Types of reactive arthritis

Viral arthritis

It is now 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 that of children. The clinical picture is more often represented by arthralgia. Clinical symptoms last for 1-2 weeks and disappear without residual effects.

The defeat of small joints is characteristic of viral arthritis, associated with rubella and hepatitis, or vaccination against these infections.

The defeat of 1-2 large joints (often knee joints) is characteristic of viral arthritis caused by mumps viruses, herpes zoster.

With some viral arthritis, the pathogen is found in the joint cavity (rubella, chicken pox, herpes, CMV), in other cases - circulating immune complexes (CIC) containing the virus (hepatitis B, adenovirus 7), in the third - neither the virus nor the antigen not succeed.

The diagnosis of viral arthritis is based on a chronological connection with a viral infection or vaccination, a clinical picture of acute arthritis.

Post-streptococcal arthritis

Diagnostic criteria for post-streptococcal arthritis:

• the appearance of arthritis on the background or 1-2 weeks after a nasopharyngeal infection (streptococcal etiology);
• simultaneous involvement of predominantly medium and large joints in the process;
• lack of volatility of the joint syndrome;
• a small number of involved joints (mono-, oligoarthritis);
• possible torpidity of articular syndrome to the action of NSAIDs;
• unsharp shifts in laboratory indicators;
• 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 the treatment of chronic foci of infection that includes sanation;
• negative for HLA-B27.

Lyme disease

Lyme disease is a disease caused by spirochetes of B. Burgdorfery, characterized by damage to the skin, joints and nervous system.

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

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

For the late stage of the Lime disease, atrophic changes on the skin, development of chronic progressive meningoencephalitis, arthritis are characteristic.

Diagnosis of Lyme disease is based on a characteristic clinical picture, the fact of the patient's stay in the endemic zone, the tick bite in the anamnesis. Confirm the diagnosis with serological methods, detecting 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 them in children under 2 years in 50% of cases.

The etiological factor is predominantly Staphylococcus aureus and Haemophilus influenzae.

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

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

The diagnosis is based on the clinical picture, the nature of the synovial fluid, the results of planting synovial fluid on the flora with the definition of antibiotic sensitivity, and radiographic data (in the case of osteomyelitis).

Tuberculous Arthritis

Tuberculosis arthritis is one of the frequent manifestations of extrapulmonary tuberculosis. It develops more often in young children due to primary tuberculosis infection. The disease proceeds according to the type of monoarthritis of the knee, hip, less often wrist joints, which is the result of tubercular destruction of bones and joint tissues. Significantly less affected by the spine and bones of fingers (tuberculous dactylitis). The diagnosis is based on family history (contact with a tuberculosis patient), pulmonary TB form in relatives, information on BCG vaccination, Mantoux reaction and its dynamics.

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

Gonococcal Arthritis

The disease causes Neisseria gonorrhoeae, is more common in adolescents who have an active sex life. It develops with asymptomatic gonorrhea or gonococcal infection of the pharynx and rectum.

The diagnosis is based on the history, cultural studies of materials from the genitourinary tract, pharynx, rectum, the contents of skin blisters, the sowing of synovial fluid, the isolation of the microorganism from the blood.

Juvenile rheumatoid arthritis

The differential diagnosis of reactive arthritis with oligoarticular variant of juvenile rheumatoid arthritis is the most difficult in connection with a similar clinical picture (oligoarthritis, predominant lesion of the lower extremities, eye damage in the form of conjunctivitis, uveitis).

The diagnosis of juvenile rheumatoid arthritis is based on the progressing course of arthritis, immunological changes (positive ANF), the emergence of characteristic immunogenetic markers (HLA-A2, DR-5, DR-8), radiographic changes in the joints characteristic of juvenile rheumatoid arthritis.

In the case of the association of oligoarthritis of "small" girls with arthritogenic infections (chlamydia, intestinal, mycoplasma), the ineffectiveness of antibiotic therapy indirectly supports juvenile rheumatoid arthritis.

Juvenile spondylitis

Juvenile spondylitis is a possible outcome of chronic course of reactive arthritis in predisposing individuals (HLA-B27 carriers). Articular syndrome (as well as in reactive arthritis) is represented by asymmetric mono-, oligoarthritis with a predominant lesion of the joints of the legs. Characteristic axial lesions of the fingers and toes with the development of "sausage-like" deformation, enthesites, achillobursitis, tendovaginitis, enthesopathy, rigidity of the spine. The main signs that allow diagnosing juvenile spondyloarthritis are X-ray findings indicating the presence of sakroileitis (one- or two-sided). Verification of the diagnosis of juvenile spondylitis requires the appointment of immunosuppressive therapy, the drug of choice - sulfasalazine.