Clinical characteristics in male and female uro-arthritis or Reiter's syndrome

To investigate the clinical characteristics of Reiter's syndrome (RS) or uro-arthritis in females, 73 consecutive patients were studied. The findings were compared to those in 72 consecutive males with RS. The mean ages and the clinical picture of musculoskeletal findings, including frequency of mono- or oligoarthritis (68-69%), polyarthritis (26%) and back complaints (76-71%), were similar in both sexes. Inflammation of the knee, sterno-clavicular joint and "sausage" toe occurred predominantly in males and finger involvements in females. Anamnestic gonorrhoea occurred in 17 males (24%) and in 9 females (12%) (p less than 0.05) and verified aseptic pyuria in 34 males (47%) and in 19 females (26%) (p less than 0.01). Clinical findings of urogenital abnormalities (61 and 51%) and evidence of chlamydial infection (61 and 58%) occurred equally frequently in both sexes, as did the less commonly observed gastrointestinal involvements as triggering infection. The males had high ESR (greater than or equal to 50 mm/h) and HLA-B27 antigen more often than females (p less than 0.005 and p less than 0.025 respectively). Pyuria and elevated ESR (greater than or equal to 20 mm/h) were associated with HLA-B27 in males (p less than 0.02) but not in females. The occurrence of sacroiliitis was not associated with HLA-B27 and was not sex-related. The many similarities in the clinical picture speak in favour of the same disease in both sexes. Though the "complete" form of RS with high ESR seems to be more rare in females than in males, the results of the present study emphasize that uro-arthritis is not a rare disease in females as compared to males.