Reactive Arthritis: purulent inflammation of the joints

September 5, 2013

  • Reactive Arthritis: purulent inflammation of the joints
  • Diagnosis and treatment

 reactive arthritis
 Sometimes, on the background of some infections suddenly starts to hurt the joint. This response of the organism to the introduction of infection, a condition called reactive arthritis. The disease was first identified in 1916 Reuter servicemen during outbreaks of intestinal infections in the First World War.


What is reactive arthritis and why it occurs

Reactive arthritis - is the body's response to the introduction of infection, which is expressed in an aseptic (without infection and pus), inflammation of the joints. This occurs as a result of an autoimmune response of the body - allergy own tissues as part of the joint tissues include substances similar in composition to those which are part of cell pathogens. Therefore developed antibodies destroy the immune system not only pathogens, but also related to their tissue of joints. It is believed that the critical importance in the development of reactive arthritis are genetic characteristics of the organism.

Developing reactive arthritis on a background of throat infections, urinary tract infections, sexually transmitted infections (particularly chlamydia often), digestive (salmonellosis iersineoza, dysentery) for about a month after the onset of the disease. The disease occurs more frequently in the active age to 40 years.


The causes and mechanism of development

Depending on what kind of microorganism provokes the development of the disease, reactive arthritis are divided into two groups. It:

  • Postenterokoliticheskie, ie those that develop after intestinal inflammation. The most common infectious agents - Yersinia, Salmonella, shigella (dysentery bacillus), Campylobacter, and Clostridium. This form of the disease is usually detected at the same time a group of people who are in closed collectives. Its occurrence is associated with poor sanitation;
  • Urogenital that are usually associated with previous chlamydial infection. For such a form characterized by isolated cases of disease.

Reactive arthritis develops mainly in people with a genetic predisposition. Microbial antigens (foreign substances which cause the development of the immune response) into the blood, and in synovial (intraarticular) fluids and tissues of the joints.

When postenterokoliticheskih forms of reactive arthritis penetration of antigens in the blood and joints contributes to increased permeability of the inflamed intestinal wall. In the pathology of which is caused by chlamydia Chlamydia: insidious and widespread disease  Chlamydia: insidious and widespread disease
 Such foreign substances are carried through the body by phagocytes - immune system cells that absorb harmful bacteria and particles.

In response to antigens produced antibodies, the last detected in blood and synovial fluid. Then, the immune complexes are formed, they are deposited in the shell that lines the inside joints, and cause its inflammation.


What are the symptoms of reactive arthritis

Classic proyavleniemi reactive arthritis are three features: joint inflammation, conjunctiva and urethra. Additionally, there may be changes in the skin, mucous membranes, some of the internal organs (liver, kidney, cardiac muscle), the central nervous system. This often occurs at the beginning inflammation of the urethra (urethritis) and conjunctivitis, and only then - arthritis.

Inflammation of the urethra is a different manifestation - from acute, with purulent discharge from the urethra Discharge from the urethra - common nuisance among women  Discharge from the urethra - common nuisance among women
 Until erased prone to prolonged or chronic. Urethra in men is complicated by prostatitis - an inflammation of the prostate gland.

Eye disease characterized by bilateral moderate, and quickly passing conjunctivitis.

Joint inflammation develops, usually acute, 2-4 weeks after the first symptoms of underlying disease (intestinal infections, genital infections, acute respiratory disease) and accompanied by a temperature rise up to high values.

The inflammation occurs most often in the joints of the lower extremities (knee, ankle, small joints of the feet). The joints are affected on both legs, but asymmetrically - in various different limbs joints. There have pain and swelling of joints. Joints of the hands are involved in the process is relatively rare. Some patients complain of pain in the lumbosacral spine. The inflammatory process over time causes stiffness. Another manifestation of arthritis is a rapidly developing atrophy (decrease in volume) muscles surrounding the affected joints, inflammation of the inguinal lymph glands. Arthritis usually begins with inflammation of joints, inflammation gradually spreads to other joints.

Reactive arthritis Arthritis - a variety of forms and complications  Arthritis - a variety of forms and complications
   often accompanied by skin and mucous membranes. So, on the palms and soles appear small red spot in the center of which is a zone of rough skin (hyperkeratosis). On the mucous membranes may appear painless erosion.

The most common reactive arthritis lasts for 3-6 months and ends in complete recovery. When you save the source of infection relapses. Sometimes the process becomes prolonged and chronic, even with the development of persistent arthritis.


Local symptoms

The period from the beginning of the urogenital or intestinal infection until symptoms of arthritis ranges from three days to two months. About a quarter of men and women do not pay attention to the early signs of arthritis.

Most people in the pathological process involved one or more (up to four) joints. Typically, joint disease of the lower extremities, with the exception of the hip.

At the very beginning of the disease develop inflammation of the ankle, knee and metatarsophalangeal joints (half the affected joints of the big toes). Later changes can join the upper extremities and the spine. Toes become sosiskoobrazny views. The defeat of the tarsal joints and ligamentous apparatus of inflammatory changes quickly lead to the development of flatfoot.

Enthesopathies - a characteristic feature of reactive arthritis. This term refers to the pathological changes in locations where tendons and ligaments attach to bones. In the area affected enthesis during movement there is pain, sometimes there is swelling. The most common pain in the plantar fascia attachment (wide tendon plate) to the heel bone and the Achilles tendon.

Half of the patients have pain in the projection of the sacroiliac joint in the lower part of the spine, which are accompanied by restriction of his mobility. It is also characterized by morning stiffness, and spasm of the paravertebral muscles.


Systemic manifestations

Fever with reactive arthritis is hectic nature, that is, during the day the temperature change varies between 3-5 ° C, while it climbs alternate with fast decay. Man gets tired quickly, it decreases appetite.

On the skin appear painless education in the form of nodules and plaques. Most often, they are located on the palms and feet, but sometimes occur on the trunk, arms, thighs and scalp.

The nails in patients with reactive arthritis yellow, deformed, thinner, and in more severe cases, the peel from the soft tissues of the fingers. Typically developing conjunctivitis (inflammation of the mucous membrane of the eye) and urethritis (inflammation of the urethra). In women, the inflammatory process involves the cervix, i.e. there cervicitis Cervicitis - can cause infertility  Cervicitis - can cause infertility

Lymph nodes often increase in size. Muscles, heart, lungs, kidneys and nervous system are also subject to pathological changes.