Reiter syndrome

Background

• Seronegative spondyloarthropathy that manifests as an acute, asymmetric, oligoarthritis (LE>UE) that occurs 2-6 weeks after infection
• Classic triad: urethritis, conjunctivitis, and arthritis ("Can't pee, can't see, can't climb a tree")

Clinical Features

1. Preceding Infection
   • Urethritis: generally caused by Chlamydia or Ureaplasma
   • Enteritis: generally caused by Salmonella or Shigella
   • Preceding infection may be clinically silent
2. Musculoskeletal symptoms
   • Arthritis: oligoarthritis, usually in the lower extremities
   • Enthesitis (pain at insertion sites)
   • Dactylitis (sausage digits)
   • Low back pain
3. Extraarticular symptoms
   • Conjunctivitis (less frequently uveitis, keratitis)
   • GU symptoms
   • Oral lesions
   • Cutaneous and nail changes

Differential Diagnosis

Oligoarthritis

• Ankylosing spondylitis
• Gonococcal arthritis
• Lyme disease
• Psoriatic arthritis
• Reactive arthritis
• Rheumatic fever
• Rheumatoid arthritis
• Systemic lupus erythematosus

Diagnosis

• Primarily a clinical diagnosis, no definitive test
• More likely if there is the presence of:
  • Characteristic musculoskeletal findings
  • Presence of preceding illness
  • Lack of more likely cause of arthritis

Management

• Treat inciting infection
• Symptomatic treatment of arthritis
  • NSAIDs are first line (naproxen, diclofenac, indomethacin)
  • Intraarticular and systemic steroids for NSAID refractory

Disposition

• Referral to a rheumatologist