Reiter's Syndrome In Children
Reiter’s syndrome is a special case of reactive arthritis. It is distinguished from other cases of reactive arthritis by the occurrence of arthritis, urethritis, and conjunctivitis. (Urethritis is irritation of the urinary tract and is typically evident because of pain or white blood cells in the urine.)
Children with Reiter’s syndrome sometimes have rashes, particularly on their hands and feet. They may also have severe, painful, acute anterior uveitis.
When evaluating a child for the diagnosis of Reiter’s syndrome, it is important to remember that the arthritis, urethritis, and conjunctivitis do not have to all be present on the same day. They may occur one after the other without ever overlapping in time.
Incomplete Reiter’s syndrome is just another term for reactive arthritis. Although Reiter’s syndrome with all of the findings is common in adults, it is rare in childhood.
The most important step in the treatment for children with infection-associated arthritis, including Lyme disease and Reiter’s syndrome, involves making sure the infection is properly treated. Once it is clear that the infection associated with the arthritis is no longer active, these children should be treated just like other children with spondyloarthropathies.
Most respond well to easily tolerated NSAIDs, but some may require indomethacin during the early phase of their arthritis. In most cases, the arthritis resolves completely over a period of a few months. Second-line agents are rarely required, but some children benefit from the addition of sulfasalazine.
Although intra-articular injection of corticosteroids may be useful if a single joint remains troublesome after the infection has been fully treated, oral corticosteroids are rarely necessary.
Physical Therapy and Surgery
Physical therapy to maintain strength and range of motion is often necessary during the acute phase of the disease. Surgery should not be necessary for a child with infection-associated arthritis unless it is necessary for treatment of the infection.
Once the infection is properly treated and has resolved, the long-term prognosis for children with infection-associated arthritis is very good.
Occasionally, children have recurrent episodes of arthritis with subsequent infections. Rarely, children may have an episode of infection-associated arthritis, recover, and then develop persistent spondyloarthropathy years later.
Thomas J.A. Lehman, MD
Chief, Division of Pediatric Rheumatology, Hospital for Special Surgery
Professor of Clinical Pediatrics, Weill Cornell Medical School
Reprinted from www.hss.edu