. Higher doses may help more, but should be used only under your doctor's supervision. Omega-3 fatty acids can increase the risk of bleeding, so ask your doctor before taking them, especially if you are taking NSAIDs or blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. (5 g) herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

The following herbs help reduce inflammation, although they have not been studied specifically for Reiter syndrome. DO NOT take these herbs without your doctor's supervision. Many interact with each other and with other prescription medications, and can cause unwanted side effects.

• Bromelain, an enzyme derived from pineapple. It is sometimes combined with turmeric, because turmeric makes the effects of bromelain stronger. Bromelain by itself or with turmeric can increase the risk of bleeding, so ask your doctor before taking it, especially if you are taking NSAIDs or blood thinners. People with stomach ulcers should avoid bromelain. If taken with antibiotics, bromelain may increase the levels of antibiotic in the body, which could be dangerous. People with a sensitivity or allergy to pineapple should not take bromelain.
• Turmeric or curcumin (Curcuma longa), yellow pigment of turmeric. Turmeric makes the effect of bromelain stronger. Turmeric can increase the risk of bleeding, so ask your doctor before taking it, especially if you are taking NSAIDs or blood thinners.
• White willow (Salix alba) bark contains salicin, which acts like aspirin to reduce inflammation and pain. DO NOT take white willow if you are also taking aspirin or blood-thinning medications. Check with your doctor if you are allergic to aspirin or salicylates before taking white willow. White willow should not be given to children under the age of 18.
• Licorice (Glycyrrhiza glabra), 3 cups of tea a day. DO NOT take licorice if you have high blood pressure, edema, or heart failure; hormone-sensitive cancers, such as breast, prostate, ovarian, or uterine cancer; diabetes; kidney disease; liver disease; or if you are taking corticosteroids prescribed by your doctor. Licorice interacts with a number of medications. So, to be safe, ask your doctor before taking licorice if you take any other medications. You should not use licorice for long periods of time.
• Cat's claw (Uncaria tomentosa). In several studies, cat's claw appears to reduce inflammation in rheumatoid arthritis (RA). But it has not been studied in Reiter syndrome. Cat's claw may stimulate the immune system, and might interact with drugs taken to suppress the immune system. It may also interact with other medications. So ask your doctor before taking it. People with leukemia should not take cat's claw.
• Boswellia (Boswellia serrata). Boswellia can increase the risk of bleeding. So ask your doctor before taking it, especially if you are taking NSAIDs or blood thinners.

For urethritis:

• Uva ursi (Arctostaphylos uva ursi), has been used traditionally to treat urinary tract infections and is approved in Germany to treat bladder infections. Uva ursi can be toxic. So you should not take it without your doctor's supervision. It should be used for sudden cases of Reiter syndrome only.
• Horsetail (Equisetum arvense) is a diuretic that may help flush bacteria out of the urinary tract. DO NOT take horsetail if you have kidney disease or heart disease, or if you take diuretics (water pills). Using horsetail for a long time may cause thiamine and potassium deficiencies.
• Meadowsweet (Filipendula ulmaria) helps fight inflammation. DO NOT take meadowsweet if you take blood thinners. Meadowsweet may interact with aspirin and other pain relievers. Pregnant women should not take meadowsweet because it can cause uterine contractions.

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for Reiter syndrome based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Rhus tox. For joint stiffness, worse when starting to move then easing with more movement.
• Arsenicum album. For burning pain in the urinary tracts accompanied by anxiety.
• Sulphur. For all sorts of burning pain, including conjunctivitis with redness that is accompanied by digestive complaints.

As with other forms of arthritis, acupuncture may help strengthen the immune system and reduce pain.

Following Up

The first attack usually lasts 3 to 6 months. Most people are able to keep doing the things they usually do with treatment.

Supporting Research

Bastos TC, Maia DC, Gomes NM, Menezes CK, Francesconi V, Francesconi F. Syphilis associated with paretic neurosyphilis mimicking Reiter's syndrome in HIV-infected patients. An Bras Dermatol. 2015;90(3 Suppl 1):212-215. PMID: 26312720 www.ncbi.nlm.nih.gov/pubmed/26312720.

Cimaz R, Meregalli E, Biggioggero M, Casadei A, Careddu P. Arthritis and infections. Minerva Pediatr. 2005;57(4):181-188. PMID: 16172597 www.ncbi.nlm.nih.gov/pubmed/16172597.

Das Gupta AB, Hossain AK, Islam MH, Dey SR, Khan AL. Role of omega-3 fatty acid supplementation with indomethacin in suppression of disease activity in rheumatoid arthritis. Bangladesh Med Res Counc Bull. 2009;35(2):63-68. PMID: 20120782 www.ncbi.nlm.nih.gov/pubmed/20120782.

Gupta R, Manchanda RK. Reiter's disease treated with Nux vomica. Homeopathy. 2006;95(2):103-104. PMID: 16569627 www.ncbi.nlm.nih.gov/pubmed/16569627.

Howard JH, Litovsky SH, Tallaj JA, Liu X, Holman WL. Xenograft calcification in Reiter's syndrome. J Heart Valve Dis. 2007;16(2):159-161. PMID: 17484465 www.ncbi.nlm.nih.gov/pubmed/17484465.

Mur E, Hartig F, Eibl G, Schirmer M. Randomized double blind trial of an extract from the pentacyclic alkaloid-chemotype of uncaria tomentosa for the treatment of rheumatoid arthritis. J Rheumatol. 2002;29:678-681. PMID: 11950006 www.ncbi.nlm.nih.gov/pubmed/11950006.

Ngaruiya CM, Martin IB. A case of reactive arthritis: a great masquerader. Am J Emerg Med. 2013;31(1):266-e5-7. PMID: 22795425 www.ncbi.nlm.nih.gov/pubmed/22795425.

Overbeck S, Rink L, Haase H. Modulating the immune response by oral zinc supplementation: a single approach for multiple diseases. Arch Immunol Ther Exp (Warsz). 2008;56(1):15-30. Review. PMID: 18250973 www.ncbi.nlm.nih.gov/pubmed/18250973.

Rosenbaum CC, O'Mathúna DP, Chavez M, Shields K. Antioxidants and antiinflammatory dietary supplements for osteoarthritis and rheumatoid arthritis. Altern Ther Health Med. 2010;16(2):32-40. Review. PMID: 20232616 www.ncbi.nlm.nih.gov/pubmed/20232616.

Ruggiero C, Lattanzio F, Lauretani F, Gasperini B, Andres-Lacueva C, Cherubini A. Omega-3 polyunsaturated fatty acids and immune-mediated diseases: inflammatory bowel disease and rheumatoid arthritis. Curr Pharm Des. 2009;15(36):4135-4148. Review. PMID: 20041815 www.ncbi.nlm.nih.gov/pubmed/20041815.