Reiter syndrome is a type of reactive arthritis that occurs as a reaction to a bacterial infection that started elsewhere in the body. Reiter syndrome occurs when reactive arthritis is present along with inflammation of the eyes and urinary tract. It is not contagious, however, the bacteria that trigger it can be passed from one person to another. There is no cure for Reiter syndrome, but you can control the symptoms.

• Arthritis -- includes pain, swelling, stiffness, and redness of joints (usually involves joints of the knees, ankles, spine, and feet, and, less commonly, the wrists and fingers).
• Conjunctivitis (inflammation under eyelids) -- usually brief and mild.
• Iritis (inflammation of the iris) -- affects 5% of people with Reiter syndrome and requires immediate medical treatment to avoid eye damage.
• Urinary tract infection -- burning during urination may or may not occur. Men may have pus drainage from penis.
• Inflammation of the cervix or fallopian tubes.
• Painless, shallow ulcers on the penis.
• Pus-filled sores on soles, palms, and penis. May also include mouth sores.
• Rashes of small nodules on the soles of the feet, and, less often, on the palms of the hands or elsewhere.
• Weight loss, malaise, morning stiffness, fever.
• Heart problems, affecting about 10% of people who have Reiter syndrome.

Reiter syndrome is a reactive arthritis, which means that another illness brings it on. There is no actual known cause, although researchers know it is triggered by a bacterial infection, and that genetics may play a role. The following factors usually precede Reiter syndrome.

• HLA-B27 gene -- About 80% of people with Reiter syndrome have the HLA-B27 gene. Only 6% of people who do not have the syndrome have the HLA-B27 gene.
• Bacterial triggers, such as salmonella, shigella, Yersinia, and Campylobacter.
• Sexually transmitted disease triggers, such as chlamydia.
• White males ages of 20 - 40 are at higher risk.

Tell your health care provider about any intestinal conditions or sexually transmitted diseases you have had recently. You may be tested for chlamydia. The doctor may test samples of cells from your throat as well as the urethra in men or the cervix in women. Urine and stool samples may also be tested, and you may need to have a blood test to exclude other diseases and to see if you have the HLA-B27 gene.

Drug Therapies

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Injectable corticosteroids
• Sometimes: drugs that suppress the immune system, such as sulfasalazine or methotrexate
• Occasionally, drugs called tumor necrosis factor (TNF) inhibitors that are also used to treat rheumatoid arthritis: etanercept (Enbrel), infliximab (Remicade), or adalimumab (Humira)

Your health care provider may also prescribe drugs to treat specific symptoms.

Complementary and Alternative Therapies

Alternative therapies may help reduce inflammation and regulate the immune system.

Nutrition and Supplements

Under the guidance of a qualified natural health care provider and in cooperation with your regular doctor, a short cleansing and detoxification program may help calm an acute inflammatory episode. This program can be a 3-day juice fast or a slightly longer plan that includes fresh juices, brown rice, and steamed vegetables. Do not fast without a doctor's supervision.

• Glucosamine (500 mg three times a day) and chondroitin sulfate (800 - 1,200 mg per day, divided in 2 - 4 doses): may provide pain relief over time, although it has only been studied in non-inflammatory arthritis.
• Decrease intake of saturated fats and alcohol (which can make inflammation worse). Increase oily fish, nuts, and flaxseed (which can lessen the amount of inflammatory chemicals your body produces). Increase fruits and vegetables (flavonoids).
• Vitamin C (1,000 - 3,000 mg a day), vitamin E (400 - 800 IU a day), beta-carotene (25,000 IU per day), selenium (200 mcg a day).
• Omega-3 fatty acids (2 Tbs. oil a day or 1,000 - 1,500 mg two times per day of flaxseed or fish oil) help lessen the body's inflammatory response. Higher doses may be helpful, but should be used only under the supervision of a physician. This supplement may interact with other medications, such as anti-inflammatory medications and blood thinners.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

The following herbs help reduce inflammation:

• Bromelain (250 - 750 mg three times a day between meals), an enzyme derived from pineapple.
• Turmeric or curcumin (Curcuma longa), yellow pigment of turmeric, (200 - 400 mg three times a day between meals). Curcumin enhances the effect of bromelain.
• White willow (Salix alba) bark contains salicin, which acts similarly to aspirin to reduce inflammation and pain. Make a tea with 1 - 2 g of bark boiled in a cup of water. Strain and cool. You can also make tea with 2 - 3 tsp. of powder in 1 cup of boiling water. Drink three times a day. Do not use if you are allergic to aspirin or take blood-thinning medication.
• Licorice (Glycyrrhiza glabra) (3 cups tea a day). Do not take licorice if you have high blood pressure or heart failure, or if you are taking corticosteroids prescribed by your doctor.
• Cat's claw (Uncaria tomentosa) (20 mg per day) shows evidence of reducing inflammation in rheumatoid arthritis, another autoimmune disease, but has not been studied in Reiter syndrome.
• Boswellia (Boswellia serrata), 300 - 400 mg three times per day.

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 2 weeks of the month as a preventative.

• Corn silk (Zea mays) has been used traditionally to soothe irritated membranes in the urinary tract. This herb also has diuretic properties.
• Uva ursi (Arctostaphylos uva ursi) (500 mg four times a day or in tea described above): used as an antibacterial and anti-inflammatory for lower urinary tract. Used for acute cases of Reiter syndrome only -- and only under the supervision of your health care provider.
• Horsetail (Equisetum arvense) (300 mg three times per day or in tea described above): diuretic. Do not take horsetail if you have kidney disease or heart disease.
• Meadowsweet (Filipendula ulmaria): anti-inflammatory. Do not take meadowsweet if you take blood-thinning medication or herbs.

For conjunctivitis:

• Horsetail, licorice, meadowsweet (see dosage directions above).
• Eyebright (Euphrasia officinalis) and bilberry (Vaccinium myrtillus) can be used as a compress for inflammation of the eyes. Use five drops of tincture in a ¼ cup of boiling water, or steep 1 tsp. herb in 1 cup boiling water for 5 - 10 minutes, strain, and cool. Soak cloth or gauze in solution, and apply over the closed eyes for 10 minutes, three to four times a day.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for Reiter syndrome based on their knowledge and experience. Finding the right homeopathic remedy is complicated, and you should consult a competent homeopathic practitioner. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Rhus tox -- for joint stiffness, worse when starting to move then easing with more movement.
• Arsenicum album -- for burning pain in the urinary tracts accompanied by anxiety.
• Sulphur -- for all sorts of burning pain, including conjunctivitis with redness that is accompanied by digestive complaints.

Acupuncture

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

The initial attack usually lasts 3 - 6 months. Most people maintain near-normal lifestyles with physical and occupational adjustments.

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

Castro M. The Complete Homeopathy Handbook. New York: St. Martin's Press; 1990.

Cimaz R, Meregalli E, Biggioggero M, Casadei A, Careddu P. Arthritis and infections. Minerva Pediatr. 2005;57(4):181-8.

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

Howard JH, Litovsky SH, Tallaj JA, Liu X, Holman WL. Xenograft calcification in Reiter's syndrome. J Heart Valve Dis. 2007;16(2):159-61.

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

Mur E, Hartig F, Eibl G, Schirmer M. Randomized double blind trial of an extract from the pentacyclic alkaloid-chemotype of uncaria tomentosa for the treatment of rheumatoid arthritis. J Rheumatol 2002;29:678-81.

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.