Symptoms of Reiter's syndrome Reiter's syndrome often begins following inflammation of the intestinal or urinary tract. In susceptible people, this inflammation sets off a disease process that involves the joints, eyes, urinary tract, and skin. A brief description of how each of these may be affected is below. Not all of these symptoms occur in every person with Reiter's syndrome. Nor do they all occur at once in the same person. Symptoms of the disease tend to come and go, but not always at the same time as the worsening of the joints. Joint swelling When Reiter's syndrome first begins, it is characterized by a great deal of swelling and pain in the affected joints. Joint involvement is usually asymmetric (meaning it affects different joints on opposite sides of the body) and confined to a small number of joints. Often, the spine, sacroiliac joints, and large joints of the legs are involved. A few small joints in the toes or fingers also may be affected. In addition, people with Reiter's syndrome may experience inflammation in areas where tendons connect to bones, as in the heels. The joint involvement of Reiter's syndrome tends to follow one of two courses. A small percentage of people have continuing joint involvement that is constant. Most people, however, have periodic attacks of arthritis that last from three to six months. In each attack, the general pattern and severity tend to be similar to previous attacks, with a small number of joints--often different joints--involved each time. After the first attack, almost half of those with Reiter's will never have another attack. Statistics are similar after the second attack. But with subsequent attacks, it is more likely that the disease will become a permanent form of arthritis. In most cases, the joint inflammation that is associated with Reiter's syndrome does not lead to permanent joint damage or disability. Conjunctivitis About 40 percent of people with Reiter's experience conjunctivitis, an inflammation of the membranes under the eyelids, early in the disease process. Conjunctivitis may be so mild that it's hardly noticed, or it may be painful and accompanied by secretions. Fortunately, it usually is short-lived and rarely causes permanent damage. Later in the disease process, about five percent of people with the disease develop iritis, an inflammation of the iris and deeper tissues that causes the pupil to open and close. Iritis is a serious condition; immediate medical attention by an ophthalmologist is required. If it is not promptly treated, scarring may occur and affect vision. Urinary tract involvement The most common form of urinary tract involvement in people with Reiter's syndrome is urethritis, an inflammation of the urethra, or tube that drains urine from the bladder out of the body. The typical symptom of urethritis, burning during urination, may or may not be present. In men, Reiter's often is accompanied by a discharge from the penis. The discharge usually is painless and carries no bacterial infection. Inflammation also may appear in the prostate gland of men with Reiter's. Cystitis, which is an inflammation of the bladder, is a common form of urinary tract involvement in women with Reiter's syndrome. In most cases these problems will go away on their own and cause no permanent damage. Skin problems People with Reiter's often experience small, hardly noticeable sores on the soft palate or back of their throat. Painless superficial sores on the penis occur in about one-third of men with Reiter's syndrome. Some women with the disease develop sores on their external genitalia. In addition, people with Reiter's syndrome may experience a rash on the soles of the feet made up of thickened and over-pigmented outer layers of skin. This type of skin involvement occurs less commonly on the palms of the hands and on other areas of the body.