Terapevticheskii arkhiv · 2001
[Reactive arthritis: current characteristics and the role of Chlamydia infections in development of a clinical picture].
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Doroshenko Iu A, Nikonova E N
Аннотация
AIM: To examine present-day peculiarities of reactive arthritis (ReA) and effects of chlamydial infection on ReA clinical manifestations.
MATERIAL AND METHODS: 120 ReA patients entered the trial. Urogenital variant was in 85%, enterocolitic in 15% of the patients. Etiology of ReA was defined with special methods diagnosing chlamydial and ureaplasma infection in scrapes from urethral or cervical epithelium (a cytological test, an enzyme immunoassay, polymerase chain reaction, cultural technique of ureaplasma detection). Antichlamydial antibodies were identified with enzyme immunoassay and reaction of indirect immunofluorescence. Factor analysis and indirect consecutive image recognition were applied.
RESULTS: In all the cases, enterocolitic ReA was preceded by acute intestinal infection. In urogenic ReA the disease started with urethritis (62.7%), conjunctivitis (2.0%), arthritis (31.4%) or talalgia (3.9%). Initially, the occurrence of a full Reiter's triad was 15%, incomplete (two signs of the three)--46.7%. The debute was characterized by predominant oligoarticular lesion (65%), in the advanced stage polyarthritis was frequently diagnosed (49.6%). Pain most frequently located in the low spine (60.5%). X-ray evidence on degenerative-dystrophic alterations of the peripheral joints and spine was obtained in 54.2% ReA cases. 60 patients were examined for chlamydial and ureaplasma infection. The etiology of ReA was chlamydial, ureaplasmic and chlamydo-ureaplasma in 43.3, and 35%, respectively. The etiology was not identified in 16.7% cases. Such extraarticular symptoms as urogenital, ocular, skin and mucosal, cardiovascular, lymph nodes were observed in 61.7, 22.5, 13.3, 76.7 and 13.3%, respectively.
CONCLUSION: At present, ReA is characterized by the following most typical features: polymorphism of clinical symptoms at the disease onset, predominance of polyarticular variant of articular involvement at the advanced stage of ReA, high incidence of extraarticular manifestations. The factor analysis shows that clinical picture of ReA is established by "activity" and "unfavourable course" factors.
MATERIAL AND METHODS: 120 ReA patients entered the trial. Urogenital variant was in 85%, enterocolitic in 15% of the patients. Etiology of ReA was defined with special methods diagnosing chlamydial and ureaplasma infection in scrapes from urethral or cervical epithelium (a cytological test, an enzyme immunoassay, polymerase chain reaction, cultural technique of ureaplasma detection). Antichlamydial antibodies were identified with enzyme immunoassay and reaction of indirect immunofluorescence. Factor analysis and indirect consecutive image recognition were applied.
RESULTS: In all the cases, enterocolitic ReA was preceded by acute intestinal infection. In urogenic ReA the disease started with urethritis (62.7%), conjunctivitis (2.0%), arthritis (31.4%) or talalgia (3.9%). Initially, the occurrence of a full Reiter's triad was 15%, incomplete (two signs of the three)--46.7%. The debute was characterized by predominant oligoarticular lesion (65%), in the advanced stage polyarthritis was frequently diagnosed (49.6%). Pain most frequently located in the low spine (60.5%). X-ray evidence on degenerative-dystrophic alterations of the peripheral joints and spine was obtained in 54.2% ReA cases. 60 patients were examined for chlamydial and ureaplasma infection. The etiology of ReA was chlamydial, ureaplasmic and chlamydo-ureaplasma in 43.3, and 35%, respectively. The etiology was not identified in 16.7% cases. Such extraarticular symptoms as urogenital, ocular, skin and mucosal, cardiovascular, lymph nodes were observed in 61.7, 22.5, 13.3, 76.7 and 13.3%, respectively.
CONCLUSION: At present, ReA is characterized by the following most typical features: polymorphism of clinical symptoms at the disease onset, predominance of polyarticular variant of articular involvement at the advanced stage of ReA, high incidence of extraarticular manifestations. The factor analysis shows that clinical picture of ReA is established by "activity" and "unfavourable course" factors.