Reactive arthritis( Reiter's syndrome) - Causes, symptoms and treatment. MF.

Many human diseases are associated with infection, but not directly. A vivid example is reactive arthritis .Infection of the joint does not, it affects the genitourinary system or the gastrointestinal tract. However, the joints suffer. Infection acts as a "trigger", which disrupts the immune system, and it is the latter that "attacks" the joints. Therefore, even eliminating the infection with antibiotics does not always help to get rid of problems.

The term reactive arthritis ( ie, joint inflammation that occurs as a response, response to infection elsewhere) was suggested by Anhoven in 1969.Interestingly, until recently, this disease bore the name of the German physician Hans Reiter( who first described this combination of symptoms), but the latter was a supporter of the Nazis and eugenics, took part in experiments on people in concentration camps. Therefore, now the preference is given precisely to the term "reactive arthritis".

General information on reactive arthritis

Reactive arthritis( Reiter's syndrome) is an inflammatory joint disease that develops after infection( not in the joint, but in another part of the body).An infection that causes the development of reactive arthritis usually affects the urinary tract or the gastrointestinal tract.

Reactive arthritis is not associated with the spread of infection through the body and its entry into the joint. It is believed that the inflammation of the joint develops due to the fact that the microorganisms contain substances( antigens), which are similar to the antigens of body tissues. The immune system "confuses" antigens of the joint and microorganisms, as a result, it attacks both the microbe and the joint. In the joint develops inflammation, which causes problems.

Symptoms of reactive arthritis

Three classic symptoms of reactive arthritis: inflammation of the eyes( conjunctivitis - redness of the eyes, burning sensation in the eyes, lacrimation), inflammation of the urinary tract( urethritis - pain or burning with urination, increased urination) and joint inflammation( arthritis - pain injoints, their redness, edema, joints are hot, mobility is limited).

Usually, reactive arthritis begins 2-4 weeks after an intestinal or venereal infection. Often the first symptoms are urethritis, then conjunctivitis develops, and the last - arthritis. Approximately every fourth patient has changes on the skin of a different appearance.

Symptoms of reactive arthritis usually last from three to twelve months. In most cases, the symptoms of conjunctivitis and urethritis are very weak and only 1-2 joints are inflamed. In some patients, however, reactive arthritis can be acute and severe, restricting their physical activity.

Relapses( repeated exacerbations) are rare.

Reasons for reactive arthritis

Most often, reactive arthritis is associated with microorganisms called chlamydia. Usually, the colds are transmitted during sexual intercourse. Often the infection does not have any symptoms, and the most frequent symptoms( if present) are pain or discomfort during urination and discharge from the penis or vagina.

In addition, reactive arthritis can cause bacteria that affect the gastrointestinal tract: salmonella, shigella, iersinia and campylobacteria. Symptoms of the defeat of the gastrointestinal tract are severe diarrhea with blood and mucus in the stool. Infection occurs due to the reception of improperly prepared food, when in contact with infected people or feces( the microorganism must enter the gastrointestinal tract).

reactive arthritis is not developed by all people after the infection. The reasons for this selectivity are unclear. It is shown that the disease develops more often in people with a special gene - HLA B 27( Ash-El-A Ba-27).

Risk factors for reactive arthritis

Reactive arthritis most often affects people aged 20-40 years. Interestingly, after sexually transmitted infections, men are nine times more likely to get sick than women, while after intestinal infections the risk is the same. Men are slightly heavier than women.

The risk is elevated in persons who have HLA B 27, however, its study before the development of the disease is not necessary.

Diagnosis of reactive arthritis

Simple and unambiguous tests that allow you to establish a diagnosis of reactive arthritis do not exist yet. The doctor may suspect this diagnosis with the proper inquiry of the patient and his examination, and then assign special studies to confirm it.

• Special attention is paid to the detection of signs of joint, eye, genitourinary and skin lesions during the examination.
• Special studies are needed for two reasons: to confirm the diagnosis of reactive arthritis and to exclude other causes of arthritis.
• In arthritis, the rate of erythrocyte sedimentation( ESR) and the content of C-reactive protein( CRP) are often increased;these tests indicate the presence of inflammation in the body.
• Studies on rheumatoid factor( RF) and antinuclear factor( ANF) in reactive arthritis give a negative result.
• Detection of HLA 27 is an argument in favor of reactive arthritis.
• Research on infection( chlamydia, Yersinia, etc.) is of great importance, since it allows to detect the probable cause of the disease. To investigate can be separated from the genital tract, blood, stool, etc.
• To exclude infection in the joint( bacterial arthritis), sometimes perform joint puncture and examine the fluid taken from it( synovial fluid).
• X-ray examination can be used to assess the condition of the joint, but it is uncommon to establish the cause of joint inflammation unequivocally.

Treatment of reactive arthritis

Treatment with reactive arthritis is primarily aimed at alleviating the symptoms.

If signs of active infection persist, it is justified to prescribe antibiotics to eliminate bacteria and remove the underlying cause of inflammation.

Non-steroidal anti-inflammatory drugs( eg, ibuprofen, diclofenac, indomethacin, etc.) reduce pain and inflammation of the joints.

In cases of severe inflammation of the joints, they sometimes receive injections of glucocorticoids( anti-inflammatory hormones).

With prolonged maintenance of pain in the joints, anti-inflammatory drugs are prescribed, which slow down joint damage - sulfasalazine, methotrexate and some others.

During active inflammation, the joint should be protected from stress. However, after its arrest, a gradual recovery of physical activity is recommended.