2. Reiter's disease,
- Sex:Men 3X > women
- General health:Good
- Antecedent events:IBD, psoriasis, non-gonococcal urethritis, dysentery.
- Prior arthritis:No
- Most common joints:Sacroiliac joints, spine, feet, heels, knees
- These chronic polyarthritides share a number of features: -
- Family history and the associated HLA-B27 haplotype
- Predilection for the sacroiliac joints and spine
- Common association with dermatitis
- Rheumatoid factor negative.
- - Asymmetric polyarthritis, especially involving the DIP joints, feet,
including the heels, and often a gradually progressive involvement of the
spine, with decreased spinal range of motion, decreased chest expansion, and
pain in the buttocks.
- Skin may demonstrate psoriasis or psoriatic-like lesions, mucus membrane inflammation, nail pitting and dystrophic changes.
- May also have conjunctivitis, urethritis, balanitis, and aortitis.
- - Radiologic evidence of sacroiliitis, spinal involvement with
syndesmophytes, peripheral enthesopathy with calcifications of tendons and
ligaments, destructive bone lesions at DIP joints.
- Negative rheumatoid factor, positive HLA-B27 antigen.
- Synovial fluid is often very inflammatory with > 25,000 leukocytes and may even appear purulent.
- -Methotrexate, 5-20mgs po once per week is the most
effective second-line agent.
-Oral minocycline (200 mg/day) recently appears safe and effective in reducing clinical and laboratory indexes of disease activity (Tilley et al, 1995)
-Hydroxychloroquine, 400 mg/d, and sulfasalazine, 1-3 g/d, are other popular choices.
-Cyclosporine and azathioprine may be helpful.
-Prednisolone, 7.5 mg daily for 2 years combined with other treatments reduces the rate of progression of rheumatoid arthritis (Kirwan et al, 1995). Low dose corticosteroids are most helpful with acute flares.