REITER'S SYNDROME.

Reiter's syndrome is defined by the classic triad of arthritis, urethritis, and conjunctivitis. It most often affects young people, with a peak onset during the 3rd decade of life. Like ankylosing spondylitis, however, it has also been reported in children and the elderly. Although men are most commonly affected, this preponderance is often overestimated because Reiter's syndrome in women may be associated with asymptomatic genitourinary disease and milder disease expression. Whereas post-venereal Reiter's syndrome is more common in males, post-dysenteric Reiter's syndrome affects the sexes equally. Reiter's syndrome is one of the most common causes of acute inflammatory arthritis in young men. Case studies of epidemic dysentery suggest an estimated incidence of Reiter's syndrome of approximately 4 cases per 1000 dysenteric subjects per year. Analysis of epidemic dysentery secondary to arthritogenic bacteria suggests that Reiter's syndrome develops in 2 to 3% of infected individuals whereas arthritis may develop in as many as 20% of HLA-B27+ infected individuals. Similarly, arthritis will develop in 1 to 3% of patients with non-gonococcal urethritis secondary toChlamydia trachomatisinfection. InHouston, the point prevalence of Reiter's syndrome was reported to be 33 per 100,000 men, and inRochester,Minnesota, the age-adjusted incidence rate for males younger than 50 years was noted to be 3.5 cases per 100,000 per year. More recent studies suggest that the incidence of Reiter's syndrome has markedly decreased in the human immunodeficiency virus (HIV) era, presumeably because of increased condom use.

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TABLE 287-4-- CAUSES OF SKELETAL HYPEROSTOSIS

Spondyloarthropathies (ankylosing spondylitis, Reiter's syndrome, psoriatic arthritis, reactive arthritis)

Diffuse idiopathic skeletal hyperostosis (Forestier disease)

Vitamin A intoxication, retinoid therapy (e.g., etretinate)

Hypoparathyroidism

Familial hyperphosphatemia

SAPHO syndrome