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- [Voiceover] Reiter's syndrome or also called reactive arthritis is classified as an auto-immune arthritis. But it's a little different from the other ones, and I'll explain why. So auto-immune means that our body is being attacked by our own immune system. And usually that should be for no good outside reason. So we have these cells in our bodies, our tissue, just doing their thing. And then the immune system somehow misrecognizes them as a target and begins to attack them. So you get the inflammation and the symptoms. That's the normal way we think of auto-immune disease. For Reiter's it's a little different, oops. That's not the right place. So for Reiter's I would say it's different because it has a different sort of trigger. So let's look at these purple circles to represent our own body's tissues. Imagine that we have some sort of antigen, an infectious attacker. This could be a bacteria, a virus, something that enters our body and triggers the immune system. And their job, the immune system's job is to kill these things. So they attack them, and we get rid of the infection like we're supposed to. And then over time, so this white line here, dotted line represents the passage of time. So our body is again, it has these normal tissue. And it's these red arrows here that's developed for the antigen here that crosses over and somehow again thinks the body cells are those attackers. That's when the auto-immune process begins again and it begins to attack its own, our own body. So that's why it's called reactive arthritis. It's not just auto-immune out of nowhere. It's reacting to an infection that our body already went through. In other words, Reiter's is usually associated with an infection. Associated with an infection. And it's something that happens after the original infection is gone and the residual immune effect. There are two big categories of infections that are particularly associated with Reiter's. There's the GI infections. So attacking our gastrointestinal system. So food poisoning, like salmonella or shigella, which are pretty common, can lead to Reiter's after the original insult is gone. Then we have genitourinary. So a lot of sexually transmitted infections, like the two big ones, gonorrhea and chlamydia. Chlamydia. And we just know from the demographic of those infections that they're more common in younger men, and so is Reiter's. So the population we're looking at would be males approximately maybe 20 to 40, younger ones. Of course, anyone could get it. But this population is the one that gets it the most often. All right, everyone knows about Reiter's from this neat little phrase that we invented, can't see, can't pee, can't climb a tree. And that tells you the cluster of symptoms. So first, can't see. So in the eyes we have some sort of reaction. So the immune cells that were generated attack the tissue in the eye. Here we get conjunctivitis, pink eye. Conjunctivitis. And uveitis, which is in the anterior chamber of the eye. Now, conjunctivitis itself could be bacterial or viral. But in this case it is neither. It is a residual reaction of a previous infection. So the eye itself is not infected. But the immune system is acting like they are. And then you have can't pee. And not necessarily cannot pee, but it hurts to pee. And we have urinary symptoms. And I'm not gonna draw the body parts for peeing. I think we should already know them. So we have the urethra being inflamed. Urethritis. So it would make it painful to pee. As well as in women inflammation of the cervix. Cervicitis. Even though this is not technically in the urinary system, since everything is so close, inflammation in the area can lead to urinary symptoms. And then these patients can't climb a tree. And this is where we hit on the arthritis aspect. Can't climb tree. I'm gonna draw a little tree. There we go. It's pretty smart to describe it this way to make everything rhyme. In terms of the arthritis that we see, it's large joints. So your hips, your knees, not really in the little joints of your fingers and toes, but always possible. Large joints asymmetric, so left and right not the same joints. And remember that again we don't have an ongoing infection in the joints. So if you took a sample of the fluid and you tried to grow a culture, fluid should be negative. So this is very different from having infectious arthritis, which you can get gonorrhea in the synovial fluids. That would be fluid positive. But this is fluid negative because the infection is not ongoing in any of these organs. The time frame is that the Reiter's syndrome can start one to three weeks after the original infection but then go up to things like 45 days. So there's a long incubation period. And it's uncertain of when the symptoms start. So one to three weeks infection should be gone. However, it's possible that it's not gone. Gonorrhea, chlamydia in women, especially, can be asymptomatic. So speaking of treatment, it's important to once Reiter's is suspected or diagnosed, is to see if the infection is still there. So it's probably worth it to do a gonorrhea, chlamydia test, and if possible, treat them with antibiotics. Antibiotics. So as the patients would happen a few weeks ago, they had other symptoms they could think of. If you can isolate and find the infection and it's treatable, of course we treat the underlying disease first. Antibiotics treat original infection. So TX is just a shorthand for treatment. Original infection. And then it's really symptom control. So symptoms can be severe to mild, depending on the person. But pain management obviously a huge part of it for arthritis, for the urinary symptoms, and for the eyes. So NSAIDs, possibly stronger meds if they really need it. And then to reduce inflammation a little bit it might help them if their symptoms are intolerable, things like steroids, although it's probably not necessary and the symptoms should go away. However, this is just a pattern for most people. They don't have any residual symptoms. But it could be chronic, especially if the infection they're getting happens to be repeated. It can turn into chronic arthritis as well as chronic symptoms in other parts of the body. In fact, it's been associated with heart disease in the long, chronic term. So really, this is kind of open-ended here because it's possible, it's worth thinking about, but it's not the norm. So remember that reactive arthritis associated with infection and in populations with a high risk for infection and they have this cluster of symptoms, they remember this special version of an infectious auto-immune disease.