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Clinical and laboratory criteria of the diagnosis of Reiter's disease are presented, based on many-year clinical and immunologic examinations of 254 male patients with this condition; these criteria help early and reliably diagnose this disease.
Cutaneous manifestations in a case of Reiter's disease were successfully treated by oral etretinate administration. The clinical and histopathological similarities between the skin lesions of Reiter's disease and those of pustular psoriasis, which is known to respond to aromatic retinoids, suggested this treatment.
A patient with a history of typical Reiter's disease developed a reversible, unilateral ascending motor neuropathy at a time when the disease was otherwise quiescent. This appears to be a case of isolated Reiter's neuropathy.
A double-blind trial comparing lincomycin hydrochloride (Mycivin) and placebo in 22 patients with Reiter's disease showed no significant difference in clinical or laboratory findings between the two groups. It is concluded that lincomycin hydrochloride is no more effective than placebo in the treatment of Reiter's disease.
HLA antigens were determined in 25 Finnish patients with both Reiter's disease and skin lesions identical with psoriasis vulgaris. HLA B27 was found in 23 cases (92%) B13 was found in one case, Bw17 and Bw37 were not found at all. The absence of these three "psoriatic" HLA antigens in the present series indicates that the psoriasis-like skin lesions belong to the varying clinical picture of Reiter's disease and not to the HLA linked psoriasis vulgaris.
Chrisanol therapy was provided to 172 men suffering from Reiter's disease, having histocompatibility antigen B35 and its combination with B27 as well as B17 and B11 indicating that the articular syndrome may run a persistent and grave course. Chrisanol therapy brought about a decrease of the activity of complement, lysozyme, bactericidal activity of blood serum, a reduction of the content of serum IgG, and autoimmune reactions parameters. Chrisanol therapy was tolerated well. The ten-year follow-up revealed relapses in 8.3% of the patients.
A case of Reiter's disease in a 15-month-old child is presented. The manifestation of this syndrome in childhood is an extraordinary event, so far few cases only have been observed. The symptoms of the syndrome are urethritis, arthritis and iritis. A specific infection could not be demonstrated. The typical clinical features are discussed and compared with earlier reports. Speculations on the etiology are made.
The case history of a female who presented with erythema nodosum is described, and the diagnosis of Reiter's disease is proposed. Reference is made to literature on Reiter's disease in the female and to sacroiliac joint abnormalities which have been observed in this condition.
HL-A27 were found in 31 of 48 patients with Reiter's disease (65%) as compared with 8% of 2 103 health controls. It is suggested that HL-A27 is closely related to the inheritance of a special immune response leading to an increased susceptibility to a special type of reactive arthritis which Reiter's disease has in common with ankylosing spondylitis and a certain type of psoriatic arthritis.
We have studied left ventricular function by non-invasive methods in 28 patients with ankylosing spondylitis and 14 with Reiter's disease and compared them with 42 normal subjects. A dilated and poorly contracting left ventricle with abnormal systolic time intervals were found in five (18%) of those with ankylosing spondylitis and two (14%) with Reiter's disease. Our results suggest that the high cardiovascular morbidity and mortality in these diseases may be due to abnormality of the myocardium in the absence of valve disease.
Based on analysis of the data on 124 patients with significant diagnosis of Reiter's disease, coxitis was discovered in 38 (30.8%) of them. During examination, the early clinical signs were revealed to diagnose any coxitis as were differential diagnostic signs to delineate lesions of the hip joints in seronegative arthritis and/or spondylarthritis (Reiter's disease, ankylosing spondylarthritis and psoriatic arthritis), having an analogous clinico-roentgenologic appearance.
We studied characteristics of ocular inflammation in Reiter's disease after Salmonella enteritis in eight patients. After an acute onset with diarrhea, fever in six patients, and headache in three patients, all patients developed arthritis; six patients had myalgia; six patients, urethritis; and one patient, carditis. Sacroiliitis was found in four patients. All patients had HLA-B28 antigen. Conjunctivitis occurred in seven patients. It was mostly mild with no chemosis, follicles, or keratitis, and resolved in ten days. In one case palpebral edema, chemosis in the conjunctiva, and purulent exudate were seen. One patient had transient episodes of keratitis and corneal erosion for two months and episodes of conjunctivitis for 11 months. Three patients developed unilateral acute anterior uveitis with aqueous flare, cells, fine keratic precipitates, and fibrinous exudation from three to four years after the onset of the illness. One of these patients had vitritis and macular and papillary edema.
Infectious agents were detected in 100% of examined children with Reiter's disease (RD). Chlamydia trachomatis were detected in 98% of cases. In children with RD lesions of joints and eyes often took acute forms with cases of sacroiliitis, early muscular atrophy and conjunctivitis. In 95% of the patients the prostatitis manifestations were detected. In children with RD a rised number of CD lymphocytes in combination with the fivefold rised IL-4 content, an essential increase in the activity of C2-C5 components of the complement and a multiple rised level of PSA were registered.
Starting from index patients with confirmed Reiter's disease, a clinical and immunogenetic study was performed on 12 families in which there were further cases of arthritis. Altogether 51 family members were investigated and some information was available on 15 additional members. In most families there were two or three affected members in addition to the proband. The manifestations included acute polyarthritis (16 cases), which frequently followed urethritis or occurred as a complication of Yersinia or Shigella infection, and chronic arthritis (9 cases), either ankylosing spondylitis or peripheral arthritis. The latter characteristically had a remitting course, affecting mainly the large joints. Not a single subject had sero-positive rheumatoid arthritis. The HLA B27 gene was detected in all 12 families, and served as the main indicator of the familial trait for developing arthritis. In individual patients however, the association was not especially close, since there were members with this antigen who did not have arthritis in spite of a seemingly adequate triggering stimulus and others who had arthritis but not the antigen.
The case of Reiter's disease with eleven years old boy was reported in this paper. Thanks to anamenstic's data, clinical examination, laboratory findings and radiological evaluation we have established the diagnosis mentioned above. Joint's symptoms and signs prevail in clinical picture, and there are eye's disturbances and urinary symptoms. The patient was treated by antibiotics, uroantiseptics, steroids and non-steroids therapy too. Also, adequately phisiatric's treatment had a good influence to the course of this disease.
A case of Reiter's disease occurring in a girl aged 7 is reported. It commenced with diarrhoea precipitated by a salmonella infection. The patient has suffered from recurring arthritis accompanied by conjunctivitis, oral lesions and nail changes. The course was protracted, the patients having had two recurrences during a period of 6 1/2 years. The first of these lasted for more than one year, the second for a few months. The patient carries the histocompatibility antigen HLA B27 and a review of the literature would seem to establish that the correlation between Reiter's disease with childhood onset and this tissue antigen is as close as that reported in adults. It is stressed that the patient is now in complete remission and that no radiological changes have been demonstrated despite the protracted course. The patient shows no signs either of spondylitis or of sacro-iliitis.
The authors prospectively encountered skin biopsies from 20 patients which demonstrated a neutrophilic or suppurative and granulomatous folliculitis accompanied by a folliculocentric neutrophilic vascular reaction of Sweet's-like or leukocytoclastic vasculitis subtypes. While in each case the histomorphology raised diagnostic consideration of bacterial folliculitis, patients frequently expressed systemic complaints such as arthritis, fever, and malaise, and special stains for micro-organisms were negative. Among the clinical presentations were folliculitis, vasculitis, acneiform eruptions, vesiculopustular lesions, and erythema nodosum-like lesions, with the legs, arms, and upper back being the most commonly involved sites. Nineteen patients were found to have specific underlying systemic diseases, namely, inflammatory bowel disease, Reiter's disease, Behçet's disease, hepatitis B, connective tissue disease including mixed connective tissue disease and rheumatoid arthritis, scrofuloderma, and hematologic dyscrasias. The other patient had antecedent bacterial sinusitis in the setting of atopy. The folliculocentric nature of these lesions may reflect preferential processing of antigens through the hair follicle and/or homology between bacterial and follicular heat shock proteins in the susceptible host, namely, one who responds excessively to exogenous antigenic triggers. Folliculitis with folliculocentric vasculopathy may be a clue to underlying systemic disease and/or an extracutaneous infection. Certain light microscopic features in concert with the clinical presentation may distinguish such cases from conventional infectious folliculitis.