Reiter's Syndrome

Reiter's syndrome has many possible symptoms with arthritis (joint inflammation) being an important one. There is no cure for Reiter's syndrome but you can control the symptoms.

Signs and Symptoms

• Arthritis—includes pain swelling stiffness and redness of joints. Usually occurs on one side of the body and usually involves joints of the spine pelvis legs fingers toes wrists feet or ankles.
• Conjuctivitis (inflammation under eyelids)—usually brief and mild
• Iritis (inflammation of the iris)—affects 5 percent of people with Reiter's and needs immediate medical treatment to avoid eye damage
• Urinary tract infection—burning during urination may or may not occur; may have pus drainage from penis
• Painless shallow ulcers on the penis
• Pus-filled sores on soles palms and penis; mouth sores
• Weight loss malaise morning stiffness fever
• Heart problems (rarely)

What Causes It?

Reiter's is a reactive arthritis which means that another illness triggers it. Scientists do not know what actually causes Reiter's. But they know that the following factors often precede Reiter's.

• HLA-B27 gene—20 percent of people who have this gene get Reiter's; about 80 percent of people with Reiter's have the HLA-B27 gene.
• Bacterial triggers such as salmonella shigella campylobacter
• Sexually transmitted disease triggers such as chlamydia
• White males ages 20 to 40 are at higher risk.

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. You may have a blood test to exclude other diseases and to see if you have the HLA-B27 gene.

Treatment Options

Treatment Plan

Treatment focuses on managing the various symptoms. Specialists for each symptom usually are needed. Your health care provider will give you drugs to reduce inflammation and pain and to maintain movement. Physical therapy can improve muscle tone maintain your range of movement and alleviate walking disturbances. Occupational therapy can teach you how to perform tasks with less stress on your joints. Surgery to reconstruct joints is performed if necessary. Psychological counseling or self-help groups for support and coping skills can be very helpful.

Drug Therapies

Prescription

• Nonsteroidal anti-inflammatory drugs (NSAIDS)—for example indomethacin reduce inflammation; side effects include gastrointestinal irritation bleeding and ulceration
• Corticosteroids—decrease inflammation and control pain
• Sulfasalazine—experimental drug for arthritis; usually well-tolerated but possible problems with long-term use
• Methotrexate—taken orally or by injection for chronic arthritis; used experimentally for Reiter's syndrome; frequent blood and liver tests are needed

Over the Counter

• Nonsteroidal anti-inflammatory drugs (NSAIDS)—for example ibuprofen

Complementary and Alternative Therapies

Alternative therapies may be effective with fewer side effects than drugs.

Nutrition

• Glucosamine sulfate (500 mg three times a day): stimulates cartilage growth and may be as effective for pain relief as NSAIDs without the side effects.
• Avoid nightshade family (tomatoes potatoes eggplant peppers tobacco); decrease saturated fats and alcohol (which can cause inflammation); increase oily fish nuts and flaxseed (which can decrease inflammation); increase fruits and vegetables (bioflavonoids).
• Vitamin C (1 000 to 3 000 mg a day) vitamin E (400 to 800 IU a day) beta-carotene (25 000 IU per day) selenium (200 mcg a day)
• Essential fatty acids (2 tbsps. oil a day or 1 000 to 1 500 mg twice a day): mix of omega-6 (evening primrose) and omega-3 (flaxseed)
• Minerals: zinc (45 mg a day) copper (1 mg a day) bromelain (500 mg three times a day) to reduce inflammation

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Unless otherwise indicated teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

Turmeric (Curcuma longa) 400 mg three times a day: helps with morning stiffness and joint instability works well when taken with bromelain

For urethritis: Mix three to four of these herbs in equal amounts and use 1 tsp. of mixture. Drink 1 cup tea three times a day or 30 drops tincture three times a day. Take daily during an acute flare-up and two weeks of the month as a preventative.

• Juniper (Juniperus communis): a diuretic for inflammatory conditions of the urinary tract; avoid if you have kidney disease.
• Uva ursi (Arctostaphylos uva-ursi): used as an antibacterial and anti-inflammatory for lower urinary tract; for acute cases of Reiter's only
• Horsetail (Equisetum arvense): soothing diuretic
• Licorice (Glycyrrhiza glabra): soothing anti-inflammatory do not take if you have high blood pressure.
• Meadowsweet (Filipendula ulmaria): anti-inflammatory

For iritis:

• Horsetail licorice meadowsweet (see dosage directions above)
• Eyebright (Euphrasia officinalis) and bilberry (Vaccinium myrtillus) have been historically used for inflammation of the eyes. Drink 30 to 60 drops tincture three times a day or 1 cup tea three times per day or use tea to make compresses for acute relief: soak a cotton ball or cloth in a cooled tea and place over the eyes.

Acupuncture

As with other forms of arthritis acupuncture may be effective at stimulating the immune system and reducing inflammation.

Following Up

The initial attack usually lasts three to six months. Most people maintain near-normal lifestyles with physical and occupational adjustments.

Supporting Research

Bartram T. Encyclopedia of Herbal Medicine. Dorset England: Grace Publishers; 1995:368–369.

Gruenwald J Brendler T Jaenicke C et al eds. PDR for Herbal Medicines. Montvale NJ: Medical Economics Company; 1998.

Koopman WJ ed. Arthritis and Allied Conditions. 13th ed. Baltimore Md: Lippincott Williams & Wilkins; 1996.

Murray MT Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin Calif: Prima Publishing; 1998.

Weiss RF. Herbal Medicines. Beaconsfield England: Beaconsfield Publishers; 1998:339.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.