During World War I, a German army doctor named Hans Reiter treated an officer for infectious diarrhea followed by conjunctivitis (inflammation of the eye), urethritis (inflammation of the urethra, the passage that empties the bladder), and arthritis.  Because this condition had no name, he decided to call it Reiter’s syndrome.  Now, Reiter’s syndrome is rare and actually a specific type of reactive arthritis which is triggered by bacteria infection.  Although reactive arthritis is not uncommon, very few people with bacteria actually go on to have serious reactive arthritis.  Reactive arthritis tends to target young adults between the ages of 20 and 40, three times more men than women and primarily Caucasians.

There is a close correlation among reactive arthritis, inflammatory bowel disease, arthritis, psoriatic arthritis and ankylosing spondylitis.  These interrelated diseases, which are different from rheumatoid arthritis, are known as seronegative spondyloarthropathies, meaning negative for rheumatoid factor and involving the joints of the spine.  Their presentations are very similar because they all include inflammation of the sacroiliac (tailbone area) joints, peripheral joints, ligaments and tendons, association with the HLA-B27 gene and involvement of the skin, eyes, bowels, genitals, and urinary tract.  However, despite their similarities, they are still somewhat different.  Reactive arthritis is triggered by bacteria infection, while the others are still unknown.  Not all types of infection are “triggering infections.”  Those generally associated as being triggers of reactive arthritis are gastrointestinal infections such as salmonella poisoning, food-borne enteric diseases, and genitourinary infections such as chlamydia and other venereal diseases.

HLA-B27 (human leukocyte antigen) is present in only 8% of the general populations; however, about 80% of those with Reiter’s Syndrome have the HLA-B27 gene.  This gene is associated with defending our body against infectious bacteria and viruses.  Suspicion has it that the presence of triggering bacteria resembling the HLA-B27 gene tricks our immune system into attacking ourselves.  Even though the cause of reactive arthritis is unknown, there seems to be a link between people who carry HLA-B27 and infection.

In general, reactive arthritis produces symptoms such as inflamed, painful, and red eyes, burning upon urination, penile discharge, abdominal pain and diarrhea followed by one-sided swelling and pain in the larger lower extremity joints, such as the knees and ankles.  Additional symptoms include increased back pain at night, ulcerations of the mouth or under a male’s foreskin, and psoriasis on the palms and soles of the feet.  The long-term outlook for most patients is good and joint pain and swelling usually settles down within weeks to months.  However, it is not unusual that some people experience recurring symptoms over years and occasionally, some may become disabled.  Aggressive treatment with DMARDs or biologics is indicated in those conditions.