Case Of Reactive Arthritis Research Articles

Treatment of Reactive Arthritis with Biological Agents.

Reactive arthritis (ReA) is an inflammatory joint condition triggered by an infection elsewhere in the body, and this review aims to provide a comprehensive synthesis of recent studies including case reports and case series to determine whether biologics are a treatment option. Recent studies indicate that biological agents, including anti-TNF agents (infliximab, adalimumab, etanercept), anti-IL17 (secukinumab), and anti-IL6 (tocilizumab), are effective in treating refractory cases of ReA. Evidence suggests these agents are associated with significant clinical improvement. Notably, the data reveal that these biologics are generally well-tolerated, with a low incidence of major adverse events, which supports their safety profile for use in ReA. Biological agents, including anti-TNF, anti-IL17, and anti-IL6 therapies, can be safely and effectively used in the treatment of ReA when conventional therapies fail. It further emphasizes the need for a well-designed controlled trial to provide scientific basis for better informed clinical decisions in cases not responding to conventional treatment.

A rare case of reactive arthritis with intermittent hematuria in a young male

Reactive arthritis (ReA) is an inflammatory arthritis that manifests days to weeks after a gastrointestinal or genitourinary infection. It is also described as a classic triad of arthritis, urethritis, and conjunctivitis. Here we discuss the clinical presentation of ReA in a 20-year-old male who presented with typical triad of symptoms. But there was presence of hematuria which couldn't be explained by this single diagnosis. So further investigations where necessary to find the cause of his haematuria. A 20-year-old male student with history of childhood onset renal stone disease presented with complaints of dysuria for 3 days followed by bilateral conjunctival congestion along with pain around right hip joint, painful swelling around right ankle joint for 2 days. All examination were normal except for bilateral conjunctivitis and features of right ankle joint arthritis. His blood investigations showed neutrophilic leucocytosis with raised CRP levels. Chlamydia IgM Antibody was detected positive, which revealed the causative organism being Chlamydia Trachomatis. Urine routine showed 50-55 RBC’S and 2+ proteinuria. Hematuria was attributed to the CT evidence of renal stone and abnormal retroaortic coarse of his left renal vein described as posterior nutcracker syndrome.

Serologic Biomarkers of Progression Toward Diagnosis of Rheumatoid Arthritis in Active Component Military Personnel.

To identify a panel of serum biomarkers that could specifically identify imminent cases of rheumatoid arthritis (RA) before diagnosis. Serum samples were collected at 4 time points from active component US military personnel, including 157 anti-citrullinated protein antibody (ACPA)-seropositive and 50 ACPA-seronegative RA subjects, 100 reactive arthritis (ReA) subjects, and 76 healthy controls. The cohorts were split into 2 phases, with samples tested on independent proteomic platforms for each phase. Classification models of RA diagnosis based on samples obtained within 6 months prior to diagnosis were developed both in univariate analyses and by multivariate random forest modeling of training sample sets and testing sample sets from each phase. Increases in serum analytes, including C-reactive protein levels, serum amyloid A, and soluble programmed cell death 1 (PD-1), were observed in seropositive RA subjects at the time point closest to diagnosis, up to several years before diagnosis. Only a small fraction of RA subjects had levels above the 95th percentile of healthy control levels until the time period within 6 months of diagnosis. For classification of RA diagnosis using samples obtained within 6 months prior to diagnosis, soluble PD-1 provided superior specificity compared to ReA cases (>89%), with a sensitivity of 48% for RA classification. An 8-analyte model provided superior sensitivity (69%), with comparable specificity relative to ReA (>82%). Our findings demonstrate that imminent RA diagnosis could be classified with high specificity, relative to healthy controls and ReA cases, using a panel of cytokines measured in serum samples collected within 6 months before actual diagnosis.

P29 An unusual case of reactive arthritis

Introduction/BackgroundThis 28-year-old gentleman with a background of cerebral palsy was admitted to hospital feeling generally unwell with pyrexia as well as a red, hot and swollen right knee. He had communication and mobilty issues at baseline but was very unsettled and less mobile than normal.CRP was over 100 and elevated temperatures were recorded. Ultrasound confirmed a small right knee effusion which was subsequently aspirated with no growth on culture. Crystal analysis on this sample was also negative.Intravenous antibiotics were commenced and the patient was managed as a septic joint with no other obvious source of infection.Description/MethodAntibiotics led to improvement in temperatures and inflammatory markers. A trial off antibiotics led to return of fever, elevated inflammatory markers and knee symptoms. In addition to this a red, hot and swollen left elbow evolved as well as discomfort in neck and left shoulder. Blood cultures remained negative. Repeat knee aspirate remained negative on culture.Antibiotics were restarted.An additional problem during admission was constipation which had been a chronic issue that had been worsened.Abdominal xray showed a 10cm faecolith in the rectum. The case was discussed with the gastro intestinal and surgical teams and conservative management was recommended with escalation of laxatives with only minimal success.MRI spine showed no discitis. MRI knee showed moderate knee effusion but no osteomyelitis. CRP fluctuated with joint flares over the coming weeks with antibiotics adjusted accordingly.CT chest abdomen and pelvis to look for an alternative infective source showed massive distention of sigmoid colon with partially calcified faeculant material, with mass effect on the urinary bladder. An infective source was not definitively identified.The case was discussed with the surgical team again with further usage of enemas to little effect. Ultimately the patient had a manual evacuation performed under anaesthetic in theatre with large volumes of faeces removed. Bowels moved well with ongoing laxatives and his joints remained settled from this point on.Discussion/ResultsThis patient had been in hospital for 10 weeks in 2019 with recurring bouts of inflammation in knee and elbow alongside pyrexias and elevated inflammatory markers. Within 48 hours of manual evacuation of a large, chronic faecolith his joints were completely settled and patient was discharged to have no further joint issues since.The joint issues were initially felt to be an infective aetiology and therefore managed with antibiotics but with the discovery of the large faecolith and subsequent removal of this and settling of joints, this appears to have been a inflammatory arthritis presumably reactive to the chronic constipation.Key learning points/ConclusionThis was a very interesting case in a young man with physical and mental disabilities with joint pain and swelling and a prolonged hospital admission. Chronic constipation appears to have been the trigger for these inflammatory joints and highlights the point to consider less common causes of inflammatory, reactive arthritis.

Reactive arthritis incidence in a community cohort following a large waterborne campylobacteriosis outbreak in Havelock North, New Zealand

ObjectivesIn August 2016, Campylobacter spp contaminated an untreated reticulated water supply resulting in a large-scale gastroenteritis outbreak affecting an estimated 8320 people. We aimed to determine the incidence of probable...

P061 Polymyalgia rheumatica following COVID-19 vaccination: presentation of four patients

Background/AimsVaccination against coronavirus is a cornerstone in the fight against the COVID-19 pandemic. Although the safety and efficacy of vaccines was established prior to roll out, long-term data and reports of rare adverse reactions remain inadequate. Literature reviews revealed two cases of PMR-like syndrome, left elbow arthritis and a case of rheumatoid arthritis (RA) flare following COVID-19 vaccination. Additionally, a case of new onset RA and case of reactive arthritis was reported with COVID infection.MethodsWe present four patients with polymyalgia rheumatica (PMR) following COVID-19 vaccination. The clinical details of the four patients are outlined in the table: P061 Table 1Patient 1Patient 2Patient 3Patient 4Demographic data76-year-old Caucasian male68-year-old Caucasian male73-year-old African male65-year-old Caucasian maleType of COVID-19 vaccineAstraZenecaPfizerAstraZenecaAstraZenecaOnset of symptoms after the second dose of COVID-19 vaccinationWithin 1 weekWithin 2 weeksWithin 1 weekWithin 1 weekClinical symptoms-Inflammatory joint pain mainly in shoulders and hand with two hours morning stiffness -Bilateral knee and ankle swelling. -Significant restriction of self-care activities in daily living (ADL)-Severe shoulder pain and morning stiffness -Hand pain affecting ADL-Widespread painful joints affecting the neck, pelvic girdle, and hands -Significant restriction of self-care activities-Sudden onset of pain and stiffness of both shoulders and pelvic girdle -Requiring a walking stick. -Significant morning stiffnessClinical signs- Limited shoulder abduction -Tenderness over PIP and MCP without synovitis- Limitation of shoulder movement-Limitation of shoulder movement-Limitation of both shoulder movementAutoimmune profile (RF, CCP, ANA, ANCA and protein electrophoresis)NegativeNegativeNegativeNegativeFull blood countHaemoglobin (Hb) 125 g/l and white blood cells (WBCs) 17 10 × 9/1Hb 147 g/l and WBCs 11.5 10× 9/1Hb 160 g/l WBCs 14 10× 9/1Hb 124 g/l and WBCs 9.8 10× 9/1CRP at the onset of symptoms96 mg/l61 mg/l105 mg/l161 mg/lPrednisolone dose30 mg per day as there was no response to 15 mg and tapered as per PMR regime15 mg per day tapered as per PMR regime40 mg per day by A & E; and tapered as per PMR regime15 mg per day tapered as per PMR regimeUltrasound (US) revealed typical finding of bilateral sub deltoid bursitis and biceps tendonitis in the first patient and there was severe right sub deltoid bursitis with biceps tendonitis in the second patient. None of the patients had features to suggest malignancy, giant cell arteritis, seronegative spondyloarthropathies or connective tissue disease.ResultsAfter exclusion of other inflammatory causes of shoulder pain, they were diagnosed with PMR based on clinical judgement and high inflammatory marker at time of presentations, ultrasound findings and significant improvement with prednisolone.ConclusionPMR following COVID-19 vaccination is exceptional and cannot be proven. In these patients post vaccination chronology of events favours this diagnosis. It is known that immunological illness may start after viral infection or vaccination (hapten or immune stimulation). The patients have responded well to the prednisolone similar to typical PMR cases. We need further studies to look at possible link between COVID-19 vaccination and PMR.Disclosure M. Mohareb: None. A. Bharadwaj: None. A. Nandagudi: None.

Post COVID Vaccination Reactive Arthritis: A Contemporary Assailant

The severe acute respiratory syndrome coronavirus 2-induced coronavirus disease 2019 (COVID-19) has had a global spread. While most patients with coronavirus disease 2019 (COVID-19) present with mild or moderate symptoms, 15% may develop severe pneumonia, 5% develop acute respiratory distress syndrome (ARDS), septic shock, and multiple organ failure. Some patients may also experience arthralgia or arthritis. Cases of reactive arthritis have been reported during or after COVID-19. Vaccines play an essential role in preventing the spread. However, almost all types ofvaccines have been reported to be associated with adverse events. With the approval of the use of COVID-19 vaccines, the vaccination program was started in our country and is still continuing. Reactive arthritis (ReA) after vaccination has been reported; however, ReA after COVID-19 vaccination has not been reported widely. We reported a 26-year’sold woman who suffered from an acute ReA on her left knee, left ankle and right wrist joint 8 days after COVID-19 vaccination anddiscussed the etiology and preventive strategy. She presented with oligoarthritic for 12 days eight days after COVID vaccination. Finally, she was diagnosed as ReA after COVID vaccination and was administered systemic steroid. The swelling and pain nearly disappeared after 7 days. On 1month follow-up, her condition was normal. ReA after COVID-19 vaccination is rare. The benefits ofvaccination far outweigh its potential risks and vaccination should be administered according to the currentrecommendations. Further attentions should be put to determine which individual is at higher risk fordeveloping autoimmune diseases after COVID-19 vaccination. More versatile and safer vaccines should beexplored.

Bilateral Gouty Arthritis Developing After Covid-19 Infection: A Case Report

Introduction and Purpose: SARS-CoV-2 virus started in Wuhan, China in 2019 and caused the COVID-19 pandemic by affecting the whole world in a short time. Arthralgia is one of the symptoms that can be seen after Covid-19 infection and can be seen in 14.9% of the cases. However, data on rheumatic and inflammatory symptoms such as arthritis are scarce. Viral infections are known causes of acute arthralgia and arthritis. In the literature, there are many examples of reactive arthritis cases developing after Covid-19 infection. Gouty arthritis is the most common form of inflammatory arthritis. Acute gouty arthritis most often affects the first metatarsophalangeal joint in the foot. 
 Case Presentation: A 76-year-old male patient with chronic kidney disease, hypertension, and a history of coronary artery bypass using both leg saphenous 12 years ago was admitted to the emergency service with chest pain and increasing fatigue. Since the Covid-19 PCR result was positive, he was hospitalized for further examination and treatment. On the 14th day of hospitalization, the patient complained about pain around both big toes that started suddenly at night and worsened in the morning. In the patient's history, he stated that he had completely similar complaints several times with an interval of one year in the last 3 years and he recovered spontaneously in 10-15 days.
 Discussion and Conclusion: Although developing gouty arthritis etiology is not clear for our patient in this case, it is thought to be a secondary condition due to the development of the disease after Covid-19 infection. It was considered that our patient has bilateral gouty arthritis triggered primarily by COVID-19. Due to the limited number of studies, more case reports should be added to the literature on this subject.

Reactive Hip Arthritis and Avascular Necrosis After Severe COVID-19 Infection: A Case Report and Comprehensive Review of Literature

COVID-19 has variable clinical presentations, severity, and multisystem involvement. Some patients have encountered arthralgia and myalgia symptoms. Reactive arthritis is an emerging musculoskeletal manifestation post-COVID-19 infection. The authors report a 29-year-old male, previously healthy, who developed acute left hip arthritis 8 weeks after recovering from severe COVID-19 pneumonia. It was associated with bilateral avascular necrosis of femoral heads, with medullary bone infarctions at both proximal tibias. Human leukocyte antigen-B27 was positive and synovial fluid culture, autoimmune workup, crystals, and infectious aetiologies were negative. The patient’s clinical condition improved with the use of non-steroidal anti-inflammatory drugs and physiotherapy. To the best of the authors’ knowledge, this is the first case reported of hip arthritis and avascular necrosis following the COVID-19 infection. In addition, the authors reviewed the literature for the reported reactive arthritis cases post-COVID-19 infection and management outcomes.

Successful use of tofacitinib in reactive arthritis refractory to conventional therapies - a case series.

Reactive arthritis is an immune-mediated aseptic arthritis resulting from either genitourinary or gastrointestinal tract in a genetically susceptible host. It commonly presents as oligoarthritis of the lower limbs with or without extra-articular features such as urethritis and non-purulent conjunctivitis. Therapies include non steroidal anti inflammatory drugs (NSAIDs), conventional disease modifying anti-rheumatic drugs (DMARDs) and, rarely, biologics in severe cases. We report the successful use of tofacitinib in four cases of reactive arthritis who failed to respond to conventional therapies.

A Case of Reactive Arthritis in a Healthy Adult

A 32-year-old man presented to the emergency department with a several-day history of low back pain, right knee pain, and left foot pain. He had been treated several weeks prior to presentation for a sexually transmitted infection but could not recall which organism or antibiotic was involved.

Acute generalized exanthematous pustulosis induced by sulfasalazine: Uncommon presentation of a common culprit

Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse drug reaction caused by drugs in the majority of cases. It is characterized by the sudden onset of nonfollicular sterile pustules, papules, and edematous plaques on an erythematous background, predominantly involving the flexures. Sulfa drugs have a notorious reputation of wide range of severe adverse reactions, including AGEP. However, nonantibiotic sulfonamides behave differently from antibiotic sulfonamides in the pattern of adverse drug reactions and seldom cause AGEP. Only one case of AGEP due to salazosulfapyridine has been documented, none due to sulfasalazine. We report a 40-year-old female patient with a known case of reactive arthritis who was started on tablet sulfasalazine 500 mg in escalating doses, 4 days before the onset of nonfollicular sterile pustules, on erythematous background predominantly over flexures. She was diagnosed as a case of definite AGEP with score of 12/12 on the European Study of Severe Cutaneous Adverse Reaction validation scale. As per the Naranjo causality scale, sulfasalazine was the probable drug with a score of 5.

Arthritis following COVID-19 vaccination: report of two cases

While most patients with coronavirus disease 2019 (COVID-19) present with mild or moderate symptoms, 15% may develop severe pneumonia, 5% develop acute respiratory distress syndrome (ARDS), septic shock, and multiple organ failure. Some patients may also experience arthralgia or arthritis. Cases of reactive arthritis have been reported during or after COVID-19. With the approval of the use of COVID-19 vaccines, the vaccination program was started in our country and is still continuing.Here we present two patients who developed arthritis after COVID-19 vaccination.

Enteric Pathogens and Reactive Arthritis: Systematic Review and Meta-Analyses of Pathogen-Associated Reactive Arthritis.

The objective of this systematic review and meta-analysis was to estimate the proportion of postinfectious reactive arthritis (ReA) after bacterial enteric infection from one of four selected pathogens. We collected studies from PubMed, Web of Science, and Embase, which assessed the proportion of postinfectious ReA published from January 1, 2000 to April 1, 2018. Papers were screened independently by title, abstract, and full text; papers in English, Spanish, and Portuguese utilizing a case-control (CC) or cohort study design, with a laboratory confirmed or probable acute bacterial enteric infection and subsequent ReA, were included. The proportion of ReA cases was pooled between and across pathogens. Factors that can induce study heterogeneity were explored using univariate meta-regression, including region, sample size, study design, and ReA case ascertainment. Twenty-four articles were included in the final review. The estimated percentage of cases across studies describing Campylobacter-associated ReA (n = 11) was 1.71 (95% confidence interval [CI] 0.49-5.84%); Salmonella (n = 17) was 3.9 (95% CI 1.6-9.1%); Shigella (n = 6) was 1.0 (95% CI 0.2-4.9%); and Yersinia (n = 7) was 3.4 (95% CI 0.8-13.7%). Combining all four pathogens, the estimated percentage of cases that developed ReA was 2.6 (95% CI 1.5-4.7%). Due to high heterogeneity reflected by high I2 values, results should be interpreted with caution. However, the pooled proportion developing ReA from studies with sample sizes (N) <1000 were higher compared with N > 1000 (6% vs. 0.3%), retrospective cohort studies were lower (1.1%) compared with CC or prospective cohorts (6.8% and 5.9%, respectively), and those where ReA cases are identified through medical record review were lower (0.3%) than those identified by a specialist (3.9%) or self-report (12%). The estimated percentage of people who developed ReA after infection with Campylobacter, Salmonella, Shigella, or Yersinia is relatively low (2.6). In the United States, this estimate would result in 84,480 new cases of ReA annually.

Uncommon Cause of Reactive Arthritis in the Elderly

Reactive Arthritis, formerly known as Reiter’s syndrome, is a delayed autoimmune mediated inflammatory reaction in the joints that occurs from a response to an infection elsewhere in the body. It usually occurs in young males in response to a genitourinary or gastrointestinal infection. These males may have a predisposition to reactive arthritis by being Human Leukocyte Antigen-B27 (HLA-B27) positive. This report will display an unusual case of reactive arthritis in an elderly female.

Treatment of Reactive Arthritis: A Case Report

Reactive arthritis is clinically defined as inflammatory aseptic arthritis which develops shortly after an extra-articular infection. The classic triad of conjunctivitis, urethritis, and arthritisis found in a minority of patients. Patiepresent with an asymmetric mono- or oligoarthritis that predominantly affect lower limbs. Here, we present a case of reactive arthritis with inadequate primary response to Nonsteroidants Usually l Anti-inflammatory Drugs (NSAIDs).

EP02 A rare case of Reactive arthritis secondary to COVID-19

Case report - IntroductionIn December 2019, the first cluster of Coronavirus disease 2019 (COVID-19) cases caused by the novel coronavirus SARS-CoV-2 was identified in Wuhan, China. The disease was declared a global pandemic on 11th March 2020. COVID-19 was initially thought to cause respiratory complications only, however several extra pulmonary manifestations of the infection have since emerged. We report a rare case of reactive arthritis (ReA), urticarial rash and angioedema in a young female secondary to COVID-19 infection. Rashes were recently added to the World Health Organisation (WHO) criteria for diagnosis of COVID-19 demonstrating their significance.Case report - Case descriptionA 31-year-old female doctor was admitted with acute swelling of her lips, dysphagia, and a widespread urticarial rash. Preceding this she had a one-week history of fever, cough, and constitutional symptoms of malaise and weight loss. Her symptoms had started at the end of April 2020 during the peak of the COVID-19 pandemic in the United Kingdom. Three days later she developed painful swelling of her wrists, elbows, knees, and hands. She reported no back or sacroiliac joint pain, enthesitis or any previous history of inflammatory joint pains. She had a history of platelet dysfunction and was treated with Desmopressin.Clinical examination revealed a widespread urticarial rash over her face, limbs, and trunk, with no nail abnormalities. She had active synovitis in her right wrist, elbow, and mild bilateral knee effusions. All other joints including spine and sacroiliac joints were normal. She had no dactylitis or enthesitis. Systemic examination was normal. Investigations revealed Hb 113 g/L, MCV 88.2 fL, Platelets 282 x 109/L, WCC 6.6 x 109/L and Lymphocytes of 0.63 x 109/L with normal neutrophil and eosinophil count. CRP was raised at 107mg/L. She had a negative autoimmune screen including ANA, ANCA, IgM-RF, anti-CCP antibodies and HLA B27. Plain radiographs of knees were normal. SARS CoV-2 PCR was positive following a nasal swab. Urine and blood cultures were negative. Treatment was commenced with intravenous hydrocortisone and antihistamines with resolution of her angioedema symptoms; however, her rash and arthritis persisted.The patient was diagnosed with Reactive Arthritis (ReA), urticarial rash and angioedema secondary to COVID-19 infection. Prednisolone 30mg daily was started, and within a week her arthritis and rash markedly improved. Prednisolone was tapered over six weeks. By her two-month clinic follow up, she reported no further joint swelling and was functioning normally.Case report - DiscussionThe most common complication of COVID-19 is Acute Respiratory Distress Syndrome (ARDS) however several other serious complications have been identified including cardiac injury, thromboembolic events, neurological abnormalities, and an aggravated inflammatory response causing a cytokine storm.ReA is a post infectious arthritis commonly seen following gastrointestinal or genitourinary infections and is yet to be recognised as a complication of this disease. ReA most commonly presents as an asymmetrical peripheral or axial spondyloarthropathy. The affected joints do not contain pathogen. More than half of ReA cases resolve spontaneously within six months without requiring long-term treatments. Up to 20% of patients with COVID-19 infection have been shown to develop cutaneous manifestations including erythematous rash, vesicular rash, acral ischaemia, rash with petechiae, and widespread urticaria. This has led to the recent addition of rashes to the World Health Organisation (WHO) Criteria for diagnosis of COVID-19 infection. Additionally, as COVID-19 has an incubation period of 14 days where patients can be asymptomatic, cutaneous manifestations may serve as an early indicator of infection, aiding in a more rapid diagnosis.Case report - Key learning pointsWe present a rare case of ReA secondary to COVID-19 infection, with complete resolution of symptoms following administration of oral glucocorticoids. A detailed history and examination of the musculoskeletal system should be undertaken in all patients presenting with COVID-19. Urticarial rashes should be considered as an early symptom of COVID-19 infection as per the WHO criteria for diagnosis. Glucocorticoids can be considered in treating patients with this presentation, where traditional anti-inflammatory agents have been refractory or contraindicated.

Cohort profile of a US military population for evaluating pre-disease and disease serological biomarkers in rheumatoid and reactive arthritis: Rationale, organization, design, and baseline characteristics

PurposeThe etiology of several autoimmune disorders, including rheumatoid arthritis, remains unknown. While there are clear phases of disease progression, the mechanisms of transition between these phases are poorly understood. Additionally, treatment focuses on an alteration of the biological processes to prevent joint damage and functional decline. A goal is to potentially treat the disease during the preclinical phase to mitigate the disease process. Reactive arthritis is another rheumatologic condition known to be secondary to a distal infection. While prevention of infection would mitigate risk, serologic profiling patients with the disease may assist in the elucidation of potential disease risk factors. This study was initiated to enable an assessment of pre-disease biomarkers in patients newly diagnosed with rheumatoid arthritis and reactive arthritis. ParticipantsA retrospective cohort of 500 rheumatoid and 500 reactive arthritis cases with 500 matched controls was drawn from a population of active component US military personnel. Appropriate inclusion criteria limited subject selection. Additionally, 4 serum samples (3 pre-disease and 1 disease-associated) were obtained for each case and control. Findings to dateThe established cohort provides the framework for novel exploration of the host response through serum profiling and seroepidemiology prior to disease onset. Future plansThis study establishes the framework for the evaluation of novel serum biomarkers enabling the identification of signals prior to clinical disease that may enable disease prediction, elucidate disease pathogenesis and identify novel exposures leading to increased disease risk and/or disease severity.

Herpes virus infections in children, associated syndromes. Clinical observation

A rare variant of pathology associated, with combined, herpetic infection, involving in the joint process and the formation of reactive arthritis, is considered. A clinical case of reactive arthritis associated, with combined, herpetic infection in a child. 1 year and. 9 months is demonstrated. The indicators of the main laboratory markers of herpesvirus activity are given, the changes in the patient's complaints and. the patient's condition are tracked. The changes in the patient's complaints and. the patient's condition are monitored. Laboratory research is subject to instrumental research methods. Possible therapeutic approaches are discussed, with the use of antiviral drugs, glucocorticosteroids, nonsteroidal antiinflammatory drugs.

THE EPIDEMIOLOGICAL CHARACTERISTIC OF DISEASES OF MUSCULOSKELETAL SYSTEM

The purpose of the study. To analyze prevalence of diseases of musculoskeletal system in the Arkhangelsk region. The methods. The data of official statistics was used to implement analysis of general morbidity of main diseases of musculoskeletal system of adult population the Arkhangelsk region during 2010-2015 as compared with corresponding morbidity in the North-Western Federal and the Russian Federation in general. The results. In the Arkhangelsk region, among general morbidity percentage of diseases of musculoskeletal system made up to 4.2% (7th rank). The increasing of common morbidity of diseases of musculoskeletal system in adult population was marked in the Arkhangelsk region up to 14% and in the Russian Federation up to 7%. Since 2010, in the Arkhangelsk region the study established increasing of common morbidity rheumatoid joint inflammation up to 22%, spondylopathy up to 65%, osteoarthrosis up to 32.4%, osteoporosis up to 46% and systemic diseases of connective tissue up to 11.5% surpassing average Russian indices. At that, number of cases of reactive arthritis decreased up to 17.2% Conclusions. In the Arkhangelsk region, the register of diseases of musculoskeletal system on the basis of region rheumatological center is to be developed to implement an objective assessment in the existent situation.