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Reiter's syndrome:
Introduction:
Reiter's syndrome is a form of reactive arthritis. It is not uncommon, but can be debilitating syndrome following intestinal infection or urinary tract. The most common gastrointestinal bacteria involved are Salmonella, Campylobacter, Yersinia, and Shigella. Reiter's syndrome is characterized by the trinity of arthritis, conjunctivitis, and urethritis, although not all three symptoms occur in all affected individuals (Hill Gaston & Lillicrap, 2003). Reactive arthritis associated with Reiter's syndrome may develop after a person eats food that was contaminated with bacteria. Although the initial infection may not be recognized, can be reactive arthritis continue to occur. Reactive arthritis typically involves inflammation of one joint (monoarthritis) or four or fewer joints (oligoarthritis), those that affect preferentially the lower limbs. The pattern of joint involvement is usually asymptomatic. Inflammation is common in for enthesis (a place ligaments and tendons attach to bones), especially in the knee and ankle.

The term Reiter's syndrome fell to resentment. Reiter's syndrome in the recent medical literature referred to are simply interactive, such as arthritis, which may or may not be accompanied by extraintestinal manifestations.

The Salmonella bacteria has been most often associated with rheumatoid arthritis studied interactive. In general, studies have found rates of salmonella linked to arthritis interactive ranging between 6 and 30% (Hill Gaston, and Lillicrap, 2003). The frequency of postinfectious Reiter's syndrome, however, was not well described. In the state of Washington study of outbreaks of salmonella transmitted by the stomach and intestines, while 29% developed arthritis, and only 3% growth triad of symptoms related to Reiter's syndrome (Durkin, et al, 2001). However, the set of a new joint pain after intestinal infection, is reported to be between 1 and 4% in adults with Campylobacter, Salmonella, or Shigella infections (Rees, et al, 2004). In addition, it can be of Caucasian individuals is likely to be more than those of Asian origin for the development of arthritis, reactive (McCall, et al, 2000), and children who may be less susceptible than adults to reactive arthritis after Salmonella infection (Rudwaleit, et al, 2001).

The frequency of arthritis, acute reaction of the other bacteria varies widely, and the frequency of Reiter's syndrome is not well studied. Reactive arthritis were reported to occur in between 0.6% and 24% of patients with acute gastroenteritis Campylobacter (Pope, et al, 2007). After Shigella infection, reactive arthritis later ranged between 1.5% to 7% (Hannu, et al, 2005).

There is a clear link made between reactive arthritis and a factor of the genetic factors called human leukocyte antigens (HLA) B27 genotype. Hala is the histocompatibility complex in humans, the main, these are proteins found on the surface of all cells of the body that contains the nucleus, especially in high concentrations in white blood cells (leukocytes). He believed that Hala - B27 may affect the elimination of bacteria infecting the individual or an immune response (Hill Gaston, and Lillicrap, 2003). Hala - B27 has been shown to be a predisposing factor in half over two thirds of individuals who suffer from arthritis, reactive (BART) and Segal, 1999; Hill Gaston, and Lillicrap, 2003). Hala - B27, while does not seem to predispose to primary infection itself, also increases the risk of rheumatoid arthritis is likely to be severe and long-term. This risk may be slightly larger for Salmonella and Campylobacter Yersinia associated with inflammation of the joints, but what is needed is more research to clarify this (Hill Gaston, and Lillicrap, 2003).
Why have some forms of reactive arthritis Reiter's syndrome has been called?.

One can also ask: "Why are not called Reiter's syndrome Reiter's syndrome any more?" The answer is that this syndrome is named Hans Reiter, who described the soldier with the triad of urethritis, and conjunctivitis, and arthritis after bloody diarrhea in 1916. However, the history of this constellation of signs actually preceded the description. What is worrisome is that Reiter was a high-ranking Nazi official who was responsible for medical experiments in concentration camps (Panush, and others, 2003 and Petersel & Segal, 2005). As a result, the term Reiter's syndrome has fallen from favor and reactive arthritis is preferred to describe the post-infectious arthritis, which may be accompanied by manifestations - Articular additional (such as inflammation of the urethra, conjunctiva).

What are the symptoms of Reiter's syndrome?.

The three most common symptoms of Reiter's syndrome and rheumatoid arthritis, conjunctivitis, and urethra. The onset of symptoms usually occurs one to four weeks after the initial infection and present acutely or may develop slowly over time. Inflammation of the urethra and urinary tract infection, often associated with symptoms such as discharge in males, although in some cases it may be circulated blood in the urine. Females may present with inflammation of the cervix. Urethra in males or females and can also be present without symptoms (BART) and Segal, 1999).

Ophthalmology, or eye, and manifestations occur in approximately one third of individuals with salmonella associated with inflammation of the joints (BART), and Segal, 1999). Participation of the eye in Reiter's syndrome is most commonly manifested as conjunctivitis, inflammation of the mucous membrane covering the eyeball. Conjunctivitis usually appears within a few weeks from the beginning of arthritis and inflammation of the urethra and the symptoms are usually mild, inconsistent, and bilateral (Li et al, 1986; Ostler et al, 1971). Cultures and negative bacterial infections and usually resolves within 10 days without treatment. Conjunctivitis is present in up to 50% of patients, and can change at any time during the course of the disease, although it is more common in reactive arthritis associated with urinary or Shigella infections (Kataria and Brent, 2004). Anterior uveitis, an inflammation in the eye of the Interior, and the second is the most common symptoms of Reiter's syndrome optical, which occurs in up to 12% of affected persons (Ostler et al, 1971). Acute inflammation of the iris in most cases, from one side, and recurrent (Lao and others, 1998; Yu et al, 2001). It is more frequent in those who Hala - B27 and positive sacroiliitis with individuals, inflammation of the sacroiliac (deficit and day) joint or area (Kataria and Brent, 2004). Conjunctivitis and uveitis can cause redness in the eyes, pain in the eye and irritation, and blurred vision. Other conditions also associated with visual Reiter's, including scleritis, cataract, glaucoma, cornea, papillitis, retinal and disc edema, blood vessels in the retina (Kiss et al, 2003).

Arthritis associated with Reiter's syndrome usually occurs rapidly, with the joints become hot and swollen; large effusions, or groups of fluids, and can develop in the knee joint (Hill Gaston & Lillicrap, 2003; Barth & Segal, 1999). Be the wrists and fingers and other joints are affected, although with less frequency. Joint pain without inflammation may also occur in other sites affected by inflammation. There is a condition called enthesopathy as usually happens, which it attaches to the tendon becomes inflamed bone (BART) and Segal, 1999; Kataria and Brent, 2004). Enthesopathies occur in 5 to 21% of individuals with salmonella associated with inflammation of the joints (BART) and Segal, 1999). Heel is the most common site with the development of heel pain and Achilles tendonitis, but the inclusion of pain in the patella (knee cap) tendon in the leg, and the largest of the two bones of the lower leg, may also occur. Some individuals with Reiter's syndrome may develop Heel Spurs, bony growths that cause chronic pain in the foot. Arthritis of Reiter's syndrome can also affect the joints of the back, causing ankylosing, inflammation of the vertebrae, disks attached to ligaments in the spine and asymmetric sacroiliitis (Yu et al, 2001).

For symptoms of reactive arthritis can vary greatly. Writings indicate that the majority of affected individuals recover within a year, although the interactive arthritis can become chronic (Kataria and Brent, 2004, Thompson and others, 1995). Up to 50% of people with arthritis, the reaction may be repeated bouts of arthritis, and 15 to 30 per cent develop chronic arthritis or sacroiliitis (Yu et al, 2001). In one study, 18 (67%) of 27 individuals who developed reactive arthritis after Salmonella infection still has symptoms at five years of follow-up (Thompson et al, 1995). The symptoms were severe enough to force a change in work for four people and wounded four damage was the target of the joints X-rays.

Other symptoms of Reiter's syndrome may include a painless rash on the penis in men called balanitis circular. Rash on the soles of the feet and, less often, perhaps on the palms of the hands or anywhere else, as it happens; This rash is called keratinization blennorrhagicum (or keratoses blennorrhagica) and is similar to psoriasis. Often start in the clear vesicles (blisters) on a red base and progress to macules (flat lesions), papules (raised lesions), and nodules (bumps Company) (Kataria and Brent, 2004). In addition, some people develop mouth ulcers that come and go. In some cases, these ulcers are painful and go without being unnoticed.

How is Reiter's syndrome treated?.

Symptomatic treatment with high doses of sedative drugs anti-inflammatory (NSAID) and steroid injections in the affected joints can be useful (BART) and Segal, 1999). Anti-inflammatory drugs that can reduce inflammation of the joints, usually used to treat patients who suffer from arthritis interactive. Some traditional anti-inflammatory drugs, such as aspirin and ibuprofen, are available without a prescription, but others can be more effective for reactive arthritis, such as indomethacin and tolmetin, must be prescribed by a doctor. Little is known about whether a new class of anti-inflammatory drugs, called COX-2 inhibitors, is effective for reactive arthritis, but it may reduce the risk of complications associated with traditional anti-intestinal infections (National Institutes of Health, 2004). For people who suffer from acute arthritis, had injections of corticosteroids directly reduce inflammation in the affected joint. The doctors usually prescribe these injections only after trying unsuccessfully to control arthritis with anti-inflammatory drugs.

A small percentage of patients with reactive arthritis have severe symptoms that can not be controlled with any of the treatments mentioned above. For these people, medicine that suppresses the immune system, such as sulfasalazine or methotrexate, may be effective (Clegg, et al, 1996; Creemers et al, 1994; National Institutes of Health, 2004).

Topical corticosteroids can be, which comes in cream or lotion, can be applied directly to the skin lesions associated with reactive arthritis. Topical corticosteroids reduce inflammation and promote healing (National Institutes of Health, 2004).

Antibiotics to eliminate the bacteria that cause inflammation of the joints can be described as interactive. And specific antibiotics prescribed depends on this type of bacterial infection. It is important to follow the instructions on how to take a lot of medicine and for how long, but the infection may persist. Usually, antibiotics are taken for 7 to 10 days or more (National Institutes of Health, 2004). Currently, however, there is no evidence to suggest that antibiotic treatment is useful once reactive arthritis has occurred (Hill Gaston & Lillicrap, 2003).

Several relatively new treatments, which suppress tumor necrosis factor (implemented), a protein involved in the inflammatory response in the body, may be effective for reactive arthritis and other spondyloarthropathies. These include etanercept and infliximab. The first of these therapies used to treat rheumatoid arthritis (National Institutes of Health, 2004).

Exercise, when introduced gradually, may help improve joint function. In particular, the term will be strengthened to maintain or improve range of motion exercises and joint function. Exercises strengthen the muscles builds up around the joint to better support them. Muscle-flexing exercises that do not move any joints can be done even when the person has inflammation and pain. Range of motion exercises improve movement and flexibility and reduces stiffness in the affected joint. For patients who suffer from pain in the spine or inflammation, exercises to stretch and stretch it back can be particularly useful in the prevention of long-term disability. Practice of water may also be useful. Before starting an exercise program, patients should talk to a health professional who can recommend the appropriate training (National Institutes of Health, 2004). What is the diagnosis for people who Reiter's syndrome rheumatoid arthritis or reactive?.

Most people with reactive arthritis recover fully from the initial symptoms of ignition, and was able to return to regular activities 2 to 6 months after the first symptoms. In some cases, it may be a symptom of arthritis last up to 12 months, although these symptoms are usually very mild and interfere with daily activities. About 20% of people with rheumatoid arthritis will be interactive chronic (long term) and rheumatoid arthritis, which usually is mild. Studies indicate that between 15 and 50% of patients will evolve to have other symptoms some time after the initial outbreak had disappeared (Yu et al, 2001; National Institutes of Health, 2004). Back pain, arthritis and the symptoms that are most commonly reappear. Up to one third of affected individuals will be chronic, acute arthritis, which is difficult to control with treatment and may cause joint deformities (Kataria and Brent, 2004; Leirisalo-Repo et al, 1997; National Institutes of Health, 2004; Yu et al, 2001). One study found that two thirds of individuals who developed reactive arthritis after Salmonella infection still has symptoms at five years of follow-up (Thompson et al, 1995). The symptoms were severe enough to force a change in the work of four of 18 people and wounded four damage was the target of the joints X-ray.

Generally, of course, relapse appears to be less common in the intestinal infection-related diseases associated with Chlamydia in reactive arthritis (out of polyethylene). Hala - B27 contributes to the development of chronic diseases, and therefore, the expectation is said to be less positive in those who Hala positive (Hill Gaston & Lillicrap, 2003; Leirisalo-Repo et al, 1997). How can the prevention of arthritis that the reaction?.

Because of arthritis interactive is the result of infection before, no one specific measure can be described for the prevention of Reiter's syndrome or reactive arthritis.

Bacteria known to cause reactive arthritis are sensitive to heat and other common disinfection procedures, including pasteurization of milk, adequate cooking of meat, poultry, or Ozonation and chlorination of water. This is the surest way to ensure that bacteria such as Salmonella, Campylobacter, and Shigella are killed during the cooking process is to use a digital food thermometer.