Diagnosis Of Reactive Arthritis Research Articles

Reactive arthritis in coinfection with Chlamydia trachomatis and Chlamydia pneumoniae

The below case of the development of reactive arthritis against the background of coinfection of Chlamydia trachomatis and Chlamydia pneumoniae is interesting by the features of the clinical picture, the duration of the course, the complexity of diagnosis, laboratory observation, and a comprehensive approach to therapy.
 Reactive arthritis belongs to the group of seronegative spondyloarthritis, has a variety of symptoms with damage to various organs and systems. All patients have pathology of peripheral joints and/or axial skeleton. The disease is immuno-inflammatory in nature, may follow an infection of the genitourinary or digestive tract. A special role in the development of urogenic reactive arthritis is assigned to Chlamydia trachomatis. Less often, reactive arthritis is caused by C. pneumoniae. In the case of persistent infection, non-simultaneous development or low expression of symptoms, the diagnosis of reactive arthritis is difficult, and in about one case out of five, the disease becomes chronic. Predisposition to severe course of reactive arthritis may cause the presence of HLA-B27 antigen in the patient. It can be assumed that coinfection of two varieties of chlamydia (C. pneumoniae and C. trachomatis) can act synergistically, increasing the risk of developing reactive arthritis.
 The available data on the effectiveness of the complex of antibacterial anti-chlamydia drugs, own experience of the lymphotropic method of administration, has been successfully used in the complex treatment of the patient.

Reactive arthritis after Gam-COVID-Vac vaccination: A case report.

Although the safety and efficacy of vaccinations have been evaluated through clinical trials, medical experts and authorities are very interested in the reporting and investigation of adverse events following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunisation in the general public. This article reports about a 41-year-old man without a history of underlying diseases, complaining of continuous morning stiffness and acute discomfort in his left elbow joint, 20 days after taking the first dosage of Sputnik V. The case was extensively studied, and a possible diagnosis of reactive arthritis was made.

Reactive arthritis occurring after COVID-19 infection: a narrative review.

PurposeReactive arthritis is acute aseptic arthritis occurring 1 to 4 weeks after a distant infection in a genetically predisposed individual. It may occur after COVID-19 infection.We summarize, in this article, the current findings of reactive arthritis following COVID-19 infection.MethodsA literature search has been performed from December 2019 to December 2021. We included case reports of reactive arthritis occurring after COVID-19 infection. We collected demographic, clinical, and paraclinical data.ResultsA total of 22 articles were reviewed. There were 14 men and 11 women with a mean age of 44.96 + 17.47 years. Oligoarticular involvement of the lower limbs was the most frequent clinical presentation. The time between arthritis and COVID infection ranged from 6 to 48 days. The diagnosis was based on clinical and laboratory findings. The pharmacological management was based on non-steroidal anti-inflammatory drugs in 20 cases. Systemic or local steroid therapy was indicated in 13 patients. Sulfasalazine was indicated in two cases. Alleviation of symptoms and recovery were noted in 22 cases. The mean duration of the clinical resolution was 16 + 57 days.ConclusionThe diagnosis of reactive arthritis should be considered in patients with a new onset of arthritis following COVID-19 infection. Its mechanism is still unclear.

Knowledge and Perceptions of Reactive Arthritis Diagnosis and Management Among Healthcare Workers During the COVID-19 Pandemic: Online Survey.

Reactive arthritis (ReA) is an often neglected disease that received some attention during the coronavirus disease 2019 (COVID-19) pandemic. There is some evidence that infection with severe acute respiratory syndrome coronavirus 2 can lead to "reactive" arthritis. However, this does not follow the classical definition of ReA that limits the organisms leading to this condition. Also, there is no recommendation by any international society on the management of ReA during the current pandemic. Thus, a survey was conducted to gather information about how modern clinicians across the world approach ReA. An e-survey was carried out based on convenient sampling via social media platforms. Twenty questions were validated on the pathogenesis, clinical presentation, and management of ReA. These also included information on post-COVID-19 arthritis. Duplicate entries were prevented and standard guidelines were followed for reporting internet-based surveys. There were 193 respondents from 24 countries. Around one-fifth knew the classical definition of ReA. Nearly half considered the triad of conjunctivitis, urethritis and asymmetric oligoarthritis a "must" for diagnosis of ReA. Other common manifestations reported include enthesitis, dermatitis, dactylitis, uveitis, and oral or genital ulcers. Three-fourths opined that no test was specific for ReA. Drugs for ReA were non-steroidal anti-inflammatory drugs, intra-articular injections, and conventional disease-modifying agents with less than 10% supporting biological use. The survey brought out the gap in existing concepts of ReA. The current definition needs to be updated. There is an unmet need for consensus recommendations for the management of ReA, including the use of biologicals.

Prevalence of Human Leukocyte Antigen B27 Positivity and Microbiological Profiles of Patients with Reactive Arthritis – A Cross Sectional Study

The present study aims to determine the spectrum of etiological agents and to screen HLA-B27 and, related inflammatory markers in patients presenting with symptoms of Spondyloarthritis(SpA) post diarrhea, which can aid in prompt diagnosis of reactive arthritis (ReA). A total of 903 stool samples of patients presenting with diarrhea were collected and screened with microscopic and culture techniques to identify the etiological agents. Blood samples of patients presenting with both diarrhea and arthritis were collected and subjected to C- reactive protein(CRP), Erythrocyte sedimentation rate(ESR) and Human Leukocyte Antigen B27(HLA-B27) detection tests.Among the total of 903 patients, 20 Salmonella species were isolated. Othergut microbes identified included Escherichia coli 572(63%), Klebsiella species 126(14%), Proteus vulgaris 43(5%), Proteus mirabilis 27(3%), Citrobacter species and Enterococcus species 8(1%), while some of these organisms(3.2%) caused inflammation resulting in ReA. Parasitic etiology was found in 99 patients, among which the most common parasites include Entamoeba histolytica and hookworm, identified through microscopy. Among the total, 29 patients were found to have symptoms of joint pain with articular and extra articular manifestations, and some associated with HLA-B27.

Differential Diagnosis of Reactive and Infectious Arthritis after Anterior Cruciate Ligament Reconstruction

Summary. Relevance. Negative results of the anterior cruciate ligament (ACL) reconstruction occur in 10-20% of cases. The incidence of infectious arthritis can reach up to 1.7% and even up to 7.1%, according to the literature. However, ACL reconstruction can be complicated not only by infectious but also by reactive arthritis. Differential diagnosis between infectious and reactive arthritis is often hard to be done, but it is necessary for effective treatment. Objective: to determine the possible causes of the development of reactive and infectious arthritis after ACL reconstruction, peculiarities of their diagnostics and differential diagnostics. Materials and Methods. The literature data regarding the frequency of reactive and infectious arthritis after various methods of surgical treatment of ACL injury and the use of different types of implants, as well as laboratory indicators of the activity of the inflammatory process in the postoperative period and such indicators in reactive and infectious arthritis, were analyzed. We also analyzed literature data on the sensitivity and specificity of various methods of microbiological studies in patients with infectious synovitis or arthritis. Results. Numerous probable causes of a higher incidence of infectious arthritis in ACL reconstruction are suspected. Synthetic implants may be the cause of the development of reactive arthritis, according to a number of studies. Our experience in using different biodegradable fixators from various manufacturers suggest that the percentage of complications depends not only on the fact of the biodegradability of the implant, but on its composition, and even on the percentage of tricalcium phosphate or the manufacturer. Therefore, it is impossible to unambiguously state that biodegradable fixators are worse or better then metallic or non-biodegradable polymeric ones. However, on average, if we consider all existing fixators from various manufacturers, the number of complications when using biodegradable implants is higher. Diagnosis of reactive arthritis is often based on negative bacteriological findings. Given the not always high sensitivity of bacteriological inoculation of synovial fluid and the duration of the investigation, we cannot rely only on its results. Conclusions. The most difficult for differential diagnosis between infectious and reactive arthritis (synovitis) is acute synovitis after ACL reconstruction with normal results of bacteriological studies, but high biochemical parameters of inflammation. We suggest to suspect infectious arthritis after ACL reconstruction in the following hemogram values: 1) CRP >40-50 mg/l, 2) ESR >30-50 mm/h, 3) fibrinogen >800 mg/ml, 4) procalcitonin in blood plasma >0.5 ng/ml, 5) leukocytosis and left shift of the leukocyte formula, with the following synovial fluid test parameters: a) CRP >40-50 mg/l, b) leukocytosis with an increase in the percentage of polymorphonuclear leukocytes >75%.

On the diagnosis and coding of reactive arthropathies

According to statistics from the Ministry of Health of Russia, the incidence of reactive arthropathies varies significantly by region and year. In ICD-10, reactive arthropathies include reactive urogenic arthritis (M02.3), other reactive arthropathies (M02.8), and reactive arthropathies, unspecified (M02.9). Information on reactive arthritis (ReA) cannot be extracted from these data.Objective: to specify the number of patients with ReA among inpatients with reactive arthropathies.Patients and methods. A retrospective analysis of 224 case histories was made in the patients treated at the V.A. Nasonova Research Institute of Rheumatology Clinic in 2009–2018 and discharged with Codes M02.3, M02.8, and M02.9.Results and discussion. Nineteen out of the 224 patients were diagnosed with reactive urogenic arthritis (M02.3), 128 had reactive arthropathies (M02.8), and 77 had reactive arthropathies, unspecified (M02.9). All the 19 patients with this diagnosis met the criteria for reactive urogenic arthritis. Among the 128 patients with reactive arthropathies, 77 met the ReA criteria, 8 of them were found to have reactive urogenic arthritis, since the clinical picture had a triad consisting of arthritis, urogenic or enterocolitic infection, and conjunctivitis. Twenty-five out of the 77 patients discharged with Code M02.9 met the criteria for certain ReA and 6 did those for possible ReA. Thus, the diagnosis fitted the criteria for ReA in only half (56.7%) of the patients with reactive arthropathies.Conclusion. The performed investigation revealed that clinicians paid insufficient attention to the diagnosis of ReA and that statisticians did this to the coding of reactive arthropathies.

Reactive arthritis due to asymptomatic Escherichia coli bacteriuria in a young tuberculosis patient

Reactive arthritis (ReA) is commonly associated with gastroenteritis by Yersinia, Salmonella, Shigella, Campylobacter, and Clostridium difficile and genitourinary infections by Chlamydia trachomatis and Neisseria gonorrhea. Urinary tract infection (UTI) with Escherichia coli is rarely associated with ReA. Failure to screen for UTI, especially in patients with asymptomatic bacteriuria, can lead to delayed diagnosis and inappropriate treatment. A 31-year-old homemaker, who had been diagnosed with pulmonary TB 1 month back and had completed 1 month of successful anti-TB therapy, presented with pain and swelling of the right knee and fever of 1-week duration. She had healing erythema nodosum on both her thighs. Her right knee had pain and swelling that lead to restriction of movements. X-ray of the right knee showed joint effusion with no joint destruction. Work up for autoimmune arthritis was negative. Synovial fluid studies ruled out septic arthritis, crystal arthropathies, and tuberculous arthritis. Urinalysis suggested UTI and urine culture isolated E. coli. Hence, we made the diagnosis of ReA due to UTI with E. coli. She received oral nonsteroidal anti-inflammatory drugs and a course of ciprofloxacin. She had a complete recovery.

Chlamydia Trachomatis Associated Reactive Arthritis: A Urinary PCR Based Study.

Background and Objective:Chlamydia trachomatis is increasingly being associated with reactive arthritis (ReA). The present study was undertaken to assess the role of C. trachomatis in patients with ReA since such data is lacking from the Indian population.Materials and Methods:PCR using specific primers for C. trachomatis was carried out from urine samples of 65 patients with ReA, 20 of other inflammatory arthritis, and 20 healthy controls.Results:C. trachomatis DNA was detected from urinary samples with PCR in 24 (36%) of 65 ReA patients. PCR was negative in the patients of other inflammatory arthritis as well as in normal healthy control group. Out of the 24 patients with urinary PCR positivity, 14 (58.33%) were males and 10 (41.66%) were females.Conclusion:Urinary PCR plays an important role in rapid diagnosis of ReA associated with C. trachomatis.

Ultrasonographic findings in a patient with reactive arthritis induced by intravesical BCG therapy for bladder cancer

Intravesical bacillus Calmette-Guerin (BCG) therapy is an effective and safe immunotherapy for superficial bladder cancer. However, reactive arthritis (ReA) is reported as an adverse event in about 0.5-1% of patients receiving intravesical BCG therapy. ReA is known as a kind of spondyloarthritis, the main pathological finding of which is enthesitis. Here we report a patient with ReA induced by intravesical BCG therapy for bladder cancer, in whom the diagnosis of ReA was supported by ultrasonographic findings of enthesitis and synovitis. A 69-year-old male was diagnosed with carcinoma in situ of the bladder and treated with intravesical BCG therapy. After the third intravesical BCG injection, pain and swelling appeared in both wrists. Ultrasonographic examination revealed not only intra-articular synovitis in the bilateral wrist joint, wrist flexor tenosynovitis, and wrist extensor tenosynovitis, but also enthesitis of the flexor carpi radialis tendon (FCR). The severe enthesitis of the FCR in both wrists was considered to be an important finding that supported the diagnosis in this patient. Thus, we diagnosed this case as ReA induced by intravesical BCG therapy. In clinical practice, ReA is often difficult to distinguish from seronegative rheumatoid arthritis and other rheumatic diseases. Ultrasonographic findings of enthesitis may support a definitive diagnosis for these patients.

Potential risk factors for reactive arthritis and persistence of symptoms at 2years: a case-control study with longitudinal follow-up.

The objective of the study is to determine the risk factors for the development of reactive arthritis (ReA) and examine the factors associated with the persistence of symptoms. Patients with a new diagnosis of ReA and controls with a gastrointestinal (GI), urogenital, or sexually transmitted infection in the 3-6months prior to study entry were prospectively enrolled in Guatemala City. ReA patients fulfilled the Assessment in Spondyloarthritis International Society criteria for peripheral spondyloarthropathy (SpA). Patients underwent history, examination, Achilles tendon ultrasound, and blood draw. Human leukocyte antigen (HLA) type and serum biomarkers were measured. t tests and nonparametric equivalents were used to examine the association of clinical, laboratory, and imaging factors with ReA. Patients were contacted 2years later to assess for persistence of symptoms. Study subjects included patients with ReA (N = 32) and controls (N = 32). ReA patients were most frequently infected in April whereas controls were most frequently infected in August. Two ReA patients and two controls were HLA-B27-positive. Serum cathepsin K and C-reactive protein were higher in ReA patients compared to controls (p = 0.03 for both), while total cholesterol and low-density lipoprotein were lower (p = 0.008 and 0.045, respectively). Among those with ReA, 15 (47%) patients had continued symptoms at 2years. These patients had a lower matrix metalloproteinase-3 level at diagnosis than patients for whom ReA resolved (p = 0.004). HLA-B27 was not associated with development of ReA in Guatemala; however, the month of infection was associated with ReA. The most striking finding was the persistence of arthritis at 2years in nearly half of the patients.

Childhood hospitalisation with infections and later development of ankylosing spondylitis: a national case-control study.

BackgroundThe role of environmental exposures in the pathogenesis of ankylosing spondylitis (AS) remains unclear. In particular, two types of exposures have been suspected to play a role: mechanical stress and infections. The objective of this case-control study was to determine if childhood infections are associated with later development of AS.MethodsThe cases with AS were identified through the Swedish national outpatient specialised-care register, based on having been given at least one AS diagnosis in the register between 2001 and 2010. Five controls per case were identified in the Swedish population register, matched at the time-point of the index case’s first spondyloarthritis diagnosis on sex, birth year, and county. All cases/controls matched prior to the age of 17 years were excluded, as well as all cases/controls given a diagnosis of reactive arthritis or juvenile arthritis at any time point, or any other diagnosis of a rheumatic disease, psoriasis, iridocyclitis, or inflammatory bowel disease before the time-point of matching. All events of hospitalisation with an infection before the age of 17 years were retrieved from the register, and categorised according to the focus of the infection. Odds ratios (ORs) and confidence intervals (CIs) were determined through conditional logistic regression analyses.ResultsOf the 2453 cases with AS and 10,257 controls, 17.4 % of the cases and 16.3 % of the controls had been hospitalised with an infection before the age of 17 years (OR 1.08, 95 % CI 0.96–1.22).Appendicitis (1.5 % cases; 2.5 % controls; OR 0.59, 95 % CI 0.41–0.83), respiratory tract infections (cases 11.2 %; controls 9.2 %; OR 1.24, 95 % CI 1.07–1.44) and, in particular, tonsillitis (cases 3.7 %; controls 2.8 %; OR 1.31, 95 % CI 1.03–1.67) were associated with AS. There were no associations between AS and any other type of infection, and the point estimates were similar in several sensitivity analyses.ConclusionsChildhood appendicitis was associated with a decreased risk, whereas respiratory tract infections were associated with an increased risk for later development of AS. These findings support a possible relationship between childhood infections and later development of AS, although the study is limited to infections resulting in inpatient care.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-016-1141-8) contains supplementary material, which is available to authorized users.

Вопросы инструментальной диагностики реактивного артрита

Вопросы инструментальной диагностики реактивного артрита

Skeletal indicators of reactive arthritis: A case study comparison to other skeletal conditions, such as rheumatoid arthritis, ankylosing spondylitis, ankylosing sero-negative SpA, and DISH

In this case study we report a unique modern case of severe reactive arthritis (Reiter's Syndrome) observed on an elderly Cypriot female from the St. Nicholas cemetery in Limassol, Cyprus and the successful differential diagnosis of the condition. The individual exhibited lesions specific to fusion of the thoracic and lumbar spinal column, primarily along the posterior aspect of the spine with sacroiliac fusion, fusion of the left femoral head within the acetabulum, no intervertebral fusion, and severe Launois’s deformity with no corresponding fusion or arthritis mutilans of the hands. Diagnosis of reactive arthritis is much more compatible than other common HLA-B27 related seronegative spondylarthropathies such as ankylosing spondylitis, psoriatic arthropathy, or enteropathic arthropathy given the suite of conditions present. We conclude with the confirmation of reactive arthritis and stress the importance of having a broad literature base when making differential diagnoses.

Cutaneous manifestation of reactive arthritis: Case report

Abstract Introduction Reactive arthritis (ReA) is one of the forms of seronegative spondyloarthropathies. The difficulties in the diagnosis of reactive arthritis, despite a complex clinical picture, result from the lack of unequivocal diagnostic criteria, especially in the initial period. Diverse clinical manifestation of ReA may require the cooperation of many specialists. Aim The case of a 59-year-old man with reactive arthritis caused by an acute Yersinia enterocolitica infection 3 weeks before was described. Case study A 59-year-old patient, so far healthy, was admitted due to fever for a few days, pain and swelling of crurotalar joints, pain in the left part of the lumbosacral region, escalating at night, and additional complaints impeding urinating. Joint involvement was accompanied by numerous cutaneous and mucosal lesions. Results and discussion In this case the presence of characteristic cutaneous symptoms as keratoderma blenorrhagicum and balanitis circinata allowed to identify the disease quickly, despite a short course of the disease. The presence of antibodies of Y. enterocolitica IgA was noticed, without the presence of IgG and IgM. The presence of HLA B27 antigen was positive. In this case, the occurrence of many characteristic cutaneous lesions enabled a quick identification of the disease, despite the difficulties with determining the etiological factor. Conclusions The diagnosis of ReA is clinical, based on the history and physical examination findings. A high index of suspicion is required because no laboratory tests, markers or imaging finding allow diagnosing of ReA. The most important is proper cooperation between a rheumatologist and a dermatologist.

Seronegative reactive spondyloarthritis and the skin

Spondyloarthritidies represent a group of conditions affecting the axial and peripheral muscoloskeletal apparatus and are often associated with psoriasis, infections, and inflammatory bowel diseases. Other diseases included in this category are psoriatic arthritis, ankylosing spondylitis, and enteropathic arthritis. Reactive arthritis is an elusive spondyloarthritis, commonly occurring 1 to 3 weeks after a digestive or a genitourinary tract infection, in which microorganisms do not infect the joint directly. Reactive arthritis is classically characterized by large-joint arthritis, urethritis in men and cervicitis in women, and eye inflammation (usually conjunctivitis or uveitis) but encompasses numerous other symptoms and signs, including manifestations of dermatologic interest such as keratoderma blenorrhagicum and circinate balanitis. The diagnosis of reactive arthritis is clinical, and the infectious agent cannot always be identified due to disease latency after the infection. Most cases are self-limiting, but reactive arthritis may become chronic in 30% of cases. Treatment options include anti-inflammatory drugs, steroids, and sulfasalazine; biologic agents, such as tumor necrosis factor α (TNF-α) blockers, have been recently used, but there are only a few randomized clinical trials on the treatment of reactive arthritis. The effectiveness of antimicrobials needs further evaluation.

Differential diagnosis of reactive arthritis in a patient with intravesical BCG immunotherapy

Case report We report the case of a 50 year-old female patient known with bladder tumor operated in January 2014 followed by 4 weeks of intravesical BCG immunotherapy, one administration per week. After each course the patient accused low grade fever, nausea, pollakiuria and hematuria with limited duration. In March 2014, after a cystoscopy and a bladder resection, she underwent another 5 weeks of BCG instillations. After the fourth course the patient presented to our clinic for fever with chills, pollakiuria, hematuria, conjunctivitis, myalgia and disabling migratory arthritis of the left ankle and right knee. Clinical exam at admission: high fever, left ankle and right knee arthritis, impaired mobility in the left temporomandibular joint. Following admission the patient developed left metacarpophalangeal and proximal interphalangeal arthritis of the index and medius. She had leukocytosis with neutrophilia, reactive thrombocytosis and high biologic inflammatory syndrome. Urinalysis showed frequent leukocytes, no albuminuria and negative cultures. The patient underwent arthrocentesis for synovial fluid sampling; the smear showed absence of bacteria, 40% polymorphonuclear cells, 15% small lymphocytes, 20% medium lymphocytes, 25% large lymphocytes and the Ziehl-Neelsen smear was negative. The culture for Mycobacterium spp. was negative. Suspecting a BCG arthritis and cystitis we started empiric antituberculous (antiTB) and glucocorticoid therapy. A week after admission Serratia marcescens was identified in one blood culture out of three collected, so we added ertapenem for 14 days. Rheumatological examination raised suspicion of an autoimmune illness, but all specific blood tests were negative. Despite that, the rheumatologist added sulfasalazine, considering that even BCG arthritis can associate an autoimmune disorder. After 2 months of antiTB, glucocorticoid and sulfasalazine treatment the evolution was favorable, with remission of arthritis and fever.

Pathogenesis and Diagnosis of Reactive Arthritis, Inflammatory Bowel Disease-associated Spondyloarthropathy, Juvenile Idiopathic Arthritis, and Adult-onset Still’s Disease

Pathogenesis and Diagnosis of Reactive Arthritis, Inflammatory Bowel Disease-associated Spondyloarthropathy, Juvenile Idiopathic Arthritis, and Adult-onset Still’s Disease

Reactive arthritis

Reactive arthritis (ReA) can be defined as the development of sterile inflammatory arthritis as a sequel to remote infection, often in the gastrointestinal or urogenital tract. Although no generally agreed-upon diagnostic criteria exist, the diagnosis is mainly clinical, and based on acute oligoarticular arthritis of larger joints developing within 2-4 weeks of the preceding infection. According to population-based studies, the annual incidence of ReA is 0.6-27/100,000. In addition to the typical clinical picture, the diagnosis of ReA relies on the diagnosis of the triggering infection. Human leucocyte antigen (HLA)-B27 should not be used as a diagnostic tool for a diagnosis of acute ReA. In the case of established ReA, prolonged treatment of Chlamydia-induced ReA may be of benefit, not only in the case of acute ReA but also in those with chronic ReA or spondylarthropathy with evidence of persisting chlamydia antigens in the body. In other forms of ReA, there is no confirmed evidence in favour of antibiotic therapy to shorten the duration of acute arthritis. The outcome and prognosis of ReA are best known for enteric ReA, whereas studies dealing with the long-term outcome of ReA attributable to Chlamydia trachomatis are lacking.

Arthrite réactionnelle dans les suites d’une infection urinaire à Escherichia coli

Reactive arthritis following Escherichia coli urinary tract infection is very rare. We report a 25-year-old woman with acute oligoarthritis associated with bilateral anterior uveitis after an episode of urinary tract infection due to E. coli. The diagnosis of reactive arthritis was considered and the patient treated with non-steroidal anti-inflammatory agents. Disease course was rapidly successful and at 6-month follow-up the patient was asymptomatic. Reactive arthritis is associated with intestinal infection but also with common urinary tract infection.