A syndrome which in its full blown picture consists of urethritis, arthritis, and conjunctivitis. Urethritis usually occurs first. There are countless clinical symptoms, but the clinical picture is dominated by polyarthritis. There is pain, swelling, redness, and heat in the joints.
The disease usually affects white men 16 to 42 years of age, although it can occur in older people or children. Male Negroes rarely get the disease, and women only a fifth as often as men. The sexually transmitted form is more common among young, sexually active men. The postdysenteric form is more common in women and may occur in children.
Reiter’s disease may be self limiting, frequently recurring, or develop continually. Repeated attacks over many years is common, and more than 40 percent of the patients end up with chronic and disabling arthritis, heart disease or impaired vision.
The condition is usually observed following an infection of the intestine or the lower urinary tract, often after infection with Shigella flexneri, Salmonella typhimurium, Yersinia enterocolitica, Campylobacter jejunu, or Chlamydia trachomatis.
The aetiology is unclear, but pleuropneumonialike organisms and Chlamydia are suspected as possible etiologic factors. However, no certain causative organism has been demonstrated, but the disease is assumed to be caused by a virus. In 344 cases occurring in Finland after an epidemic of Flexner’s dysentery, two thirds of the cases were a continuation of the dysentery. Reiter’s disease considered to be an autoimmune disorder initiated by the infecting organism.
Both the terms Reiter’s disease/syndrome and morbus Reiter are commonly used. The term morbus Reiter should be reserved for those cases where the triad follows an intestinal or urinary tract infection. Both for Reiter’s patient and the case described by Fiessinger and Leroy (Syndrome oculo-urethro-synovial), the condition occurred following an intestinal infection.
Hans Reiter described the disease in a World War I soldier who had recovered from a bout of diarrhoea. He described three characteristic features of the disease: inflammation of the joints, urinary tract, and eyes. More recently, doctors have recognized a fourth major feature: ulcerations of the skin and mouth.
Most people with Reiter's syndrome can expect to live normal life spans and maintain a near-normal lifestyle with modest adaptations to protect the involved joints.
The term abortive Reiter’s syndrome is used when two of the symptoms are present, and this is usually without conjunctivitis.
An early, good description is in Sir Benjamin Collins Brodie’s classical work on diseases of the joints.
- B. C. Brodie:
Pathological and Surgical Observations on Diseases of the Joints. London, 1818.
- N. Fiessinger, E. Leroy:
Contribution à l’étude d’une épidemie de dysenterie dans la Somme juillet-octobre 1916.
Bulletins et mémoires de la Société médicale des hôpitaux de Paris, 1916, 40: 2030-2069.
- H. Reiter:
Ueber eine bisher unerkannte Spirochäteninfektion (Spirochaetosis arthritica).
Deutsche medizinische Wochenschrift, Berlin, 1916, 42: 1535-1536. Über die Reitersche Krankheit.
Münchener medizinische Wochenschrift, 1941, 49: 1295.
- L. Waelsch:
Über chronische nicht gonorrhoische Urethritis.
Archiv für Dermatologie und Syphilis, Berlin, 1916, 123: 1089-1105.