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Reiter Syndrom

Morbus Reiter

(Urethro-konjunktivales-synoviales Syndrom)

Bei dem Reiter-Syndrom handelt es sich um eine Sonderform der sogenannten reaktiven Arthritiden (Gelenkerkrankungen)

Typisch ist die Symptomentrias aus Arthritis, Konjunktivitis (Bindehautentzündung des Auges) und Urethritis (Harnröhrenentzündung).

Nach gegenwärtigem Kenntnissstand betrifft die Erkrankung HLA-B27 positive Personen (80% der Patienten) nach einer Infektion des gastrointestinalen oder urogenitalen Systems mit Bakterien (meistens Chlamydien).

Häufigkeit

Die Inzidenz für Chlamydien basierte reaktive Arthritiden beträgt in den westlichen Ländern etwa 4-5 auf 100.000.

Symptome

  • Arthritis: Die Gelenkentzündung beginnt in der Regel etwa 2 bis 3 Wochen nach der lokalen Entzündung. Häufig verläuft diese primäre Infektion jedoch stumm, so dass es schwer fallen kann, einen solchen Zusammenhang herzustellen. Der Gelenkbefall befällt meist asymmetrisch die unteren Extremitäten.

    Die Arthritis ist steril (die Erreger sind im Gelenkpunktat nicht anzüchtbar)
  • Konjunktivitis
  • Urethritis
  • Reiter-Dermatose: Hautveränderungen an der Mundschleimhaut, den Genitalorganen, den Handflächen und Fußsohlen.


Diagnose

  • Anamnese der vorhergegangenen Infektes
  • Labor: Nachweis von HLA-B27 und des Erregers
  • Ausschluss anderer Erkrankungen des rheumatischen Formenkreises


Komplikationen

  • siehe Sklerodermie
  • Im Gegensatz zur diffusen Form der Sklerodermie können zeitlich begrenzte Remissionen autreten.


Therapie

  • symptomatische Behandlung der Entzündung mit nichtsteroidalen Antiphlogistika (z.B. Diclofenac)
  • krankengymnastische Therapie
  • Sanierung der zugrunde liegenden Infektion
  • Sulfasalazin oder Methotrexat bei chronischen Verläufen