Reiter's disease in women

Reiter's disease in its classic form is defined by the triad of arthritis, conjunctivitis, and urethritis and occurs predominantly in men. Recent descriptions have emphasized other ancillary findings: mucocutaneous lesions, plantar fasciitis, Achilles tendinitis, sausage digits, asymmetrical sacroiliitis, and an association with HLA-B27. This study describes 29 women followed over the past 4 years who have a rheumatic disorder most consistent with Reiter's disease. All 29 patients were seronegative, 72% presenting with an asymmetrical pauciarticular arthritis, and the majority evidenced lower extremity involvement. During the course of their illness, 52% of the patients developed either eye and/or urinary tract involvement. Additional features were mucocutaneous lesions in 8 patients, heel pain or Achilles tendinitis in 15 patients, sausage digits in 20 patients, and clinical sacroiliitis in 20 patients. HLA-B27 was positive in 59% of patients, and radiographic bone and joint abnormalities were present in 52% of the patients. The recognition of this group of patients has both therapeutic and prognostic implications, because they preferentially respond to indomethacin or phenylbutazone and often pursue a chronic course, albeit without widespread joint destruction.