Reactive arthritis: symptoms

One of the brightest representatives of reactive arthritis is Reiter's syndrome or urethro-oculo-synovial syndrome.

Reiter's syndrome is an inflammatory process that develops in a chronological connection with infection of the urinary tract or intestine and manifests itself in a classic triad of symptoms - urethritis, conjunctivitis, arthritis.

Reiter's syndrome usually begins with symptoms of the urinary tract injury in 2-4 weeks after a previous intestinal infection or an alleged infection with chlamydia or bacteria of the intestinal group. In the following, the symptoms of damage to the eyes and joints are added.

The defeat of the genito-urinary tract is characterized by the erosion of the clinical picture. The boys develop balanitis, infected synechia, phimosis, girls - vulvitis, vulvovaginitis, leuko- and microhematuria, cystitis. The defeat of the genito-urinary tract may precede the development of the joint syndrome for several months.

Eye damage is conjunctivitis, often catarrhal, unexpressed, short-lived, but prone to recurrence. With yersiniotic reactive arthritis, conjunctivitis can be purulent, severe. In 30% of patients develops acute iridocyclitis, threatening blindness. Eye damage can also precede the development of joint syndrome for several months or years.

The defeat of the musculoskeletal system is limited asymmetric, mono-, oligo- and less often polyarthritis. In the process, the joints of the legs are mostly involved, with the most frequent lesion of the knee, ankle, metatarsophalangeal, proximal and distal interphalangeal joints of the toes.

Arthritis can begin with acute, with pronounced exudative changes. Some patients have fever, up to febrile numbers.

Exudative arthritis in Reiter's disease of chlamydial etiology proceeds without pain, stiffness, pronounced impaired function, with a large amount of synovial fluid, continuously recurring. The defeat of the joints is characterized by a prolonged absence of destructive changes, despite the recurrent synovitis. Characteristic of the development of tenosynovitis and bursitis, achillobursitis, unilateral involvement of the sternoclavicular joint.

Typically for reactive arthritis - the defeat of the first toe, the formation of "sausage-like" deformation of the toes due to the pronounced edema and hyperemia of the affected finger.

In a number of patients, enthesitis and enteropathy develop (pain and tenderness in palpation in places where tendons attach to the bones). Most often, enthesopathies are determined along the course of the spinous processes of the vertebrae, the crests of the iliac bones, in the sites of the projection of the sacroiliac joints, the attachment of the Achilles tendon to the heel of the calcaneus, and also the attachment of the plantar aponeurosis to the heel of the calcaneus. For patients with reactive arthritis pain in the heel (talalgia), pain, stiffness and limitation of mobility in the cervical and lumbar spine and ileosacral articulations are characteristic. These clinical symptoms are characteristic of adolescent boys with HLA-B27; the risk of formation of juvenile spondylitis is high.

With prolonged (6-12 months) or chronic (more than 12 months) course of the disease, the character of the joint syndrome changes, the number of affected joints increases, arthritis becomes more symmetrical, the joints of the upper extremities and the spine are more often involved.

Symptoms of Reiter's syndrome are not chronologically related, which makes diagnosis difficult. Sometimes, even with a careful examination, it is not possible to identify signs of one of the symptoms (urethritis or conjunctivitis), which makes treating the disease as incomplete Reiter syndrome. In addition to the classic triad of symptoms in Reiter's disease, skin and mucous membrane lesions are often detected. They manifest keratodermia of the palms and feet, psoriasis-like eruptions, trophic changes in the nails. Children also develop erosions of the oral mucosa by the type of stomatitis or glossitis, often not clinically apparent and remaining unnoticed. Other extra-articular manifestations: lymphadenopathy, less often hepatosplenomegaly, myopericarditis, aortitis.

Post-enterocolitis reactive arthritis proceeds more sharply, more aggressively than reactive arthritis associated with chlamydial infection. With postterocerotic reactive arthritis, there is a more pronounced chronological association with an intestinal infection. The disease occurs with severe symptoms of intoxication, fever, acute articular syndrome, high rates of laboratory activity.

Diagnostic criteria for post-enterocolitis arthritis:

• the development of arthritis 1-4 weeks after diarrhea;
• the predominantly acute nature of joint damage (swelling, increased local temperature, redness of the skin above the joints, sharp soreness in movement;
• asymmetric joint damage;
• primary lesion of large joints (knee, ankle);
• oligo-, polyarthritis;
• possible bursitis, tendovaginitis;
• significant shifts in laboratory indicators;
• increased titres of antibodies to the causative agents of intestinal infection and antigen;
• torpidity of joint syndrome, process chronology;
• HLA-B27 in 60-80% of patients.

In some cases, reactive arthritis occurs without distinct extra-articular manifestations related to the symptom complex of Reiter's syndrome (conjunctivitis, urethritis, keratoderma). In such cases, the leader in the clinical picture is an articular syndrome, characterized by a predominant asymmetric lesion of the joints of the lower extremities. The number of affected joints is dominated by mono- and oligoarthritis. In general, the nature and course of arthritis are similar to Reiter's syndrome. For reactive arthritis, it is typical to defeat the first toe of the foot, forming a "sausage-shaped" deformation of the toes. A number of patients may develop enthesitis and enteropathy. Regardless of the presence of extra-articular manifestations, these children have a high risk of developing juvenile spondyloarthritis.

In the absence of a complete clinical picture of Reiter's syndrome (even with a characteristic articular syndrome), the diagnosis of reactive arthritis presents significant difficulties. A characteristic mono- or oligoarthritis with a predominant lesion of the joints of the legs, expressed exudation; Associated with a transferred intestinal or genitourinary infection or serological markers of these infections allows attributing the disease to probable reactive arthritis.

[1], [2], [3], [4]