Daily Bolus of LR: Reiter’s Syndrome

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May 24, 2011 by dailybolusoflr

Reiter’s syndrome

·         This is an inflammatory spondylopathy, which typically affects young males after infection with Chlamydia trachomatis, Salmonella, Shigella, Yersinia or Campylobacter

·         Patients will often have a history of dysuria or penile discharge associated with Chlamydia infection, or diarrhea and other gastrointestinal symptoms

·         The typical triad includes nongonoccocal urethritis, assymmetic polyarthritis, and conjunctivitis

·         Asymptomatic presentations are more typical in women


·         The Urethritis is usually present before the development of the joint pain, although patients may be asymptomatic

·         The Polyarthritis is asymmetric and most often present in the knees, ankles and feet

o   The heel is a commonly affected location and is known as “lover’s heel” given the association with Chlamydia infection

·         Ocular findings can range from conjunctivitis to frank uveitis and vision loss

·         Dermatologic findings may include ulcers on the oral mucosa or tongue, which begin as painless shallow ulcers and become painful as they become deeper ulcerations

o   Hyperkeratotic lesions may develop on the palms and soles (keratoderma blennorrhagia) and have a waxy appearance

o   Digits (both fingers and toes) may develop fusiform swelling, which can also be seem in psoriatic arthritis

·         Patients may present with back pain and limitation of movement, which is a finding seen in the most common type of seronegative spondylarthopathy, ankylosing spondylitis

·         Treatment for this condition is with anti-inflammatory agents and in instances of infectious associated disease (Chlamydia trachomatis, Salmonella etc) treatment with antibiotics




Rosen’s Emergency Medicine



Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions


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