Introduction:

Reiter or Reiter' s syndrome is a type of reactive arthritis, meaning that it happens as a reaction to a bacterial infection in the body. The infection usually occurs in the intestines, genitals, or urinary tract. Reiter syndrome includes joint swelling and pain (often in knees, ankles, and feet) along with inflammation of the eyes and urinary tract. It is not contagious, but the bacteria that trigger it can be passed from one person to another. There is no cure for Reiter syndrome, but you can control the symptoms. For most people, symptoms will disappear in 2 - 6 months.

Signs and Symptoms:

• Arthritis -- includes pain, swelling, stiffness, and redness of joints (usually the knees, ankles, spine, and feet).
• Conjunctivitis (inflammation of the eye) -- usually brief and mild.
• Iritis (inflammation of the iris of the eye) -- less common but requires immediate medical treatment to avoid eye damage.
• Uveitis (inflammation of the inner eye) -- less common but requires immediate medical treatment to avoid eye damage.
• Urinary tract infection -- pain or burning during urination and urge to urinate. May include inflammation of the prostate or cervix. Men may have pus drainage from penis.
• Painless, shallow ulcers on the penis.
• Pus-filled sores on soles, palms, and penis. May also include mouth sores.
• Rashes of small nodules on the soles of the feet, and, less often, on the palms of the hands or elsewhere.
• Heart problems, affecting about 10% of people who have Reiter syndrome.

What Causes It?:

Reiter syndrome is a type of reactive arthritis, which means that another illness brings it on. Researchers don' t know exactly why some people develop Reiter syndrome after an infection while others don' t, although they suspect that genetics may play a role. The following factors may raise your risk for Reiter syndrome.

• HLA-B27 gene -- About 80% of people with Reiter syndrome have the HLA-B27 gene. Only 6% of people who do not have the syndrome have the HLA-B27 gene.
• Bacterial triggers, such as salmonella, shigella, Yersinia, and Campylobacter.
• Sexually transmitted disease triggers, such as chlamydia.
• White males ages of 20 - 40 are at higher risk. Women tend to have milder symptoms.

What to Expect at Your Provider's Office:

Tell your health care provider about any intestinal conditions or sexually transmitted diseases you have had recently. While there is no test for Reiter syndrome, you may be tested for chlamydia. The doctor may test samples of cells from your throat as well as the urethra in men or the cervix in women. Urine and stool samples may also be tested, and you may need to have a blood test to rule other diseases and to see if you have the HLA-B27 gene. Your doctor may refer you to a rheumatologist (a specialist who treats arthritis).

Treatment Options:

Drug Therapies

• Antibiotics -- if you still have the bacterial infection that triggered Reiter syndrome.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) -- lower inflammation. These drugs include ibuprofen (Advil, Motrin), naproxen (Aleve), and prescription drugs.
• Corticosteroids -- may be injected into affected joints to reduce inflammation.
• Immunosuppressants -- drugs that suppress the immune system, such as sulfasalazine or methotrexate, may be given in more serious cases.
• Tumor necrosis factor (TNF) inhibitors -- these drugs block a protein that causes inflammation in the body. They may be used in more severe cases and are also used to treat rheumatoid arthritis. TNF inhibitors include etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira)

Your health care provider may also prescribe drugs to treat specific symptoms, such as steroid eye drops for eye inflammation.

Complementary and Alternative Therapies

Although no complementary and alternative therapies have been shown to help Reiter syndrome specifically, some may help reduce inflammation and support your immune system.

Nutrition and Supplements

• Eat fewer foods that are high in saturated fat (like red meat and fried foods) and limit alcohol. These foods can make inflammation worse. Eat more fatty fish (like salmon), nuts, and flaxseed, which can help reduce the amount of inflammatory chemicals your body produces. Eat more fruits and vegetables, which have disease-fighting flavonoids.
• Shark cartilage or chondroitin sulfate (800 - 1,200 mg per day, divided in 2 - 4 doses) may help provide pain relief over time, although it has only been studied in osteoarthritis.
• Vitamin C (1,000 - 3,000 mg a day), vitamin E (400 - 800 IU a day), beta-carotene (25,000 IU per day), selenium (200 mcg a day) may help strengthen your immune system.
• Omega-3 fatty acids (2 Tbs. oil a day or 1,000 - 1,500 mg two times per day of flaxseed or fish oil) help reduce inflammation and are good for your heart. Higher doses may be helpful, but should be used only under the supervision of a physician. Omega-3 fatty acids can increase the risk of bleeding, so ask your doctor before taking them, especially if you are taking NSAIDs or blood thinners (anticoagulants).

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

The following herbs help reduce inflammation, although they have not been studied specifically for Reiter syndrome. Do not take these herbs without your doctor' s supervision. Many interact with each other and with other prescription medications, and can cause unwanted side effects.

• Bromelain (250 - 750 mg three times a day between meals), an enzyme derived from pineapple. It is sometimes combined with turmeric, because turmeric makes the effects of bromelain stronger. This combination can increase the risk of bleeding, so ask your doctor before taking it, especially if you are taking NSAIDs or blood thinners (anticoagulants).
• Turmeric or curcumin (Curcuma longa), yellow pigment of turmeric, (200 - 400 mg three times a day between meals). Turmeric enhances the effect of bromelain. Turmeric can increase the risk of bleeding, so ask your doctor before taking it, especially if you are taking NSAIDs or blood thinners (anticoagulants).
• White willow (Salix alba) bark contains salicin, which acts like aspirin to reduce inflammation and pain. Make a tea with 1 - 2 g of bark boiled in a cup of water. Strain and cool. You can also make tea with 2 - 3 tsp. of powder in 1 cup of boiling water. Drink three times a day. Do not use if you are allergic to aspirin or take NSAIDs or blood-thinning medication, as white willow can increase the risk of bleeding.
• Licorice (Glycyrrhiza glabra), 3 cups tea a day. Do not take licorice if you have high blood pressure, edema, or heart failure, or if you are taking corticosteroids prescribed by your doctor.
• Cat's claw (Uncaria tomentosa) (20 mg per day). In several studies, cat' s claw appears to reduce inflammation in rheumatoid arthritis, but has not been studied in Reiter syndrome.
• Boswellia (Boswellia serrata), 300 - 400 mg three times per day. Boswellia can increase the risk of bleeding, so ask your doctor before taking it, especially if you are taking NSAIDs or blood thinners (anticoagulants).

For urethritis:

• Uva ursi (Arctostaphylos uva ursi), 500 mg four times a day or in a tea as described above, has been used traditionally to treat urinary tract infections and is approved in Germany to treat bladder infections. It should be used for acute cases of Reiter syndrome only -- and only under the supervision of your health care provider.
• Horsetail (Equisetum arvense) (300 mg three times per day or in a tea as described above) is a diuretic that may help flush bacteria out of the urinary tract. Do not take horsetail if you have kidney disease or heart disease, or if you take diuretics (water pills).
• Meadowsweet (Filipendula ulmaria) helps fight inflammation. Do not take meadowsweet if you take blood-thinning medication (anticoagulants) or herbs.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for Reiter syndrome based on their knowledge and experience. Finding the right homeopathic remedy is complicated, and you should consult a competent homeopathic practitioner. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Rhus tox -- for joint stiffness, worse when starting to move then easing with more movement.
• Arsenicum album -- for burning pain in the urinary tracts accompanied by anxiety.
• Sulphur -- for all sorts of burning pain, including conjunctivitis with redness that is accompanied by digestive complaints.

Acupuncture

As with other forms of arthritis, acupuncture may help strengthen the immune system and reduce pain.

Following Up:

The initial attack usually lasts 3 - 6 months. Most people are able to maintain their usual activities with treatment.