Reactive arthritis

Reactive arthritis is non-infectious inflammation of the joints that develops in response to an infectious disease located outside the joint within a few days/weeks. We classify it among the group of spondyloarthritis, therefore also reactive arthritis has common manifestations, which are typical for this group of diseases:

• binding to positivity HLA-B27
• more frequent eye damage (uveitis, conjunctivitis)
• more frequent enthesitis
• skin and mucous membrane damage (aphthae, erythema nodosum,...)
• changes in the axial skeleton are only a late consequence
• increased sedimentation and CRP

Etiology and Pathogenesis

Genetic factors play a role (96 % pac. HLA-B27 pozitivních) + infections of the gastrointestinal tract: (salmonella, shigella, yersinie, Campylobacter jejuni), urogenital infection: (Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum) and infections of the respiratory system. Sometimes without a previous detectable infection.

The clinical picture

General manifestations

Twitching, fatigue, temperature.

Musculoskeletal manifestations

Keratoderma blenorrhagicum

• Asymmetric mono-/oligoartritis (max. 4 joints) with predilection localization of the supporting joints; affected joints reddish + warmer;
• enthesopathy, which can lead to movement provision interfusion of the tendon insertion on a bone (Achilles tendon, plantar fasciitis)

Cutaneous manifestations

Keratoderma blenorrhagicum (peeling skin of the palms or soles similar to psoriasis like patches) and balanitis.

UGT symptoms

Sterile urethritis - Reiter's syndrome - ( arthritis , urethritis , conjunctivitis, etc.); ocular findings may progress to episcleritis, corneal ulcers and hl. anterior uveitis .

Diagnosis

• Oligoarthritis of the supporting joints affecting younger individuals following an infection in UGT / GIT
• lab. higher: unspecified markers of inflammation in the acute phase high (FW, CRP, mucoproteins, ELFO proteins), serology (detection of antibodies against microorganisms), higher. effusion (different from septic arthritis);
• X-ray: mostly negative, sometimes in the chronic phase of the disease sacroiliitis;
• complete Reiter's syndrome: arthritis + urethritis + conjunctivitis (complete triad is rather rare);
• incomplete Reiter's syndrome: arthritis + 1 more symptom; there may also be enthesitis, skin and mucosal ulceration, periostitis .

Differential diagnosis

• Arthritis uratica;
• Rheumatoid arthritis;
• Infectious purulent arthritis.

Therapy

Individual, based on NSA, for heavier forms glucocorticoids (initial dose 30–50 mg with a gradual decrease; for recurrent joint effusions intra articularly); ATB (for isolating infectious agents / sometimes also with positive serology); basal medicamentations (in chronic course with higher activity; sulfasalazinTemplate:HVLP 2–3 g, MTXTemplate:HVLP 10–20 mg/week).

Prognosis

Mostly good, but in a some patients the transition leads to chronicity. (imminent m. Bechtěrev).

Links

Related articles

• Chlamydial infections of the genitals
• Psoriatic arthritis
• Ankylosing spondylarthritis

References

• VOKURKA, Martina – HUGO, Jan. Velký lékařský slovník. 6. edition. 2006. 0 pp. ISBN 80-7345-105-0.