A family is reported in which three brothers had respectively, ankylosing spondylitis, Reiter's disease, and Reiter's disease followed by rheumatoid arthritis; the father had atypical spondylitis following stigmata of Reiter's disease. The literature of Reiter's disease affecting more than a single family member is reviewed.
Several authors have suggested that rheumatic diseases are prevalent in families of patient's with Reiter's disease (RD) (14). Moreover, RD has occasionally affected more than one member of a family (1, 2, 5-14). Preliminary results of a family study of relatives of patients with RD have disclosed evidence of a link between RD and psoriasis and also between R D and ankylosing spondylitis (AS) (15).
I have encountered a family in which two sons and possibly the father had RD, and a third son, classical AS. This may be the first report of RD and AS, respectively, affecting different siblings (Fig 1). The family is also noteworthy in that definite rheumatoid arthritis has appeared in one case following RD.
From 1939 to 1954 he noted attacks of low back pain lasting several days. During this 15-year period he had morning stiffness for one hour, but no lassitude, weight loss or weakness. He was never disabled from working and sought no medical treatment for his spinal symptoms. From 1953 to 1955 he had recurrent brief attacks of pain a t the lumbo-dorsal junction and the right lower anterior thoracic area. After 1955 he had no further pain, but became aware of progressive restriction of spinal motion and dorsal kyphosis. He had no history of conjunctivitis, urethral discharge, or pain in peripheral joints.
Physical examination showed a nontender, movahle mass in the right cervical area with several 1-2 cm satellite nodes. He had pronounced dorsal kyphosis, loss of lumbar lordosis, and marked forward protrusion of the head (Fig 2). There was severe limitation of motion in the cervical spine, and the lumbar spine was virtually fixed. Chest expansion was 3 cm. T h e peripheral joints were normal. T h e sedimentation (Wintrobe) rate was 10 mm/hr.
Radiographs of the spine (Fig 3A ) showed advanced changes of AS. Biopsy of cervical node was
Case 1
T h e patient, MLH, Ann Arbor VA Hospital, No -.
10913, a 46-year-old mechanic, was admitted in 19F2 diagnostic for-Hodgkin's disease, from which he because of cervical lymphadenopathy.