Reactive Arthritis Research Articles

Keratitis and corneal perforation in reactive arthritis: A case report and review

To report a rare case of corneal perforation in reactive arthritis and review the scientific basis for it. A case report. A 22-year-old male patient presented with redness, foreign body sensation, and blurred vision associated with knee and lumbar arthritis after an episode of urethritis was diagnosed with reactive arthritis (ReA). Ophthalmological examination revealed keratitis and corneal perforation at the time of admission. The patient received antibiotic drops and systemic steroids and underwent a corneal patch graft, which improved his visual acuity and outcome; however, he developed chronic arthritis and had to be treated with infliximab. The classical ocular manifestations of ReA are conjunctivitis, anterior uveitis, keratitis, and scleritis; however, this case report demonstrates a rare but severe presentation of ReA that should be considered.

AKT question relating to reactive arthritis

AKT question relating to reactive arthritis

AKT answer relating to reactive arthritis

AKT answer relating to reactive arthritis

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.

Revisiting articular syndrome in the peri-pandemic COVID-19 era.

Articular syndrome is often the presentation of a person's various rheumatic or related diseases. It includes both arthralgia and arthritis, with objective signs of joint inflammation defining the latter. This syndromic approach to joint pain enables a scientific method for early diagnosis of common rheumatic conditions without compromising the recognition of uncommon conditions. This review explores common rheumatic conditions associated with articular syndrome, including osteoarthritis, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE). It supports the early differentiation of uncommon but emerging entities such as reactive arthritis (ReA). The aim of the review is to comprehensively overview various forms of articular syndrome to update rheumatologists' and allied health specialists' knowledge. Epidemiology, clinical presentations, diagnostic approaches, and therapeutic strategies are discussed in the context of articular syndrome. The challenges emerging in the peri-pandemic COVID-19 era are highlighted. The improved understanding of the spectrum of clinical conditions and disease states presenting with articular syndrome may facilitate early diagnosis, optimal management, and enhanced patient outcomes within the realm of rheumatology.

Hand conditions as sequelae of infection with COVID-19: a literature review.

Patients have attended our clinics with various hand pathologies after contracting COVID-19 or receiving vaccination. We postulate the virus stimulates a systemic inflammatory response that triggers these pathologies and conducted a search of the literature for associated conditions. Twenty publications were included for this review. Three studies identified skeletal muscle inflammation, and several identified reactive arthritis post-infection. Rheumatoid arthritis post-infection was also recognized, along with crystalline arthropathy. Carpal tunnel syndrome was seen in two cases. There is a current paucity in published scientific material regarding COVID-19 sequalae in the hand. This review aims to stimulate discussion in how a virus can induce pathological processes causing common hand pathologies.

Spondyloarthropathies and arthritis post-infection: a historical perspective.

The spondyloarthropathies are a group of conditions characterised by spinal joint pain and have related clinical, epidemiological and genetic-related features. Ankylosing spondylitis, reactive arthritis, the spinal form of psoriatic arthritis and Crohn's and colitis enteropathic arthritis are the major clinical entities of the spondyloarthropathies, and principally occur in HLA-B27 positive individuals. Ankylosing spondylitis is much more common in males than females. Patients are usually seronegative for rheumatoid factor, and extra-articular features including iridocyclitis, mucous membrane and skin lesions: aortitis, may occur in some patients. The reactive arthritis form classically occurs following an infection of the gastrointestinal or genitourinary tract. The Crohn's and colitis enteropathic arthritis forms often have an associated large joint asymmetrical arthritis. Also discussed are acute rheumatic fever and Lyme disease which are conditions where the individual develops arthritis after an infection.

Multidisciplinary non-pharmacological treatments with effects on pain modulation and functioning in spondyloarthropathies – a systematic review

Abstract: Treatment for chronic rheumatic diseases, included various modalities for pain management and for functioning modulation, has the main gole to increase the quality of life and to improve also the activities of daily living. Seronegative spondyloarthropathies (SpA) are a group of rheumatologic disorders that include ankylosing spondylitis, psoriatic arthritis, entheropatic SpA, reactive arthritis and undifferentiated SpA. Treatment methods include clasically pharmacological modalities. Physical therapy should also be highlighted as being part of the treatment. Balneotherapy and spa therapy are increasingly taken into account in evidence-based treatment guidelines for multiple rheumatic diseases, for specific effects on functional parameters and also for the involvement in cartilage regeneration. Balneotherapy is universally defined as the treatment method which uses bathing in thermal and mineral waters. Other balneological treatments include peloidotherapy, balneological gases and therapeutic waters in various forms of bathing, inhalation or drinking. Spa therapy comprises complementary and alternative treatment modalities including balneotherapy, hydrotherapy, exercises, and massage therapy. This systematic literature review aims to highlight the effects of balneotherapy in spondylarthropathies. The review is based on the internationally accepted method, the “PRISMA” methodology- “Preferred Reporting Items for Systematic Reviews and Meta-Analysis”.

Chronic or recurrent Campylobacter enteritis in primary immunodeficiency: a UK national case-series and review of the literature.

Chronic or recurrent Campylobacter enteritis in primary immunodeficiency: a UK national case-series and review of the literature.

Structure, demography, and medico-social characteristics of articular syndrome in rheumatic diseases: a retrospective monocentric analysis of 2019-2021 data.

Rheumatic diseases encompass a wide range of conditions characterised by joint inflammation and pain, significantly impacting individuals' quality of life. Articular syndrome, manifested through joint-related symptoms such as pain, swelling, and reduced mobility, is a common feature of rheumatic diseases. This study aimed to analyze articular syndrome's structure, demography, and medico-social characteristics in rheumatic diseases. We retrieved case notes of 370 patients examined in 2019-2021 at the Rheumatology Department of the Regional Clinical Hospital, Shymkent, Kazakhstan. We processed data on gender, age, place of residence, social status, clinical diagnosis, comorbid conditions, complications, and delays. The material was counted by frequency analysis. Statistical and mathematical data processing was performed using the SPSS application software package version 26.0 (IBM). The identified rheumatic diseases among the patients included rheumatoid arthritis (183), systemic lupus erythematosus (47), osteoarthritis (42), ankylosing spondylitis (31), systemic scleroderma (30), reactive arthritis (18), gouty arthritis (14), psoriatic arthritis (3), and dermatomyositis (2). The distribution of patients with articular syndrome varied across the study years, with 102 patients in 2019, 216 patients in 2020, and 52 patients in 2021. The study revealed the age distribution of patients, with an average age of 46 at the time of examination and an average age of disease onset at 39. The study further investigated the distribution of rheumatic diseases categorized by gender, place of residence (urban or rural), and disease duration. Additionally, the study examined the prevalence of comorbid conditions and complications related to the underlying rheumatic disease. By examining the structure, demography, and medico-social characteristics of the articular syndrome in patients with rheumatic diseases, this retrospective analysis provides valuable insights into the epidemiological aspects of these conditions. The findings may contribute to a better understanding of the burden of rheumatic diseases on individuals and society. Such knowledge can aid in developing targeted interventions, improving healthcare delivery, and enhancing patients' overall well-being.

Skeletal and muscular manifestations of post-COVID syndrome: literature review

The 2019 outbreak of a novel coronavirus infection in Wuhan City has resulted in a pandemic that has not only brought about global social change, but has also been a challenge for the entire medical community. The accumulation of material on this disease has revealed the multisystemic nature of internal organ damage with the development of new associated conditions, particularly those related to immunopathology and rheumatologic diseases. This review describes the literature on musculoskeletal symptoms during different periods of new-onset coronavirus infection (COVID-19). The paper defines the terms post-COVID syndrome and Long COVID, and describes clinical observations and the most common symptoms in adults and children. Clinical cases of joint syndrome are described in patients who have had a new coronavirus infection and no history of rheumatologic disease. Possible molecular pathogenesis of autoimmunity activation (cellular and humoral immune response as well as direct cytotoxic effect of the virus) both in acute period of coronavirus infection as well as during recuperation is also considered. Literature analysis of peculiarities of course of COVID-19 in patients with rheumatological diseases was carried out, in particular the risk of infection, its severe course and unfavourable outcome. In general, according to the analysis of the literature, musculoskeletal lesions occur more frequently between 3 and 10 weeks after the end of the acute stage of infection, most often manifested by muscle and joint pain, while the incidence of true reactive arthritis associated with COVID-19 is low. The pathogenesis of musculoskeletal damage requires further investigation and patients should be followed up for a longer period of time.

Knowledge, attitudes, practices, and compliance of rheumatic disease patients toward COVID-19 during the late pandemic

BackgroundRheumatic disease (RD) patients are liable for severe coronavirus disease 2019 (COVID-19). It is noticeable that RD patients’ practices have changed during the late COVID-19 pandemic. This study aimed to assess the knowledge, attitudes, practices, and compliance of RD patients during the late pandemic.ResultsThis study included 188 patients with various RDs. The majority were female (61.7%) and were rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) patients (40.4% and 30.9%, respectively). We found knowledge deficiencies regarding some symptoms, contact isolation, and transmission. Negative attitudes toward COVID-19 final control were detected in a large proportion (50%). Furthermore, the majority did not think they were at risk of COVID-19 due to either RD (61.7%) or their drugs (66%). Their practices were also negative; the majority stopped wearing masks (56.4%) and went to crowded places recently (83%). Moreover, most did not stop or reduce their drugs for fear of COVID-19 but for availability issues (5.3% and 9.6% vs. 37.2%). Male gender and higher education and socioeconomic levels were significantly associated with better knowledge. In addition, RDs such as reactive arthritis, steroid use, lower steroid doses, COVID-19 vaccination, high education and socioeconomic levels, and Internet use as main knowledge sources had a significant association with better attitudes. Conventional disease-modifying anti-rheumatic drugs (DMARDs) use, biologics non-use, high education, severe functional impact, and compliance before the pandemic were significantly associated with higher practice scores. Knowledge was positively correlated with attitudes and practice (P = 0.0001 and 0.003, respectively). Moreover, attitudes were negatively correlated with age (P = 0.016). In multiple linear regression analysis, education, socioeconomic status, and practice were significant positive predictors of knowledge (P = 0.002, 0.001, and 0.046, respectively). Good knowledge, COVID-19 vaccination, younger age, and lower steroid doses were significant predictors of better attitudes (P = 0.02, 0.001, 0.02, and 0.002, respectively). Furthermore, non-use of biologics and functional disability were significant predictors of good practice (P = 0.002 and 0.015, respectively).ConclusionImproving knowledge and educating RD patients about the importance of protective measures is essentially needed to decrease the pandemic fatigue consequences and prevent serious COVID-19 complications in those patients.

Unexpected Adverse Events of Immune Checkpoint Inhibitors.

The introduction of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment standards and significantly enhanced patient prognoses. However, the utilization of these groundbreaking therapies has led to the observation and reporting of various types of adverse events, commonly known as immune-related adverse events (irAEs). In the following article, we present four patients who encountered uncommon toxicities induced by ICIs. The first patient was a 59-year-old female diagnosed with stage 4 lung adenocarcinoma. She received immunotherapy (pembrolizumab) together with chemotherapy and subsequently developed autonomic neuropathy (AN). The next two patients also received chemo-immunotherapy (pembrolizumab) and were both 63-year-old males with stage 4 lung adenocarcinoma. One of the two experienced palmoplantar keratoderma, while the other presented with Reiter's syndrome (urethritis, conjunctivitis and arthritis). The 4th patient, an 80-year-old male with stage 4 squamous cell carcinoma of the lung, received chemo-immunotherapy (pembrolizumab) and developed myasthenia gravis.

Chlamydia trachomatis and the HLA involvement in the development of infection and disease: a narrative review.

CT (Chlamydia trachomatis) is among the most common pathogens leading to sexually transmitted diseases. Considering the uncertain mechanism by which HLA polymorphisms influence the CT infection, reinfection, comorbidities or evolution and because there is no consensus regarding the alleles involved in the pathogenesis of the infection, we considered necessary to perform a review to summarize the current knowledge of HLA related to CT. Pubmed was researched using key terms. Out of the 198 results found, we analyzed articles of all types which describe how the MHC, through HLA alleles, participates in the different stages of CT penetration in the body, including studies about cells or other molecules involved in the process. Almost 40% of the variation in the clinical course of CT infection depends on host genetic factors. There are haplotypes that influence the infection susceptibility/resistance, haplotypes that are involved in the recurrence of the infection, haplotypes that are related to tubal infertility, pelvic inflammatory disease development or trachoma. Antibody to Chsp60 (influenced by MHC genes) has been observed to correlate with late tissue-damaging sequelae. Toll-like receptors were found to increase the susceptibility to CT. The association of HLA-B27 creates susceptibility of reactive arthritis in the organisms infected by CT, but does not influence the carriage of CT. We identified HLA haplotypes belonging both to MHC class l and ll, which influence different stages of CT infection. Genetic risk factors still need research, especially on Caucasians. Studies are moving towards designing a safe and effective vaccine.

Clinical features of patients with ankylosing spondylitis with inefficacy of two or more biological disease modifying antirheumatic drugs

The “Treat-to-target” (T2T) strategy for axial spondyloarthritis (axSpA) has made it possible to optimize therapy in most patients, but in some of them the treatment goals are not achieved.Objective: to analyze the clinical features of patients with ankylosing spondylitis (AS) with inefficacy of two or more biological disease modifying antirheumatic drugs (bDMARDs).Material and methods. From February 2020 to March 2022 458 patients with AS, who met the modified New York criteria of 1984, were admitted to V.A. Nasonova Research Institute of Rheumatology. From this group, 30 (6.6%) patients with high clinical disease activity and inefficacy of at least two bDMARDs were selected. The control group consisted of 139 (30.5%) patients with AS, who either had no history of bDMARDs use, or had previously received only one of them. All patients were examined in accordance with generally accepted methods and underwent a double expert control.Results and discussion. Men predominated in the main and control groups (67 and 60%, respectively). In patients of the main group, there was a higher laboratory activity of the disease, especially ESR (p=0.002), more often peripheral arthritis was detected. In both groups, there was a high incidence of coxitis (69.2 and 69.7%, respectively), while in the main group there were significantly more patients who underwent total joint arthroplasty, and the frequency of detected syndesmophytes was 2 times lower compared to the control. Differences in the features of AS onset were also established: in the main group, the disease often began with reactive arthritis (ReA), while in the control group, with inflammatory back pain.Conclusion. The T2T strategy in axSpA does not always lead to the achievement of the intended goals, and, according to our data, among inpatients with AS, the number of people with a history of inefficacy of two or more bDMARDs reaches 6%. In these patients, compared with the control, the following features of the disease can be distinguished: frequent onset with ReA, a significant incidence of peripheral arthritis and joint arthroplasty, and a higher ESR.

Joint damage in patients with COVID-19 in family medicine

Rheumatoid pathology of the articular apparatus is a significant social problem due to the high incidence of disability. Cases of the development of arthropathy after SARS-CoV-2 infection have been described. The basis of the pathogenesis of this condition may be the excessive synthesis of pro-inflammatory cytokines (cytokine storm), which is characteristic of the acute course of COVID-19. In patients with a severe form of the coronavirus infection, a high concentration of a number of cytokines IFN-γ, IL-1, IL-6, IL-12, and TGFβ was observed. Due to the activation of osteoclasts, resorptive processes in bone tissue were significantly enhanced. Autoimmunization due to cross-reactivity of the virus can also lead to joint damage. Reactive arthritis tends to be acute and occurs in the form of monoarthritis or oligoarthritis. The pathological process develops mainly in the joints of the wrist, ankles, and small joints of the distal parts of the limbs.

A nagy imitátorok – Szifilisz és szisztémás lupus erythematosus differenciáldiagnosztikája egy eset kapcsán

The authors report the case of a 29-year-old male patient presenting with erythematous maculopapular rash, painful oral and genital erosions, dysuria, scleroconjunctivitis, painful palmoplantar hyperkeratotic papules, asymmetric, migratory oligoarthritis, recurrent fever and alopecia parvimaculata. Based on the clinical symptoms the first suspected diagnoses were secondary syphilis and reactive arthritis, however the performed laboratory tests did not confirmed the diagnoses. The autoimmune serology tests, the clinical symptoms, and the results of further investigations established the diagnosis of systemic lupus erythematosus (SLE). By presenting this case the authors highlight the differential diagnostic challanges of secondary syphilis and SLE.

A Cross-Sectional Survey to Evaluate the Influence of the COVID-19 Pandemic on Treatment Adherence in Chronic Dermatological Diseases

Background: The COVID-19 pandemic and subsequent nationwide lockdowns have contributed to complex problems in the management of chronic dermatological diseases. Objectives: The objective of this study is to evaluate the impact of the COVID-19 pandemic on the management of chronic dermatological diseases treated with/without systemic immunomodulators and phototherapy. Materials and Methods: A single-center, cross-sectional, questionnaire-based survey via telephone calls/Google Forms was conducted from May 2020 to July 2020. Multivariate correlation analysis with adherence to treatment as dependent variable was performed to study the influence of various demographic variables, treatment-related factors, and pandemic issues. Results: Data of 138 patients (55% with psoriasis, 21% with vesiculobullous diseases, 18.2% with connective tissue diseases, and 5.8% with conditions such as alopecia areata, vitiligo, lichen planus, and reactive arthritis) were analyzed. The study population consisted of 81.1% of patients on systemic immunomodulators. Autonomous treatment modification was reported by 77% leading to poor disease control in 53.7%. There was a statistically significant negative correlation between income loss during the pandemic and treatment adherence. Duration of illness also showed a significant negative correlation, thereby indicating that treatment adherence reduced with disease chronicity. The highest nonadherence was noted with apremilast. None of the patients reported confirmed COVID infection. Conclusions: The study findings emphasize the direct and indirect effects of the COVID-19 pandemic on treatment adherence in chronic dermatological diseases. It underlines the need for better pandemic response by the development of patient education programs, standard protocols, and functional teledermatology units in Indian public health-care settings.

Allergic Rhinitis and Other Allergic and Autoimmune Disorders in Children with IgA Deficiency

Background: Selective IgA imunodeficiency is the most frequently occurring primary antibody deficiency. Serum IgA level is decreased or even completly absened, while IgM and IgG antibodies displey normal serum levels. IgA plays an important role in immune protection in the gastrointestinal and respiratory tract. Patients with selective IgA imunodeficiency can be asimptomatic (>50% of cases) and can suffer from recurrent gastointestinal and respiratory infecitions, allergies and autoimmune diseases. Allergic rhinitis (AR) is the most common cause of chronic rhinitis. Characteristic feature of allergic rhinitis is eosinophilic inflammation of the nasal mucosa. Several studied have shown that IgA represents a potent trigger of eosinophil degranulation, while other studies have shown that IgA imunodeficiency is a well-known risk factor for atopy. Objective: Objective of this study was to evaluate the frequency of allergic rhinitis and other allergic and autoimmune disorders in children with IgA immunodeficiency. Methods: The study included 36 children diagnosed with IgA imunodeficiency. The presence of allergic and autoimmune disorders was evaluated by specialist of allergology, immunology, rheumatology and otorhinolaryngology. Results: 22 (71,1%) of children were male and the mean age of the patients was 10.5 years. Among the patients 31 (86,11%) had at least one allergic disease: 20 (55,55%) had asthma, 17 (47,22%) had allergic rhinitis, 6 (16,67%) had atopic dermatitis and 5 (13,89%) had urticaria. 14 (38,89%) had at least one of autoimmune disordes: 8 (22,22%) had reactive arthritis, 5 (13,89%) had juvenile idiopathic arthritis, 2 (5,56%) had Mb Hashimoto and 1 (2,78%) had SLE. Conclusion: This study showed that the main clinical manifestations in patients with IgA deficiency were asthma and allergic rhinitis. Results also show increased frequencies in other allergic and autoimmune diseases, compared to available data from general population.

Systemic exposure to bacterial amyloid curli alters the gut mucosal immune response and the microbiome, exacerbating Salmonella-induced arthritis

ABSTRACT The Salmonella biofilm-associated amyloid protein, curli, is a dominant instigator of systemic inflammation and autoimmune responses following Salmonella infection. Systemic curli injections or infection of mice with Salmonella Typhimurium induce the major features of reactive arthritis, an autoimmune disorder associated with Salmonella infection in humans. In this study, we investigated the link between inflammation and microbiota in exacerbating autoimmunity. We studied C57BL/6 mice from two sources, Taconic Farms and Jackson Labs. Mice from Taconic Farms have been reported to have higher basal levels of the inflammatory cytokine IL − 17 than do mice from Jackson Labs due to the differences in their microbiota. When we systemically injected mice with purified curli, we observed a significant increase in diversity in the microbiota of Jackson Labs mice but not in that of the Taconic mice. In Jackson Labs, mice, the most striking effect was the expansion of Prevotellaceae. Furthermore, there were increases in the relative abundance of the family Akkermansiaceae and decreases in families Clostridiaceae and Muribaculaceae in Jackson Labs mice. Curli treatment led to significantly aggravated immune responses in the Taconic mice compared to Jackson Labs counterparts. Expression and production of IL − 1β, a cytokine known to promote IL − 17 production, as well as expression of Tnfa increased in the gut mucosa of Taconic mice in the first 24 hours after curli injections, which correlated with significant increases in the number of neutrophils and macrophages in the mesenteric lymph nodes. A significant increase in the expression of Ccl3 in colon and cecum of Taconic mice injected with curli was detected. Taconic mice injected with curli also had elevated levels of inflammation in their knees. Overall, our data suggest that autoimmune responses to bacterial ligands, such as curli, are amplified in individuals with a microbiome that promote inflammation.