Classification of reactive arthritis
Today we look at what are the different types of reactive arthritis, and will tell us about this A. K. Petrov - the author of the blog about the treatment of feet: .
Over the course of reactive arthritis can be divided into:
- acute (up to 2 months);
- prolonged (up to 1 year);
- chronic (over 1 year);
- recurrent (episodes of arthritis involving no less than 6 months).
the number of affected joints of the disease is divided into:
- monoartrit / monoaromatic (involvement of one joint)
- oligoarthritis / oligoarthropathy (2-4 joints);
- polyarthropathy (≥ 5 joints).
it Should be emphasized that the concept of «protracted" and "chronic" the course of reactive arthritis is used only for cases where there is a reason that causes reactive arthritis, which for a long time can not be eliminated. If the reason is not proven, the diagnosis of prolonged / chronic reactive arthritis is unlawful, and the patient is classified as ill YURA.
post-streptococcal reactive arthritis
From the group of reactive arthritis should be allocated post-streptococcal reactive arthritis due to its etiological similarity to acute rheumatic fever and the need for antibiotikov prevent next to anti-inflammatory therapy. This disease like other postinfectious arthritis is characterized by asymmetric oligoarticular by lesions mainly the large joints of the lower extremities develops after acute tonsillopharyngitis caused by β-haemolytic Streptococcus group A (GABHS). Unlike acute rheumatic fever, arthritis is not migratory, inflammation and develops somewhat earlier (on average 11 days after suffering tonsillitis), stroke synovitis does not improve dramatically in the background-steroidal anti-inflammatory drugs (NSAIDs). The important point is that the patient must not meet the criteria of acute rheumatic fever. Modern research shows that there are two clinical patterns of post-streptococcal reactive arthritis:
- one more similar acute rheumatic fever and may be accompanied by carditis;
- another relates to HLA-B27-positive reactive arthritis.
Criteria post-streptococcal reactive arthritis:
- Arthritis with acute onset of asymmetric (although it may be symmetrical), not normally migratory, can affect any joint and have persisting or relapsing course;
- moved the Confirmation of GABHS infection;
- Mismatch for Jones criteria acute rheumatic fever.
Septic arthritis / acute hematogenous osteomyelitis
Special caution concerning septic arthritis should cause the patient monoarticular defeat. Only in case of antibacterial treatment in the first 4 days from the appearance of the first symptoms prognosis for functional capacity of the patient is satisfactory. Manifestations of this type of arthritis are:
- swelling of joint;
- severe pain during passive movements;
- redness of the skin over it;
- pronounced increase in thermosets.
the Pain of osteomyelitis characterized by spread to the bone within the projection of the joint. The high-risk group of transition osteomyelitis septic arthritis in children under 1 year because they have developed vascular net, connecting metaphases and the epiphysis. In 50% of cases in children under 12 months of acute hematogenous osteomyelitis goes into septic arthritis.
this disease accounts for up to 5% of all cases extraregional of tuberculosis in children. For tuberculosis of the musculoskeletal system indicator is a destructive lesion of the lumbar vertebral bodies. With regard to arthritis, in the classic version of chronic is observed monoartrit involving the hip or knee. In history it is possible to detect the contact with a tuberculosis patient. Predominate the exudative processes, pain syndrome weakly expressed. Is characterized by the formation of bone or sequestration of boundary defects of the bones forming the joint, which can be detected by radiography or computed tomography of the affected area. A positive Mantoux test, dioscin-test or test with gamma-interferon confirm the diagnosis. DNA of the pathogen could be detected by PCR in the synovial fluid of the affected joint along with: a reduced level of glucose compared to its serum concentration, a predominance of lymphocytes over neutrophils cytological study.
Is a systemic borreliosis (caused by Borrelia burgdorferi - transmitted by the bite of Ixodes ticks). The first manifestations occur after several days or weeks: to the site of the bite erythema migrans appears, in the later the appearance of the child elements of the rash. Common symptoms are:
In the late phase occur:
- chronic atrophic acrodermatitis (phase of inflammation - erythema red / purple color - phase is gradually replaced by atrophy of the skin);
- the arthritis.
ESR increased in 77 % of cases. Lyme arthritis is characterized by mono - (64,2 %), oligoarticular form (29,4 %), polyarthritis (6,4 %); involvement of small joints is unusual. Most often affects the knee joint (90 %), hip (14 %), ankle (10 %), brush (9%), elbow (7 %) and other (7 %).
Acute rheumatic fever
this disease is characterized by non-destructive migratory polyarthritis with predominant involvement of large and medium-sized joints. Inflammation of one joint lasts about 3-4 days. In addition, for acute rheumatic fever is characterized by the lesion of the heart with the development of valvulitis of mitral ± aortic valve, and in severe cases - even pericarditis or pancarditis. Much less common are other specific manifestations of the disease: chorea, annular erythema, rheumatic nodules.
Juvenile rheumatoid arthritis
the Difficulty of differential diagnosis lies in the possibility of the flow of the JURA in the form of oligoarthritis, service of infectious disease as a trigger of the debut of the JURASSIC, significant overlap of the spectra of the clinical and laboratory manifestations of reactive arthritis and intestazioni forms of JRA (including intesity and positivity for HLA-B27 antigen). A major factor in differential diagnosis is the history of the disease. If when you turn off or eliminate all possible causes of arthritis despite anti-inflammatory treatment, the disease lasts more than 6 weeks, this patient can be classified as having JRA.
Systemic inflammatory disease of connective tissue
This group of diseases, except arthritis, are characterized by other specific clinical manifestations and laboratory parameters. So, for the systemic lupus erythematosus is characterized by:
- erythema on the face by type «butterfly»
- kidney disease;
- the presence of antinuclear antibodies and antibodies to DNA desperatley;
- and the like.
In juvenile dermatomyositis / polymyositis to the fore myopathic ± cutaneous syndromes. For juvenile systemic sclerosis scleroderma primarily characterized by skin lesions and Raynaud's phenomenon.
bleeding into the joint cavity is characterized by:the
- limitation of mobility in the joint and pain;
- accompanies traumatic injury or coagulopathy / thrombocytopenia. In the first case the characteristic history of trauma and signs of traumatic lesions of the skin over the joint (laceration, abrasion, bruise). To identify the damaged bone structures of the joint helps radiography or computed tomography, rupture of soft tissue structures - ultrasound and MRI. If coagulopathy / thrombocytopenia there is usually a history of spontaneous bleeding; coagulation, determination of platelet count and activity of coagulation factors allow to confirm the diagnosis. To distinguish from hemarthrosis reactive arthritis help ultrasonic diagnostics.
villonodular Pigmented synovitis
the Pathogenesis of this disease has not been finally determined, the disease is a benign villous proliferation of the synovia with colouring it in brown / brown color due to deposits of hemosiderin hemorrhagic and education ("rusty" color) effusion in the joint cavity. Articular syndrome is mostly monoarticular localization (in 95 % of cases, there was lesion of the knee joint, less frequently the ankle, hip, elbow, wrist). Symptoms are severe swelling with little pain, impaired mobility in the absence of improvement of thermosets joint, morning stiffness is absent. Laboratory changes, evidence of inflammation (elevated erythrocyte sedimentation rate and C-reactive protein), which is not typical. Anti-inflammatory therapy is almost no effect. Is diagnostic arthrocentesis when you receive the "rusty" content. MRI can identify foci of hemosiderin deposits in proliferants of synovia. The only reliable method of diagnosis - biopsy of the synovia with histological examination. Treatment is surgical synovectomy.
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