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Reactive arthritis (syndrome of Reuters)
Reactive arthritis is an inflammatory process of not purulent character in joints which development happens as an effect of urinogenital or intestinal infection.
If to consider all rheumatic diseases, then reactive arthritis which is also called by an illness of Reuters it is considered the most widespread illness in this category. The name "reactive arthritis" appeared in 1969 and designates reaction to development in an organism of the infection which is shown an inflammation of joints.
Most often such diagnosis takes place at boys at teenage age, and also at young men. According to medical statistics, reactive arthritis develops at 86,9 patients on 100 thousand people.
Reasons of reactive arthritis
Most often development of reactive arthritis happens against a chlamydial infection. The illness of Reuters at children owing to infection with chlamydias develops approximately in 80% of cases. Infection with hlamidy occurs at direct contact with carriers of this infection. Also chlamydias can catch from animals. Ways of infection — airborne, sexual, air and dust, contact and household. Zzarazheniye occurs in the course of passing of a fruit in patrimonial ways of the infected mother. At infection with chlamydias, as a rule, at the person visible symptoms are not shown. Sometimes there is a discomfort and an urodynia, existence of allocations from generative organs.
One more disease-producing factor of Reuters – intestinal microorganisms. These are salmonellas, iyersiniya, a kampilobakter, shigellas which can catch at contracts with the infected people, excrements, at reception of the spoiled food. At such defeats at the person very heavy diarrhea is noted.
However display of reactive arthritis is noted not at all people who had such infections. According to some researches, the disease is noted only at people who possess a special gene — HLA B 27. Therefore origins of reactive arthritis are studied still.
At defeat rheumatic arthritis at men notes heavier disease, than at women. It is noted that after the postponed sexually transmitted infection have reactive arthritis of the man by nine times more often than women. And here after the postponed intestinal infections approximately identical incidence is noted.
Symptoms of reactive arthritis are noted at the person approximately in 2-4 weeks after he had sexually transmitted or intestinal infection. Reactive arthritis at children and adults is shown most often by urethritis symptoms, conjunctivitis develops later, and in the last turn arthritis of joints is noted. As a rule, at conjunctivitis not plentiful departments are shown. Some patients (approximately at every fourth case) have changes at integuments. Defeats on skin are mainly shown by rash, defeat mucous oral cavities.
Symptoms of reactive arthritis remain at the sick person a different span. It lasts from three months to one year. Generally at this time weak signs of an urethritis and conjunctivitis remain, and the inflammation affects one-two joints. For example, inflammatory process of a hip joint, knee joint can be observed. However sometimes reactive arthritis passes very hard and considerably limits physical activity of the person, passing into chronic arthritis. In that case the patient actively looks for an opportunity to get rid of an illness, practicing treatment by folk remedies. However high-quality diagnosis of an illness initially has to be carried out and to be appointed doctor's instructions.
Beginning of reactive arthritis, as a rule, acute: sharply body temperature increases, the general state considerably worsens. There is a damage of large joints of legs: generally ankle, knee, calcaneal, interphalangeal, metatarsophalangeal joints suffer from a disease, there is a damage of joints of hands less often.
Most often fingers of feet on which hypostasis which gradually covers all finger develops are surprised. Skin on a finger becomes crimson-blue. Except arthritises at patients with an illness of Reuters entezopatiya develop. So call inflammatory processes in sinews which occur in those places where sinews are attached to bones. Most often such phenomenon is observed in a heel. Sometimes patients complain of pain in a backbone.
If treatment of a syndrome of Reuters happens timely, then symptoms of a disease disappear for rather short span. However it happens that reactive arthritis passes into a chronic form.
At a disease of reactive arthritis doctors speak about the favorable forecast for normal life and preservation of functions. However there are also some adverse factors worsening the forecast. In this case it is about too frequent aggravations of a joint syndrome, existence of a hereditary favor to diseases of rheumatic character, HLA-B27 gene carriage, absence of effect of therapy. Lethal outcomes at this disease meet very seldom. The complication provoking damage of heart of the person is a basic reason of death. To prevent development of similar complications, it is necessary to take care of timely and correct treatment of a disease and regular supervision at the specialist rheumatologist.
In the course of diagnosis of reactive arthritis the doctor initially conducts survey of the patient. It is possible to establish the diagnosis in case of manifestation at the person of an illness of Reuters, based on data on an infection which took place at the patient soon. Also the doctor studies clinical manifestations, uses laboratory and tool methods of inspection. In the course of research the special attention should be paid to existence at the person of damages of eyes, urinogenital bodies, skin, and also joints. Also analyses on existence in an organism of the sick activator are carried out. In the course of laboratory research blood, a chair, allocations from a genital tract is used. In certain cases carrying out X-ray inspection of the affected joint practices.
In this case important not only to confirm the diagnosis of reactive arthritis, but also to exclude existence of other reasons which provoked development of arthritis.
Beginning therapy of reactive arthritis, the doctor puts for the purpose to destroy an infection, to cure an illness or to reach a condition of permanent remission. An illness of Reuters it is necessary to treat in the conditions of a hospital. Treatment of an illness of Reuters is carried out with use of conservative methods. At the same time therapy of an illness at women and at men assumes use of antibiotics, non-steroidal anti-inflammatory drugs, sometimes glucocorticoids are also used. When inflammatory symptoms abate, occupations by physiotherapy exercises, a massage course practice. Features of how to treat a disease, the attending physician specifies in an individual order.
Antibiotics – one of the main methods of treatment, and their choice has to be carried out taking into account feature of life activity of the chlamydias or other microorganisms which provoked an infection. Generally at treatment of this illness tetracyclines, macroleads, ftorkhinolona are applied. However, considering toxicity of some antibacterial drugs, at treatment of the illness caused by chlamydias at children only macroleads are applied. However it is necessary to consider that treatment by antibiotics effectively at the acute course of a disease. If reactive arthritis passes into a chronic form, then antibacterial agents do not render due effect any more.
At the same time at therapy of chronic Chlamidia arthritis various immunomodulatory drugs are used. But such treatment can be carried out only under continuous supervision of the doctor. Medicines from this group help to increase the general body resistance and its protective properties.
But not only disposal of chlamydias is the only condition of treatment. Antigens of microorganisms in an organism remain longer time, than the activator. Therefore it is very important to conduct control examination through certain periods. Sometimes carrying out repeated courses of treatment is required by antibacterial drugs and immunomodulators.
Besides, if necessary the patient appoints a symptomatic treatment. Non-steroidal anti-inflammatory drugs are appointed to reduce pain in the acute period. Doses of such drugs are calculated depending on age of the patient.
Steroid anti-inflammatory drugs possess strong antiinflammatory influence therefore are appointed if it is necessary to stop quickly pain, complications or activity of an illness. At reactive arthritis glucocorticoids enter vnutrisustavno.
If the articulate syndrome becomes aggravated, and at the same time the entezopatiya takes place, mobility of a backbone is limited, then reception of mmunopodavlyayushchy drugs practices. They are also appointed if standard treatment is inefficient. Treatment by such drugs can last for several years, however at the same time continuous supervision of the doctor is necessary.
If the joint pain remains throughout a long time, they need to be protected from loadings. But later, after the inflammation recovers, it is necessary to recover physical activity gradually. Treatment of a disease, as a rule, continues about 4-6 months.
Primary methods of prevention of reactive arthritis do not exist. It is necessary to take all measures to warn the beginning of development of an illness. Therefore, special attention needs to be paid on a healthy lifestyle, hygiene, treatment of clamidiosis, and also prevention of infection with sexually transmitted infections. The acute and chronic centers of an infection it is necessary to treat timely.
Measures of secondary prevention assume the prevention of palindromias. It is important not to allow self-treatment and in time to address the specialist.