Reiter's disease (syndrome) in men and women
Content:
- Reiter's disease symptoms
- Causes of Reiter's disease
- Diagnosis of Reiter's disease
- Reiter's disease treatment
Reiter's disease is a disease of a rheumatic nature with simultaneous or sequential damage to the urethra, prostate, joints and mucous membranes of the eyes. Immunity disorders triggered by a genitourinary or intestinal infection underlie the disease. Reiter's syndrome has a tendency to frequent relapses, often becoming chronic.
According to statistics, the disease in 80% of cases develops in males, in the age range from 20 to 40 years. In women and children, Reiter's symptom is rarely diagnosed.
The disease goes through two successive stages - infectious, when the pathogen is in the genitourinary system or in the intestine, and immunopathological, expressed in an immune complex reaction with damage to the conjunctiva and joints.
Reiter's disease symptoms
Symptoms of Reiter's disease are expressed in specific damage to the organs of vision, the urogenital tract, joints and skin.
Dwelling on the clinical picture in more detail, the following symptoms can be noted:
- The onset of the disease is characterized by the manifestation of urethritis, cystitis or prostatitis. Often, a person previously undergoes enterocolitis, or a genital infection. During urethritis, the patient suffers from the corresponding dysuric disorders: mucous contents are separated from the urinary canal in small quantities, itching and burning appear during the emptying of the bladder. Disturbed by the feeling of discomfort in the area of the external urethra and its hyperemia. Sometimes the onset of the disease is erased, which is observed in 30% of patients, and an inflammatory reaction can only be detected after examining a smear to increase the number of leukocytes in it.
- The next symptom characteristic of Reiter's disease is damage to the organs of vision. Most often, patients develop conjunctivitis, although iridocyclitis, uveitis, iritis, retinitis, keratitis, and retrobulbar neuritis are not excluded. It is possible that the patient will not notice the symptoms of conjunctivitis, since it often proceeds in a latent form and passes quickly enough.
- 4-6 weeks after the urogenital infection, reactive arthritis develops, which becomes the defining symptom of Reiter's disease. The joints are involved in the pathological process asymmetrically, the interphalangeal, ankle, and knee joints are affected in the lower extremities. The pain is maximal in the morning and night hours, the skin over the site of inflammation becomes red, and effusion occurs inside the articular cavity. When the big toe is involved in the inflammation process, pseudogouty symptoms develop.
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The process of inflammation proceeds sequentially, starting from the distal small joints and ending with the large joints located closer to the body.
- For urogenic arthritis, edema is characteristic, while the fingers acquire a shape resembling sausages, becoming a crimson-cyanotic color.
- Calcaneal bursitis, tendinitis, rapid formation of heel spurs - all these diseases can act as additional signs of Reiter's disease.
- Some patients complain of pain in the spine with the subsequent development of sarcoiliitis.
- The defeat of the skin and mucous membranes occurs according to various sources in 30-50% of cases. So, mouth ulcers form like stomatitis, inflammation of the tongue like glossitis is possible. In men, the addition of balanoposthitis and balanitis is likely. Skin rashes appear as red papules, erythematous spots, or hyperemic areas with hyperkeratosis. The palms and feet are prone to cracking and peeling.
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Damage to the cardiovascular system (myocarditis, myocardial dystrophy), pulmonary system (pneumonia, pleurisy), kidneys (amyloidosis, nephritis), nervous system (polyneuritis) is not excluded.
- Inguinal lymph nodes are often enlarged. On palpation, they remain painless. Reiter's syndrome can be accompanied by a prolonged increase in body temperature to subfebrile levels.
Causes of Reiter's disease
The causes of Reiter's disease are as follows:
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Most often, the disease develops as a result of infection of the body with gram-negative bacteria (chlamydia). These are the smallest intracellular parasites, which, in the presence of a favorable environment for them, begin to actively multiply, leading to chronic infection. Chlamydia is sexually transmitted and in 60% of cases is the cause of urethritis in men. A household route of infection is also possible, when chlamydia is found in the conjunctiva, in the synovial membrane of the joints, in the epithelium of the urethra. Moreover, women are often carriers of chlamydia, and they themselves may not suffer from urethritis. Once in the body, chlamydia forms a focus of inflammation and from it spreads through the tissues, causing an autoallergic reaction. The nature of the course of the disease depends on the degree of its severity.
- Salmonella, shigella, which remain in the body after entercolitis, can provoke Reiter's syndrome.
- There is evidence of participation in the manifestation of the disease of the ureoplasm.
- The disease itself is not inherited, but there may be a genetic predisposition to it. Moreover, the antigen marker is detected in 95% of patients with Reiner syndrome.
If the disease lasts more than 1 year, then it is transferred to the category of chronic. There is a sporadic form of Reiter's disease, which manifests itself after a genitourinary infection, and an epidemic, which develops after an intestinal infection.
Diagnosis of Reiter's disease
If there is a suspicion of Reiter's syndrome, then the patient can be referred for consultation to a venereologist, rheumatologist, urologist, ophthalmologist. Women are advised to undergo a gynecological examination.
To confirm the diagnosis, appoint:
- Blood chemistry.
- General blood analysis.
- Urine samples: according to Addison-Kakovsky, according to Nechiporenko, three-glass sample.
- Cytological scraping of the urethra.
- Cytological scraping of the cervix.
- Study of prostate secretion according to Romanovsky-Giemsa.
- Performing PCR with isolation of the pathogen DNA.
- Performing ELISA and other serological tests to determine antibodies of chlamydia and other sources of infection.
- Isolation of the HLA 27 antigen, which is specific for Reiter's symptom.
- Puncture of the joint with the collection of synovial fluid.
- X-ray examination of the joints.
It is important to take anamnesis, establish a connection between a previous urogenital or intestinal infection, identify symptoms of conjunctivitis, skin rashes.
Reiter's disease treatment
Treatment of Reiter's disease should be aimed at treating the infection itself with antibacterial drugs and at eliminating inflammation in the joints. Therapy only for articular manifestations, as well as the use of cephalosporins and penicillins, will lead to a prolonged chronic process.
Antibiotics are prescribed in maximum maximum doses. The duration of their admission is from a month to 6 weeks. The beginning of therapy is reduced to the infusion method of administering drugs with the subsequent transition to oral administration. It is recommended to change antibacterial agents by group every 2 to 2.5 weeks.
The drugs of choice are drugs from the groups of tetracyclines, macrolides and fluoroquinols. Of the tetracyclines, the recommended use of Doxycycline intravenously and Doxycycline monohydrate orally.
From the fluoroquinol group, the intake of Ciprofloxacin, Ofloxacin, Lomefloxacin is recommended.
From the group of macrolide antibiotics, it is possible to use Erythromycin, Azithromycin, Josamycin, Clarithromycin, Roxithromycin.
- For the correction of immune disorders, it is possible to use the immunomodulators Timogen, Timalin, adaptogens, drugs aimed at producing interferon (Neovir, Cycloferon).
- In parallel, antimycotics, vitamins, hepatoprotectors are prescribed. If the patient suffers from elevated body temperature, then desensitizing therapy with the use of antihistamines is indicated.
- Taking NSAIDs, hormones, cytostatics allows you to relieve inflammation in the joints. Of the non-steroidal anti-inflammatory drugs, Diclofenac, Ketoprofen, Naproxen, Piroxicam, Meloxicam are more often prescribed, the drugs are taken for a long time, changing the drug every 10 days.
- Glucocorticoids can be used only during an exacerbation of the disease if it has a severe course. Initially, high doses of Prednisolone, Methylprednisolone or Betamethasone are administered, followed by a rapid dose reduction and a switch to NSAIDs. In case of relapses of the disease, pulse therapy with Methylprednisolone is recommended for up to 5 days.
- As the inflammatory process fades away, patients are recommended to undergo physiological procedures: phonophoresis, UHF, magnetotherapy, laser therapy.
- If there is significant joint effusion, then puncture with glucocorticosteroids and evacuation of the joint fluid is indicated. For the introduction into the joint, drugs with prolonged action are used, such as: Diprospan, Depo-medrol.
- Local treatment is reduced to the application of ointments with anesthetic and anti-inflammatory effect.
- All extragenital foci of infection, if any, should be promptly sanitized. This applies to sinusitis, cholecystitis, respiratory infections, etc. Treatment of urinary inflammation and prostate gland is equally important.
- If the patient has minor psychological disorders, is quick-tempered, irritable, then he is shown taking sedatives of mild action, for example, Valerian tincture.
- The exercise therapy complex begins to be performed immediately after the diagnosis. As the inflammation in the joints fades away, the loads increase. With increasing muscle weakness and atrophy, therapeutic massage is required.
- An ophthalmologist should monitor patients with Reiter's disease on a regular basis. For the elimination of conjunctivitis, the use of antibacterial ointments is shown - erythromyin or tetracycline.
- Skin rashes are treated depending on their manifestations.
It is important that both sexual partners undergo antibiotic therapy, even if one of them has no signs of the disease.
The prognosis of the course of the disease is most often favorable. In most of the patients, it is possible to achieve a stable remission, however, an exacerbation of the disease subsequently is not excluded. This can happen even after many years. In 25% of patients, the disease becomes chronic and leads to persistent dysfunction of the joints, atrophy of muscle tissue, and the formation of flat feet. Therefore, in order to prevent the disease, the development of intestinal and urogenital infections should be prevented, and if they are detected, promptly undergo treatment under the supervision of a specialist.
Author of the article: Lebedev Andrey Sergeevich | Urologist
Education: Diploma in the specialty "Andrology" received after completing residency at the Department of Endoscopic Urology of the Russian Medical Academy of Postgraduate Education in the urological center of the Central Clinical Hospital No. 1 of JSC Russian Railways (2007). Postgraduate studies were completed here by 2010.
