Types of reactive arthritis

Viral arthritis

It is currently known that about 30 viruses can cause the development of acute arthritis.

Etiology of viral arthritis:

• rubella viruses;
• parvovirus;
• adenovirus;
• hepatitis B virus;
• herpes viruses of various types;
• mumps virus;
• enteroviruses;
• Coxsackie virus;
• ECHO viruses.

The prevalence of viral arthritis among adults is higher than among children. The clinical picture is often represented by arthralgia. Clinical symptoms last for 1-2 weeks and disappear without residual effects.

Damage to small joints is typical for viral arthritis associated with rubella and hepatitis or vaccination against these infections.

Damage to 1-2 large joints (usually the knees) is typical for viral arthritis caused by the mumps and herpes zoster viruses.

In some viral arthritis, the pathogen is found in the joint cavity (rubella, chickenpox, herpes, CMV), in other cases - circulating immune complexes (CIC) containing the virus (hepatitis B, adenovirus 7), in others - neither the virus nor the antigen can be found.

The diagnosis of viral arthritis is made on the basis of a chronological connection with a previous viral infection or vaccination, and the clinical picture of acute arthritis.

Poststreptococcal arthritis

Diagnostic criteria for poststreptococcal arthritis:

• the appearance of arthritis against the background of or 1-2 weeks after a nasopharyngeal infection (streptococcal etiology);
• simultaneous involvement of mainly medium and large joints in the process;
• absence of volatility of joint syndrome;
• small number of involved joints (mono-, oligoarthritis);
• possible sluggishness of the joint syndrome to the action of NSAIDs;
• slight changes in laboratory parameters;
• elevated titers of post-streptococcal antibodies;
• chronic foci of infection in the nasopharynx (chronic tonsillitis, pharyngitis, sinusitis);
• restoration of the function of the musculoskeletal system as a result of treatment that includes the sanitation of chronic foci of infection;
• HLA-B27 negative.

Lyme disease

Lyme disease is a disease caused by the spirochete B. burgdorfery, characterized by damage to the skin, joints, and nervous system.

The pathogen enters the body as a result of the bite of a tick of the Ixodes species.

Clinical manifestations depend on the stage of the disease. Early stage: migratory erythema (with skin lesions) and lymphocytic meningitis (with nervous system lesions), manifested by headache, fever, nausea, vomiting, paresthesia, cranial nerve paresis. Lesions of the musculoskeletal system - arthralgia and myalgia.

The late stage of Lyme disease is characterized by atrophic changes in the skin, the development of chronic progressive meningoencephalitis, and arthritis.

Diagnosis of Lyme disease is based on the characteristic clinical picture, the fact of the patient's stay in an endemic zone, and a tick bite in the anamnesis. The diagnosis is confirmed by serological methods that detect antibodies to B. burgdorfer.

Septic arthritis

The disease is detected in 6.5% of children with juvenile arthritis, more often in girls, at an early age (75%), of which in children under 2 years of age in 50% of cases.

The etiological factor is mainly Staphylococcus aureus and Haemophilus influenzae.

Septic arthritis is accompanied by systemic manifestations of the disease (fever, nausea, headache); the development of a generalized infection is possible: meningitis, purulent skin lesions, osteomyelitis and damage to the respiratory tract.

Local clinical signs: intense pain in the joint, hyperemia, hyperthermia, swelling of surrounding tissues, painful limitation of mobility. In terms of the number of affected joints, monoarthritis predominates (93%), 2 joints - 4.4%, 3 joints or more - 1.7% of patients. The knee and hip joints are most often affected, less often - elbow, shoulder, wrist joints.

The diagnosis is made on the basis of the clinical picture, the nature of the synovial fluid, the results of synovial fluid culture for flora with determination of sensitivity to antibiotics, and radiological data (in the case of osteomyelitis).

Tuberculous arthritis

Tuberculous arthritis is one of the frequent manifestations of extrapulmonary tuberculosis. It develops more often in young children due to primary tuberculosis infection. The disease occurs as monoarthritis of the knee, hip, and less often wrist joints, which is the result of tuberculous destruction of bones and joint tissues. Much less often, the spine and finger bones are affected (tuberculous dactylitis). The diagnosis is suggested based on family history (contact with a patient with tuberculosis), pulmonary tuberculosis in relatives, information on BCG vaccination, Mantoux reaction data and its dynamics.

The clinical picture is represented by general symptoms of tuberculosis infection (intoxication, subfebrile temperature, vegetative disorders) and local symptoms (joint pain, mainly at night, arthritis). To confirm the diagnosis, X-ray data, synovial fluid analysis, and synovial membrane biopsy are required.

Gonococcal arthritis

The disease is caused by Neisseria gonorrhoeae, and is more common in sexually active adolescents. It develops during asymptomatic gonorrhea or gonococcal infection of the pharynx and rectum.

The diagnosis is made on the basis of anamnesis data, cultural studies of materials from the genitourinary tract, pharynx, rectum, contents of skin vesicles, synovial fluid culture, and isolation of the microorganism from the blood.

Juvenile rheumatoid arthritis

The greatest difficulties are presented by the differential diagnosis of reactive arthritis with the oligoarticular variant of juvenile rheumatoid arthritis due to the similar clinical picture (oligoarthritis, predominant damage to the lower extremities, eye damage in the form of conjunctivitis, uveitis).

The diagnosis of juvenile rheumatoid arthritis is made on the basis of the progressive course of arthritis, immunological changes (positive ANF), the appearance of characteristic immunogenetic markers (HLA-A2, DR-5, DR-8), and radiological changes in the joints characteristic of juvenile rheumatoid arthritis.

In the case of an association of oligoarthritis in “little” girls with arthritogenic infections (chlamydial, intestinal, mycoplasmal), the ineffectiveness of antibacterial therapy indirectly indicates juvenile rheumatoid arthritis.

Juvenile spondylitis

Juvenile spondylitis is a possible outcome of chronic reactive arthritis in predisposed individuals (HLA-B27 carriers). The joint syndrome (as well as in reactive arthritis) is represented by asymmetric mono-, oligoarthritis with predominant damage to the joints of the legs. Characteristic are axial lesions of the fingers and toes with the development of "sausage-shaped" deformity, enthesitis, Achilles bursitis, tendovaginitis, enthesopathies, and spinal rigidity. The main signs that allow diagnosing juvenile spondylitis are radiographic data indicating the presence of sacroiliitis (unilateral or bilateral). Verification of the diagnosis of juvenile spondylitis requires the appointment of immunosuppressive therapy, the drug of choice is sulfasalazine.