How to identify and cure reactive arthritis

joint Pain, arthritis accompany many diseases, follow them, or may precede typical picture of acute inflammation. Arthralgia with the presence of local signs of inflammation typical for more than 200 diseases. It can be the leading symptom, or one of the related manifestations.

Main concepts

Arthritis (from the Latin artr – joint, itis – inflammation) is an inflammatory affection of joints, distinguished by origin, localization, manifestations, but have common features of local inflammation and destruction of the inner lining of the joint.

Among all patients with rheumatologic manifestations in childhood the most common reactive arthritis. In the older age group it develops in young people under 40 years. In most manifestations associated with acute intestinal infection caused by Enterobacteriaceae, and acute urogenital chlamydial infection. Can provoke the development of reactive arthritis and respiratory mycoplasmal and chlamydial infections (Chlamydia pneumoniae et Mycoplasma pneumoniae).

Reactive arthritis (Rea) is an acute inflammation of the joints purulent nature, symptoms develop later not later than 1 month after acute intestinal or urogenital infections, is associated with the histocompatibility antigen HLA-B27. May be due to development of immunological mediated inflammation after vaccination, the flu, tuberculosis and other infections.

Thus, the true cause of the disease is not infectious inflammation triggered by the pathogen, and the damaging action of immune complexes, provoking the typical lesions of joints with intra-articular liquid accumulation.

Classification in ICD-10

They All belong to the class of infectious arthropathy: in the ICD-10 code M 00-M 03.

Code 02 M in ICD-10 – reactive arthropathy

Code M 02.0 to ICD-10 – arthropathy accompanying the shunt of intestine

M 02.1 Code in ICD-10 – postdysenteric arthropathy

M 02.2 Code in ICD-10 – postimmunization arthropathy

M 02.3 Code in ICD-10 – Reiter's syndrome

M 02.8 Code in ICD-10 – other reactive arthropathies

M 02.9 Code in ICD-10 – reactive arthropathy unspecified

Classification of reactive arthritis (table 1)

The Most frequent localization of lesions of the joints (table 2)

Symptoms

1. Symptoms of intoxication: raising the temperature from to high subfebrile fever, General weakness, decreased appetite and weight loss.
2. the Symptoms of joint disorders: reactive arthritis is asymmetrical; characterized by loss of both large and small joints of the legs – ankle, knee and feet joints, especially the thumbs. Less often affects the joints of the belt of the upper limb: humeral, Sterno-clavicular or the temporo-mandibular, Sacro-iliac. At the same timeaffected not more than six joints.
3. Development of inflammation in the zones of attachment of the joints and ligaments to bone (entazisom). Most often develops the toes or tenosynovitis of the hands, the heel.
4. mucous membranes: conjunctivitis symptoms of eye disease, urethritis and an annular balanitis, cervicitis in women with lesions of the genitourinary system, painful erosions on the oral mucosa.
5. Signs of keratodermia: lesions of hyperkeratosis of the plantar part of the feet or hands.
6. Signs of nail infections (usually toes).
7. Concomitant lesions of other organs:

• aortitis (inflammation of the aortic wall)
• myocarditis
• mitral valve insufficiency
• myositis – skeletal muscle
• polyneuritis – symptoms of defeat of peripheral nervous system
• swollen lymph nodes (e.g. Inguinal group in urogenital pathology).

Additional methods of diagnosis of arthritis

1. Tool:

• radiography of joint;
• spiral computed or magnetic resonance tomography
• bone scan
• NMR spectroscopy
• SPL of joint;
• arthroscopy.

2. Laboratory:

• clinical findings
• biochemical research;
• immunologic
• immunoelectrophoresis
• the study of synovial fluid.

Information about what changes in results of laboratory and instrumental examinations can be expected, we systematized in Table 3.

Differential diagnosis of reactive arthritis

Differential diagnosis of Rea are shown in Table 4.

Differential diagnosis of joint damage in reactive arthritis and other articular pathology based on the survey data shown in Table 5.

Treatment

There are three approaches to the treatment of reactive arthritis:

• drug treatment
• functional treatment;
• treatment of folk remedies.

In the first case there are the following means of treatment:

1. In identifying the source of infection and determine the cause of arthritis is treated with antibiotics based on the sensitivity of relevant organisms.
2. NSAIDs are used to reduce inflammation, pain intensity and hyperthermia.
3. systemic corticosteroids are prescribed in case of severe systemic manifestations. More often the corticosteroids treatment is carried out in the form of intra-articular injections.
4. Basic drug when the arthritis in the chronic form – sulfasalazine for a long time (several months).
5. Systemic enzyme therapy – treatment with Wobenzym.

Treatment of folk remedies involves the use of decoctions and infusions of herbs with anti-inflammatory and antibacterial properties, and the local application of compresses of comfrey, horseradish, black radish.

Drugs of medication (table 6)

Postimmunization reactive arthritis (post-vaccination) develops most often in children, so that the required correction doses of the drug per kilogram of body weight of the child.

Similar symptoms may occur with arthritis of different etiologies. Only an experienced doctor can conduct a thorough diagnosis to determine the cause of the arthritis and prescribe the correct treatment. Be aware that every drug has side effects and may be contraindicated in a particular case in this patient. Even treatment of folk remedies should be administered under the supervision of a physician, to get rid of completely from this disease, usually impossible, however, for adequate therapy long-term remission occurs. Forecasts for arthritis after enteric infections are more favourable than with Reiter's syndrome, articular syndrome on a background of ulcerative colitis and Crohn's disease.

Sources:

1. the Attending physician. E. S. Zholobova, E. G. Chistyakova. Reactive arthritis in children – diagnosis and treatment;
2. V. A. Molochkov Moscow regional research clinical Institute. M. F. Vladimirsky, Moscow. The Reiter's Syndrome. Consilium Medicum. 2004; 03
3. V. M. Chapoy. Diagnosis and treatment of diseases of the joints. Moscow. Medicine.