Long-term Progression, Prognosis, and Treatment of Patients With Recurrent Ocular Manifestations of Reiter's Syndrome

Ophthalmology. 2003 Sep;110(9):1764-9. doi: 10.1016/S0161-6420(03)00620-1.

Abstract

Purpose: To investigate the spectrum of ocular involvement, to examine the clinical outcome, and to analyze the influence of treatment in patients with chronic ocular manifestations of Reiter's syndrome (RS) referred to a tertiary care ocular immunology service.

Design: Retrospective, noncomparative, interventional case series.

Participants: Twenty-five patients with RS evaluated at the Ocular Immunology and Uveitis Service of the Massachusetts Eye and Ear Infirmary from 1981 through 2001.

Methods: Charts of patients were reviewed and data on age, gender, follow-up time, ocular symptoms, extraocular involvement, ocular complications, therapy, and visual acuities were recorded.

Main outcome measures: Visual acuity, ocular complications, disease progression, clinical outcome, and systemic treatment.

Results: Twenty-five patients (20 male and 5 female) diagnosed with RS, with a mean age at presentation to our service of 37 years, were studied. The mean follow-up was 48.5 months. Eighty-five percent of patients tested were positive for human leukocyte antigen B27. Sixty-four percent of patients had a positive family history. All patients had oligoarthritis and enthesitis, most commonly affecting the back (56%), Achilles tendon (52%), and sacroiliac joint (24%). Eighty percent had a history of infection, most frequently urethritis (68%). Forty-four percent had a history of mucocutaneous lesions. All patients demonstrated ocular involvement at the time of diagnosis (68% with unilateral and 32% with bilateral disease), 84% had evidence of uveitis, 3% had scleritis, 2% had conjunctivitis, and 1% had pars planitis and iridocyclitis. During follow-up, the ocular complications included conjunctivitis (96%), anterior uveitis (92%), posterior uveitis (64%), keratitis (64%), cataract (56%), intermediate uveitis (40%), scleritis (28%), cystoid macular edema (28%), papillitis (16%), and glaucoma (16%). Systemic treatment for ocular inflammation was initiated in all patients. Ninety-six percent were treated with nonsteroidal anti-inflammatory agents. Eighty-eight percent were treated with corticosteroids, 64% requiring systemic prednisone. Immunosuppressive therapy was initiated in 52% of patients, with all receiving methotrexate. Seven patients required more than one immunosuppressive agent. The mean initial visual acuity was 20/25 in the right eye and 20/30 in the left eye. The mean final visual acuity was 20/25 in the right eye and 20/25 in the left eye.

Conclusions: Reiter's syndrome may be associated with chronic recurrent ocular inflammation. Systemic therapy (including immunosuppressive treatment) typically is required to control the ocular inflammation and to prevent progressive visual loss.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Arthritis, Reactive* / diagnosis
  • Arthritis, Reactive* / drug therapy
  • Arthritis, Reactive* / physiopathology
  • Conjunctivitis / diagnosis
  • Conjunctivitis / drug therapy
  • Conjunctivitis / physiopathology
  • Disease Progression
  • Eye Diseases* / diagnosis
  • Eye Diseases* / drug therapy
  • Eye Diseases* / physiopathology
  • Female
  • Follow-Up Studies
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Middle Aged
  • Prognosis
  • Recurrence
  • Retrospective Studies
  • Scleritis / diagnosis
  • Scleritis / drug therapy
  • Scleritis / physiopathology
  • Syndrome
  • Uveitis / diagnosis
  • Uveitis / drug therapy
  • Uveitis / physiopathology
  • Visual Acuity

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Glucocorticoids
  • Immunosuppressive Agents