Reactive arthropathy in children and adults: symptoms and treatment of arthritis
Reactive arthropathy: causes, symptoms and treatment of this disease
Reactive arthropathy (RA) is an inflammatory purulent lesion of the joints, which occurs after infection of the urogenital system, intestines or respiratory organs.
As a rule, the disease develops after 2-4 weeks after infection. More often affects young people between 20 to 40 years who have lots of casual unprotected sex.
A greater likelihood of development of RA has been observed in HIV-infected.
The etiology and pathogenesis of the disease
At the present time is unknown, which causes disease. Assume that the basis of pathology lies the hereditary factor. 70% of the patients were found HLA-B27 antigen.
But it alone is not enough, also need the development of an infectious disease, against which develop reactive arthropathy.
Infectious agents can be:
- enterobacteria (Yersinia, Shigella, E. coli, Salmonella).
Most often, reactive arthropathy observed after suffering chlamydia.
It can be transmitted not only sexually, but also aerosol and contact-household. Source of chlamydial infection may be people and animals (cats, dogs, birds).
Second place among the diseases against which develops a reactive arthropathy is intestinal infection.
The mechanism of development of reactive arthropathies is still unclear. I believe that there is an excessive immune response to trapped in the body of the bacteria, the result is the formation of immune complexes that are deposited in the synovial membrane.
The clinical picture
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Reactive arthropathy can be accompanied by the following symptoms:
- characteristic articular syndrome;
- symptoms of the infection, which developed arthropathy;
- lesions of the skin and mucous membranes;
- lesions of the spinal column;
- lesions of the internal organs;
- systemic inflammatory reaction.
Obligatory sign of the disease is articular syndrome, which is characterized by the appearance of an asymmetric oligoarthritis affecting the lower limb joints and tenosynovitis.
Typically, the first episode of arthritis is observed within 30 days after unprotected sexual intercourse or the development of intestinal infections.
With the development of the disease the following symptoms:
- Soreness in the affected joints is observed in any physical activity, worse at night and alone. The nature of pain dull, aching, vykruchivatsya.
- Stiffness in the joints caused by the obstruction of the outflow of fluid from the affected joint. It often occurs after prolonged immobility of the joint and is held with the resumption of traffic.
- The local temperature increase in the area of the patient’s joint.
The x-rays in the initial stages can be detected: periarticular osteoporosis periarticular edema of adjacent tissues, small joints can sometimes notice the expansion of the joint space.
Symptoms of the infection, against which developed reactive arthropathy can be different:
- if that urogenital infection can be purulent discharge from the genital tract disorder urination, lower abdominal pain, intermenstrual bleeding, prostatitis, etc.
- when the cause of the disease was the intestinal infection, the patient can be diarrhea, fever, weakness, nausea, vomiting.
From skin lesions and mucous membranes in reactive arthropathy can occur conjunctivitis, keratitis, inflammation of the optic nerve and horioidita, stomatitis, psoriasis. In the beginning of the disease characterized by pain in the lumbar region, symptoms of sacroiliitis.
From lesions of the internal organs may be kidney abnormalities (protein, blood or leucocytes in the urine, Berger’s disease, glomerulonephritis), damage of the aortic valve, inflammation of the serous lining of the heart, palpitations, meningoencephalitis and peripheral paralysis.
Systemic inflammatory response manifested by General weakness, weight loss, fever and erythrocyte sedimentation rate.
Approach to diagnosis
If you suspect that reactive arthropathy is prescribed:
- General analysis of blood (see ESR);
- urinalysis (determine diseases of the genitourinary system);
- the cultures of urine (identify the pathogen);
- definition НLA-B27;
- radiography of the affected joints;
- tests to eliminate gout and rheumatoid arthritis;
- electrocardiogram and echocardiogram;
- consultation of the ophthalmologist, with the defeat of organs of vision.
For the treatment of reactive arthropathy apply an integrated approach, which can be divided into three components:
- Etiotropic therapy. Prescribed antibiotics of wide spectrum of action. This group of pharmaceuticals include antibiotics penicillin and tetracycline, fluoroquinolones, and macrolides. Dose picked individually depending on the patient’s age and severity of the disease. The duration of treatment is 10-14 days.
- Pathogenetic therapy, which aims to stimulate the immune system of the patient. Specialist appoint Immunostimulants and immunomodulators.
- Symptomatic treatment is aimed at eliminating signs of disease. The patient is discharged or the conduct of NSAIDs, short course corticosteroids. Sometimes prescribed immunosuppressive drugs. They are discharged only when a strong inflammatory process which needs to be confirmed not only clinical but also laboratory data.
Recipes of traditional medicine
For the treatment of various diseases in recent times have become increasingly popular recipes of folk medicine. It basically compresses and ointments.
They do not eliminate the cause of disease, but reduce the symptoms of the disease, so he ease the suffering of the patient.
- Recipe 1. A salve of comfrey. 0.5 cups of comfrey roots or 1 Cup of comfrey leaves pour 200 ml of vegetable oil and keep on low heat for 30 minutes. Then skip along with beeswax in a meat grinder. After 24 hours, the ointment is ready.
- Recipe 2. Horseradish and black radish. Grind them on a grater. The skin over the damaged area lubricated with vegetable oil. Slurry was applied for 2-3 hours.
Recommended therapeutic exercise, tailored to the plan. The imposition of cold compresses. Two weeks in the beginning of the disease is to limit stress on the joints, but complete immobilization is contraindicated.
Prognosis and possible complications
Generally in most patients, the pathology is self-limiting in nature, the average duration of first episode disorders ranges from 4 to 6 months.
Complications reactive arthropathies are observed usually due to aggressive arthritis. And most likely to occur when a genetic predisposition.
Somewhere near half of patients have relapses of arthritis over different time intervals. In 17% of patients the disease becomes chronic.
Observed erosive damage of the small joints of the foot. Somewhere in 12% of patients developed deformity of the feet, but strong deformation is rarely observed.
In the absence of proper therapy or private recurrences of acute anterior uveitis can cause the rapid development of cataracts.
Measures for the prevention of reactive arthropathies is aimed at prevention of infections, against which it can occur.
It is necessary to observe personal hygiene, wash hands before eating, after contact with animals or visiting the toilet, must observe the rules of storage of products, monitor the quality of the cooked food.
Citizens, who have the antigen HLA-B27, is recommended in order to prevent «traveller’s diarrhoea» to take antibacterial drugs.
To prevent urogenital infections, you must avoid casual unprotected sex.