Reiter's Syndrome

(Reactive Arthritis)
By: Jackson Nordbeck, LaChane' Ballard, Ashley Palmer, Joshua
Sutton, and Alex Vasile
2 Populations/Incidence/Etiology

-Affects men more than women

-Is not contagious
-Caused by infections that are contagious
-Commonly affects those who have had a
gastrointestinal or urogenital infection
- Those who are genetically predisposed to the HLA-
B27 allele (test positive) are more likely to have more
severe symptoms
3
0.6-27
Cases/100,000 People

20-50
Years Old Average Age

3-12
Months of symptoms on average
4 Genetic Component

The most common genetic marker found in individuals with Reactive

Arthritis is the HLA-B27 allele:
- 30%-50% of individuals carry this allele when diagnosed with
Reactive Arthritis (60%-80% have more severe symptoms)6
- Higher likelihood of allele presence in Caucasian individuals
- There is no concrete explanation for the role that HLA-B27 plays in the
pathogenesis but…
- ‘Molecular mimicry’
- Leads to aberrant cytotoxic T-cell response
- Receptors for pathogens
5 Transmission

Venereal Disease
Transmitted through sexual contact with an individual
infected by Chlamydia trachomatis or Streptococcus
pneumoniae (Human Immunodeficiency Virus)

HIV transmitted by spread of bodily fluids (e.g blood, breast

milk, semen, etc)

Dysentery Disease
Exposure to contaminated food with Shigella, Salmonella,
or Campylobacter
 Type: Infection
Target Tissue: Ligaments and tendons
Target Location: Joints

Pathology
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 Pathology
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8 Signs and Symptoms

Arthritis Symptoms Urinary Tract Eye Symptoms

Symptoms
Joint pain and Inflammation Men: Blurry Vision
(Often Knees, Feet and Ankles) ↑ Urine Output
Red Eyes
Burning during Urination
Inflammation of Tendon Discharge from Penis Conjunctivitis
Inflamed Prostate Gland
Bony growths in Joints Women: Uveitis
Inflamed Cervix, Urethra
Inflammation of Spine and/or Fallopian Tubes (Inner Eye Inflammation)
Inflamed Vulva and Vagina
Inflammation of low back
9 How to Diagnosis?

Erythrocyte
Sedimentation Rate STD Testing Arthrocentesis
(ESR)

X-Rays Genetic Testing

 Prognosis
10
11 Treatment

▹ Inactivity/Immobilization Discouraged

▹ ROM and stretching exercises emphasized

▹ Joint Protection/Maintenance
12 Differential Diagnosis

Immunotherapy
Syphilis Arthropathy

Septic Psoriatic
Arthritis Arthritis
13 Prevention

-Limit the transmission of pathogens

-Exposure to bacteria that causes infection triggering reactive arthritis can be reduced by:

Wash Hand before eating or handling food Practicing safe sex

Getting vaccinations Cooking food properly/ good food hygiene

Storing food properly Regular checkups to test for STDs

14 Why is this Important for PT’s

▷History of Venereal Disease

▷Inflammatory Disease

▷Increased Pain with PROM and AROM

▷Differential Diagnosis
15 Clinical Pearls
Signs and Symptoms-
-Triad of Arthritis, Conjunctivitis
and Urethritis

Treatment-
-Cont. Exercise and Work on /GET REACTIVE ARTHRITIS

ROM
-Treat Urinary and Eye infection
with medications/ointments
16 Question 1

How can Physical therapist's help treat patients with Reiter's

syndrome?

A. Encourage Inactivity/Immobilization
B. Work on Strengthening Exercises
C. Limit stretching due to pain
D. Educate patients on taking NSAIDs for
chronic Reiter's syndrome
17 Question 2
Which of the following infectious diseases, if left untreated could lead
to Reactive arthritis?

A. Influenza
B. Meningitis
C. Herpes
D. Chlamydia
 1.) Articles. Cedars. https://www.cedars-sinai.org/health-library/diseases-and-conditions/r/reactive-arthritis-reiters-
syndrome.html. Accessed September 20, 2022.
2.) Cheeti A, Chakraborty RK, Ramphul K. Reactive Arthritis. In: StatPearls. StatPearls Publishing; 2022. Accessed
September 26, 2022. http://www.ncbi.nlm.nih.gov/books/NBK499831/
3.) Goodman C, Fuller K. Goodman and Fuller’s Pathology. 5th ed. Elsevier, Inc; 2020.
4.) Pennisi M, Perdue J, Roulston T, Nicholas J, Schmidt E, Rolfs J. An overview of reactive arthritis. JAAPA. 2019;32(7):25-
28. doi:10.1097/01.JAA.0000558320.47868.2f
5.) Website. Reactive Arthritis: causes, symptoms and treatments | Arthritis Foundation.
https://www.arthritis.org/diseases/reactive-arthritis. Accessed September 24, 2022.
6.) Stavropoulos PG, Soura E, Kanelleas A, Katsambas A, Antoniou C. Reactive arthritis. J Eur Acad Dermatol Venereol.
2015;29(3):415-424. doi:10.1111/jdv.12741

Resources
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