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Reiter's Syndrome or Reactive Arthritis
What is Reiter's Disease or Reiter's Syndrome and Why Was Its Name Changed to Reactive Arthritis?
Reiter's Disease/Syndrome is now referred to as “Reactive Arthritis.” It used to be called Reiter's Disease pursuant to its discovery by Dr. Hans Reiter, but the name was changed because it is believed that Dr. Reiter was associated with the Nazi party in World War II.
Reactive Arthritis is an autoimmune disorder that appears to be triggered by an abnormal immunological response to a prior infection of the gastrointestinal or genitourinary systems usually with salmonella, shigella, campylobacter, yersinia, or chlamydia.
There appears to be a genetic component because the HLA-B27 antigen blood test is often positive in patients who develop Reactive Arthritis. HLA-B27 is found on the surface of white blood cells. It is one of many “human leukocyte antigens” (HLAs), which are proteins that are involved in differentiating “self” from “non-self,” as when organs are transplanted from a donor to a recipient.
How the HLA-B27 antigen interacts with infections to cause Reactive Arthritis has been investigated for many years, but it's still not entirely known how that happens.
The Classic Triad
There is a classic “triad” of arthritis, conjunctivitis, and urethritis that many patients with Reactive Arthritis develop. However, that's not true for all patients. Some patients develop only one or two of the triad.
Symptoms of Reactive Arthritis
Reactive Arthritis is considered an autoimmune disease marked by inflammation (swelling and pain) of multiple joints, erosions of cartilage and bone of involved joints, and inflammation at the insertion sites of ligaments and tendons, which is referred to as “enthesitis.” Patients with Reactive Arthritis often develop “sacroiliitis,” or inflammation of one or both sacroiliac (SI) joints. Low back pain and stiffness, that may be worse at night or in the mornings, are commonly seen as a result.
Frequent symptoms include pain and swelling of the knees, ankles, heels, and feet, along with inflammation of the eyes and urinary tract. Reactive arthritis appears to be associated with an antecedent infection that serves to “trigger” the arthritis, but the arthritis itself is not contagious.
Patients can develop diffuse swelling of the toes, which often is referred to as “sausage” toes. They can develop pustular skin rashes of the palms of the hands and the soles of the feet. Mucous membrane lesions of the mouth are not uncommon.
The arthritis may resolve over a period of several months in many patients, but approximately 30% of patients develop chronic arthritis that lasts many years, even a lifetime.
Diagnosis of Reactive Arthritis
Reactive Arthritis is diagnosed usually by rheumatologists. The “classic triad” of inflammatory arthritis, conjunctivitis, and urethritis (when it's present) can help to make the diagnosis purely on clinical grounds. However, doctors often do lab tests and x-rays to sort out Reactive Arthritis from other forms of arthritis, such as rheumatoid arthritis, lupus, ankylosing spondylitis and psoriatic arthritis.
The HLA-B27 antigen blood test is often positive in Reactive Arthritis, but not always. Markers of inflammation, such as the sedimentation rate (ESR) and the C-Reactive Protein (CRP) may be elevated. X-rays of the sacroiliac joints may show unilateral or bilateral (less common) sacroiliitis, with erosive changes. X-rays of involved joints may show erosions.
The Cause of Reactive Arthritis is Not Known
Although we know that the immune system, infection, and genetics (HLA-B27 antigen) are involved, the precise way they come together to cause arthritis and the other symptoms that patients with Reactive Arthritis suffer from is not really known.
Rarely, Reactive Arthritis has developed in patients who have undergone bone marrow (stem cell) transplantation for other conditions, such as lymphoma or leukemia. [Ref: Koch B and Pfreundschu M. “First manifestations of seronegative spondylarthropathy following autologous stem cell transplantation in HLA-B27-positive patients.” Bone Marrow Transplantation(2000) 26, 673–675.]
Ankylosing spondylitis and psoriatic arthritis are other arthritic disorders that have similarities to Reactive Arthritis, including having sacroiliitis and a positive HLA-B27 antigen blood test.
Treatment of Reactive Arthritis
In many patients who develop Reactive Arthritis, the symptoms last several months (2-6 months) and then gradually resolve. However, that's not the case in about a third of patients, who unfortunately develop chronic arthritis that may become crippling and deforming.
Treatment includes non-steroidal anti-inflammatory drugs (NSAIDs), methotrexate, and some of the “biologic” drugs, such as Enbrel and Humira.
Disability Benefits for Reactive Arthritis
In patients who suffer from chronic Reactive Arthritis, long-term disability (LTD) benefits may be available under the Social Security program (SSDI) or from an employer-based group plan (ERISA). In order to get benefits, it is important to work with your doctor and an experienced disability attorney to get the proper documentation into your medical records.
That documentation must include not only the diagnosis of Reactive Arthritis and the symptoms that you have, it must also include specific impairments and restrictions with respect to your functional exertional capabilities.
Your best chance of getting an LTD benefit award, either from SSDI and/or an ERISA-insurer, is if you can document in the medical records that you are unable to perform a full range of “sedentary work,” meaning a sitting limitation of 4-6 hours in an 8-hour workday, standing/walking less than 2 hours, and lifting/carrying less than 10 pounds.
Working with your treating physician and with an experienced disability attorney will help improve the likelihood of a successful outcome. At Law Med, we are knowledgeable and experienced in handling SSDI and ERISA claims and know the important legal and medical points essential to litigate your claim effectively.