Reactive Arthritis Research Articles

История артрологии в зеркале нумизматики

Целью работы был анализ истории артрологии по нумизматическим материалам. Отрасль исторической науки нумизматика (от лат. numisma — «монета») зародилась в XIX веке и стала тесно связанной с экономикой, политикой, культурой и правом, включает в себя тематическое изучение монет, медалей и плакет. Лучше всего историю артрологии иллюстрируют различные формы медальерного изобразительного искусства (экзонумия, или паранумизматика), а медаль стала прообразом памятной (мемориальной) монеты. В данной работе представлен каталог 157 нумизматических материалов (138 медалей, 15 плакет, 4 монеты), в том числе некоторых уникальных, впервые приведенных, отражены этапы развития изучения использования лечебных факторов, есть ссылки на значительные исторические события, упоминаются краткие биографии медиков (62 персоны), внесших неоценимый вклад в формирование этой научной дисциплины. На медалях можно встретить портреты основоположников мировой артрологии, древнеиндийского врача Чараку и древнегреческого Аретея, а также украинских медиков — Агапита Печерского, Е.И. Мухина, А.А. Киселя, Д.Ф. Чеботарева. Работа содержит следующие разделы: «Зарождение артрологии», «Структура и функция суставов», «Остеоартрит», «По­дагрический артрит», «Ревматоидный артрит», «Инфекционный и инфекционно-аллергический (реактивный) артрит», «Туберкулезный артрит», «Другие артриты». К большому сожалению, пока память о знаменитых врачах прошлого недостаточно отмечена выпуском нумизматической продукции, поэтому в будущем надеемся на планомерный подход к этому делу, на целенаправленную пропаганду достижений ревматологии средствами нумизматики, которая подает наглядный пример для изучения истории артрологии, способствует повышению уровня образованности врачей. Авторы рассчитывают на появление новых интересных материалов таких малых форм изобразительного искусства.

The Evaluation of Cases with Ocular Complications due to Bacillus Calmette-Guerin (BCG) Treatment using the Pool Analysis Method

ABSTRACT Objective The aim of this study was to investigate cases with ocular complications associated with intravesical BCG therapy in terms of clinical features, demographic features and type of ocular involvement. Methods PubMed database was scanned for relevant publications using the keywords. Thirty-seven publications and 147 reported cases were identified related to the development of ocular complications due to intravesical BCG treatment. Results As a result of the analysis performed according to eye involvement, there were 17 cases of conjunctivitis, 7 uveitis, and 5 endophthalmitis. Only 27 (18.3%) cases were of primary ocular involvement and Reiter's syndrome was present in 120 (81.6%) of all cases. Conclusions Most of the side-effects of BCG therapy are minor and of short duration. Although rare, it has been reported that potentially serious ocular complications can develop after treatment. Physicians must keep these facts in mind and be alert to the development of ocular symptoms following BCG therapy.

A case of Epstein-Barr virus presenting as spondyloarthritis

Viral arthritis can be caused by various viruses such as parvovirus, alphavirus, rubella, hepatitis B, C and flavivirus. High titre of antibodies to Epstein-Barr virus (EBV) is present in rheumatoid arthritis (RA) patients. EBV, a member of the herpes virus family, is one among the most common human viruses. Vitamin D deficiency can worsen the prognosis in such patients. Abnormalities in innate and adaptive immune reactions in response to EBV infection were one of the complications observed in RA patients. It was a self-limiting infection with a 90% lifetime prevalence. On the other hand, spondyloarthritis was rarely associated with viral infections. A 35 year old male patient who had a history of TB, admitted through OP, with complaints of intermittent fever, joint pain, pain radiating from back to lower limbs. On investigation, the patient was found to be vitamin D deficient. Differential diagnosis such as TB with reactive arthritis, lymphoma and CMV infection were ruled out. MRI of the spine and pelvis confirmed spondylarthritis. The serology for EBV showed that the EBV IgM levels had increased by two-fold. The on-going inflammatory status was well-managed with NSAIDS, as there was low evidence for antiviral therapy. EBV infection presenting as spondyloarthritis is a very rare presentation and here we are discussing a case of spondylarthritis in a patient with infectious mononucleosis. The patients with fever, polyarthritis, lymphadenopathy and spondylarthritis are to be investigated for EBV infection along with the other cause of polyarthritis.

Застосування пентозану полісульфату при місцевому лікуванні реактивних артритів у дітей

Мета роботи — вивчити ефективність застосування пентозану полісульфату при місцевому лікуванні реактивних артритів (РеА) у дітей та визначити його безпечність. Матеріали і методи. У дослідження було включено 56 дітей віком від 5 до 15 років, які перебували на лікуванні в хірургічному відділенні № 2 ДМКЛ № 1 із первинно маніфестованим суглобовим синдромом, у яких під час обстеження не підтверджено гнійну патологію та ревматологічні захворювання. У діагностиці використовувались лабораторні методи (розгорнутий аналіз крові, загальний аналіз сечі, визначення С-реактивного протеїну, ревматоїдного фактора, циркулюючих імунних комплексів, серомукоїду, ASLO), електрокардіографія, ультразвукове дослідження (УЗД) органів черевної порожнини. Усі діти консультовані кардіоревматологом. В окремих випадках проводилися рентгенографія та пункція суглобів. Також усім пацієнтам проводили УЗД уражених суглобів на апараті LogiQ 5 датчиками з частотою від 7,5 до 10,5 МГц. Для вивчення дії досліджуваного препарату було сформовано 2 групи: основну (27 осіб), у якій додатково до базової терапії застосувався місцево гель Тромбоцид, та контрольну (29 осіб), ідентичну за віком та статтю до основної групи, у якій застосовувалась лише базова терапія. Оцінка ефективності пентозану полісульфату (Тромбоцид) базувалась на динаміці локальних проявів та ультразвукової картини уражених суглобів, що визначались на 3-тю, 5-ту та 7-му добу. Результати дослідження. Виявлено, що за декілька тижнів появі РеА передували такі чинники: гостре респіраторне захворювання (63 %), діарея (2 %), травма (6 %), у 29 % дітей можливих причинних факторів не встановлено. За кількістю уражених суглобів у дебюті РеА відзначався переважно моноартрит (52 дитини — 93 %), зрідка мали місце олігоартрит (2 — 3,5 %) та симетричне ураження суглобів (2 — 3,5 %). При РеА початок захворювання найчастіше відзначався артритом колінних (60,47 ± 3,28 %) або кульшових (34,14 ± 2,35 %) суглобів. Рідко першими уражались гомілковостопні суглоби (4,32 ± 2,32 %). Припухлість суглобів у половини пацієнтів (55,10 ± 7,11 %) була помірною, у чверті (22,80 ± 2,09 %) — значною, у решти припухлість не від­мічалась або була мінімальною. У 58,26 ± 8,23 % дітей мала місце локальна гіпертермія. ­Динаміка місцевих проявів та ультразвукової картини засвідчує виражений позитивний ефект та прискорення темпів одужання в групі із застосуванням місцево гелю Тромбоцид. Висновки. Застосування пентозану полісульфату в комплексній терапії РеА прискорює регресування локальних суглобових проявів, сприяє ранній активізації хворих за рахунок ранньої ліквідації больового синдрому та прискорює темпи одужання. Використання даного препарату є безпечним у дитячому віці.

MRI and Sonography of the Knee in Acute Reactive Arthritis: An Observational Cohort Study.

Reactive arthritis (ReA) is a unique subgroup of spondyloarthritis with acute presentation and tendency to develop chronicity. Magnetic resonance imaging (MRI) has enabled identification of sensitive markers of response to therapy. A longitudinal pilot study of acute ReA with knee joint involvement satisfying the Braun's criteria was undertaken. Magnetic resonance imaging of the knee was assessed at baseline, and agreement with ultrasonography was assessed. Clinical details were recorded using a detailed and structured case record form. Patients were followed up, and MRI predictors of transition to chronic arthritis were looked for. In 25 patients with ReA, synovial thickening was the most common feature. Enthesitis was observed on MRI in 20%. Urethritis-related and HLA-B27-positive ReA had higher synovial thickening scores (p = 0.007). Agreement was poor between MRI and ultrasonography (synovial hypertrophy: k = 0.04). On follow-up, 34% (n = 7/21 for >12 months) continued to have active disease. None of the clinical or radiological features were predictive of chronicity. Posturethritis and B27-positive ReA was more severe than postenteritis ReA and RA on MRI. One third develop chronic disease on follow-up. Magnetic resonance imaging is superior to sonography, although baseline imaging is not predictive of chronicity. The results of this pilot exploratory study argue for larger studies on MRI in ReA.

The importance of non-pharmacological treatment in spondyloarthritis

Spondyloarthritis (SpA) is a related group of inflammatory joint diseases comprising axial SpA (axSpA), psoriatic arthritis (PsA), arthritis associated with inflammatory bowel disease, reactive arthritis and undifferentiated SpA [1]. These entities share clinical features like asymmetrical oligoarticular arthritis, sacroiliitis and/or spondylitis, enthesitis, dactylitis and/or uveitis.

Elucidating the role of a positive family history in differentiating between axial and peripheral spondyloarthritis: an ancillary analysis of the ASAS-PerSpA study.

Positive family history (PFH) of spondyloarthritis (SpA) is important in the diagnosis of SpA. However, the contribution of a PFH in differentiating the two SpA subtypes (axial and peripheral spondyloarthritis (pSpA)), in particular the importance of second-degree relative (SDR) has not been well-studied. We aimed to investigate whether PFH of radiographic axial spondyloarthritis (r-axSpA), psoriasis, uveitis, reactive arthritis and inflammatory bowel disease in first-degree relative (FDR) and second-degree relative (SDR) contributes to differentiation between axSpA and pSpA using the data from a multinational cohort study. The ASAS-PerSpA study dataset was used to assess the effects of a PFH on differentiating between axSpA and pSpA via generalised structural equation modelling. Model building using backward selection was performed to obtain a final model. Direct, indirect and total effects of the path analysis were calculated. A total of 3803 patients were included: 2458 axSpA and 1345 pSpA patients. FDR (OR: 3.75, 95% CI: 2.86-4.91, p<0.001) and SDR (OR: 4.58, 95% CI: 3.19-6.59, p<0.001) with r-axSpA were positively associated while FDR (OR: 0.262, 95% CI: 0.207-0.331, p<0.001) and SDR (OR: 0.305, 95% CI: 0.221-0.420, p<0.001) with psoriasis were negatively associated with differentiating patients with axSpA from pSpA. The presence of r-axSpA and psoriasis in FDR or SDR are useful in differentiating axSpA from pSpA. SDR with r-axSpA may contribute greater towards the differentiation than FDR. Clinicians should consider taking an extensive family history of SpA and their subtypes to better differentiate the subtypes within the SpA spectrum.

MUSTARD OIL – GARLIC COMBO MASSAGE- AN EFFECTIVE KNEE PAIN HOME REMEDY

Background: Knee pain is one of the most prevalent disorders affecting the quality of life of elderly age group and geriatric population. This can occur due to numerous reasons including obesity, constant weight bearing rheumatic diseases, rheumatoid arthritis, reactive arthritis as well as osteoarthritis that may lead to swelling, redness, warmth, weakness, tenderness, and stiffness of the joint. A number of pain reliever formulations are available in the market that include NSAIDs based creams, intra synovial injections and steroid based formulations however none of them proves to be completely effective in improving the quality of life of geriatric population. In addition to it, there are a number of reported side effects/adverse events related to these formulations.&#x0D; Methods: The present study was conducted to evaluate the effectiveness of a home remedy prepared from Mustard oil and garlic as mentioned in ancient texts of Ayurveda in the knee pain subjects for improving quality of life. A quasi-experimental study (two group pretest and posttest design) was conducted in 70 subjects in two groups of 35 each with knee joint pain meeting the inclusion and exclusion criteria. Pain was assessed using numeric pain scale. Data analysis was done using inferential and descriptive statistics. Majority of the samples in both group I and group II had moderate and severe level of pain.&#x0D; Results: After intervention, the pain level had reduced to mild level in experimental group as compared to conventional group. The mean pretest values of pain score in experimental group had significant difference during posttest measurement of mean pain score. The difference was found to be significant in experimental group with warm mustard oil massage, but in conventional group difference was not significant.&#x0D; Conclusion: Mustard oil-garlic combo massage proved to be a good home remedy in knee pain&#x0D; Key words: effectiveness, mustard oil with garlic massage, knee pain

Reactive arthritis: a clinical review.

Reactive arthritis (ReA) is a form of inflammatory arthritis triggered by a remote antecedent infection, usually in the genitourinary or gastrointestinal tract. It is part of the spondyloarthropathy (SpA) spectrum, an umbrella term for a group of distinct conditions with shared clinical features. Typically, it presents with an asymmetric oligoarthritis of the lower limb joints, and patients may also have sacroiliitis, enthesitis and dactylitis. Other features often seen include anterior uveitis, urethritis and skin manifestations such as pustular lesions on the plantar areas. Although ReA was characterised initially as a sterile arthritis, the detection of metabolically active Chlamydia species in the joint fluid of some affected patients has generated further questions on the pathophysiology of this condition. There are no formal diagnostic criteria, and the diagnosis is mainly clinical. HLA-B27 can support the diagnosis in the correct clinical context, and serves as a prognostic indicator. The majority of patients have a self-limiting course, but some develop chronic SpA and require immunomodulatory therapy.

Trends in amyloidosis in spondyloarthritis: results from the Spanish National Inpatient Registry over a 17-year period (1999–2015)—TREND-EspA study

ObjectiveTo assess the incidence of amyloidosis and trends therein in patients with spondyloarthritis (SpA) over a long period (17 years).MethodsAn observational retrospective population-based matched cohort study was conducted. All the...

Profile of dermatology inpatients and admissions over a four year period in a tertiary level government teaching hospital in North India.

Although dermatology is mostly an outpatient specialty, some patients with severe skin disease need hospital admission for management. There is a paucity of data regarding the profile of these dermatology in-patient admissions. We studied the profile of patients admitted to the dermatology ward of our tertiary care government hospital in North India. This was a retrospective analysis of discharge sheets of patients admitted in the dermatology ward from January 1, 2014 to December 31, 2017. Discharge sheets of 2032 admissions for 1664 patients were analyzed. The most common diagnoses in the admitted patients were immunobullous disorders (576, 28%), connective tissue diseases (409, 20%), infections, including leprosy and sexually transmitted infections (179, 8.8%), psoriasis (153, 7.5%) and reactive arthritis (92, 4.5%). The mean duration of admission was 13.95±11.67 days (range 1-118 days). Two hundred and fifty-six patients (15.38%) were re-admitted, accounting for 368 (18.11%) re-admissions. Patients with immunobullous disorders (OR 1.72, 95% CI 1.29-2.28) and psoriasis (OR 1.62, 95% CI 1.02-2.55) were more likely to be re-admitted. Adult patients, those who were admitted for more than four weeks, those who had comorbidities, and those who developed a complication during the hospital stay also had a greater likelihood of being re-admitted. The retrospective design of the study, and the non-availability of data regarding transfers to other specialties or intensive care units and deaths were the main limitations of this study. This study describes the profile of patients admitted in a dermatology ward of a tertiary care centre center in North India. The patient profile and admission characteristics associated with a higher probability of re-admission were identified.

Infliximab (an antitumor necrosis factor) induced lupus in a patient with inflammatory bowel disease

Infliximab is a monoclonal antibody that works by inhibiting the proinflammatory cytokine and tumor necrosis factor-alpha. Systemic lupus erythematosus is an autoimmune disease that affects multiple organs, and its pathogenesis involves abnormal immune complexes, environment factors, and genetics. Several reports have documented a controversy regarding infliximab-induced lupus disease. This paper reports on infliximab-induced lupus in an 18-year-old Saudi female having short stature, hypogonadism, and Crohn's disease with ileocolonic fistula. The patient developed reactive arthritis, and serology showed positive anti-double strand DNA and antihistone antibodies after infliximab administration, suggesting drug-induced lupus. More cohort studies are recommended to monitor the presentation and reversibility of infliximab-induced lupus disease.

Yersinia enterocolitica: A Follow-up of the Outbreak in the Norwegian Armed Forces in 2014.

In the spring of 2014, there was an outbreak of Yersinia enterocolitica (YE) gastroenteritis in four Norwegian military camps-the largest outbreak ever reported in Norway. YE is usually transmitted via food, and the gastrointestinal disease caused by the bacterium is considered a public health problem in several countries. Common symptoms of YE gastroenteritis are abdominal pain, diarrhea, fever, nausea, and vomiting. Post-infectious complications can occur after YE gastroenteritis, the most common of which are erythema nodosum and reactive arthritis. Based on self-reported data, we describe the duration of illness, the duration of any absence from service, and the incidence of symptoms of post-infectious complications in two groups of servicepeople: one diagnosed with YE gastroenteritis and the other with an unspecified acute infectious gastroenteritis. The Norwegian Armed Forces Health Register (NAFHR) is a central health register that contains data from conscripts and from military and civilian personnel in the Norwegian Armed Forces. In this study, we identified all individuals with a diagnosis of YE gastroenteritis in the NAFHR in the period from January 1 to June 30, 2014 (n = 128) as well as all those with a diagnosis of an unspecified acute infectious gastroenteritis in the same period (n = 323) to participate as controls. In October 2018, a link to an internet-based questionnaire was distributed by e-mail to all identified individuals. The questionnaires collected data on the duration of illness, the duration of absence from service, and the incidence of symptoms of post-infectious complications. Of all those who received the questionnaire, 72 (59%) were included in the YE group and 117 people (36%) were included in the control group. Half of those in the YE group were ill for more than 13 days, while almost all (90%) of those in the control group recovered after 1 week. There were no differences between the groups in the incidence of symptoms of post-infectious complications during the 6 weeks after recovery. There was a significantly larger proportion of officers than conscripts in the YE group who reported symptoms of post-infectious complications. None of the respondents reported symptoms of post-infectious complications in the 6 months after the termination of military service. One strength of this study is that we were able to investigate a large outbreak of YE gastroenteritis in a group of individuals with good underlying health. Weaknesses are the low response rate, especially in the control group, and the fact that we sent out the questionnaire >4 years after the acute gastroenteritis occurred. YE gastroenteritis among personnel in the Norwegian Armed Forces was associated with a significantly longer duration of illness and a longer duration of absence from service than that resulting from an unspecified acute infectious gastroenteritis. However, YE gastroenteritis was not associated with more symptoms of post-infectious complications.

Espondiloartritis: caracterización de la cohorte del Hospital Pablo Tobón Uribe, Medellín, Colombia

IntroductionSpondyloarthritis is a group of chronic inflammatory diseases. Several factors of the disease remain unknown, including clinical and radiological behaviour, the demographic characteristics and burden of disease in Colombian patients. ObjectiveTo characterise the demographic aspects, the clinical and paraclinical behaviour, and the therapeutic requirements of a cohort of patients with spondyloarthritis followed-up in the Hospital Pablo Tobón Uribe from January 1, 2005 to December 31, 2017. MethodologyCohort study. The population was characterised using descriptive statistics, qualitative variables using simple and relative frequencies, and quantitative variables using means and standard deviation or medians with their interquartile ranges. ResultsThe cohort consisted of 181 patients, 100 men (54.9%) and 81 women (44.5%). Just under one half (45.1%) had ankylosing spondylitis, 18.1% undifferentiated spondyloarthritis, 17.1% psoriatic arthropathy, 14.8% reactive arthritis, and 4.4% inflammatory bowel disease. More than two-thirds (69.8%) of the patients had peripheral manifestations, and 67% had axial. A positive HLAB27 was observed in 55.6% of patients. The MRI showed acute and chronic changes in the sacroiliac in 69% and 37%, respectively, with radiological sacroiliitis being observed in 59.5% of cases. The large majority (91.1%) of the patients were treated with NSAIDs, 60.1% with sulfasalazine, 43.4% with COX2 inhibitors, and 33.7% with methotrexate. TNFα inhibitors were required by 56.6% of the subjects 3 years after the onset of symptoms. The most commonly used biological drugs were adalimumab (31.1%), etanercept (21.7%), infliximab (13.1%), golimumab 6.1%, and certolizumab 0.5%. ConclusionsOur population was characterised by a high activity and functional compromise demonstrated by the high scores of BASDAI and BASFI, and because 56.6% of the patients required anti-TNFα agents.

A Preliminary Risk Assessment of Yersinia Enterocolitica in the Food Chain: Some Aspects Related to Human Health in Norway

This preliminary risk assessment is a result of self-tasking by the Panel on Biological Hazards, Norwegian Scientific Committee for Food Safety. The suggestion was offered to the Norwegian Food Safety Authority (Mattilsynet), which responded and requested a risk profile, or a preliminary risk assessment, to evaluate whether a full risk assessment would be needed at a later date.&#x0D; Yersinia enterocolitica is one of a few zoonotic bacteria that have a stable reservoir within the domestic animal population in Norway. This bacterial species has been isolated from human patients with acute enteritis, who sometimes exhibit symptoms resembling appendicitis. Y. enterocolitica has attracted considerable attention due to its ability to cause serious post-infectious complications. Serious clinical consequences occur relatively often with Y. enterocolitica as a relatively high frequency of people in Norway possess the tissue type HLA-B27. A severe sequela linked to this tissue type is reactive arthritis. The cold climate in Norway may enhance growth of Y. enterocolitica. Although the predominant cause of yersiniosis in Norway is Y. enterocolitica O:3, and the pig is considered the main source of infection, the relative contribution of pork consumption compared with other risk factors, for example drinking untreated water, is unknown. In Norway, a decline in human cases of yersiniosis has been recorded since the beginning of the 1990s. This decline has been attributed to implementation of improved slaughtering methods, including enclosure of the anus into a plastic bag after rectum-loosening. In Norway, most fattening pigs are slaughtered at the age of 150 to 180 days. By this age the tonsils may be an even more significant source of human pathogenic Y. enterocolitica than intestinal contents, since the occurrence in the intestinal tract and faeces is reduced at the time of slaughter. Accordingly, hygienic handling of the head and the plucks during slaughter and dressing is very important to avoid contamination of the carcass. The most efficient way to limit the spread from tongue and tonsils is probably decapitation early on in the carcass dressing procedure. In such a procedure, the head, including tongue and tonsils, should be removed on a separate line. Also, avoidance of incision of the sub-maxillary lymph nodes might reduce the spread, Epidemiological data suggest that it is possible to reduce the herd prevalence of Y. enterocolitica O:3 by minimising contact between infected and noninfected herds. Further, attempts to reduce the prevalence at the top levels of the breeding pyramids may be beneficial for the industry as a whole. The meat industry might be able to categorise herds using serological methods, and use these results in its strategy to reduce the risks for consumers. However, such a strategy has to be evaluated in a cost benefit context. The apparently low prevalence of pathogenic Y. enterocolitica in food may be due to lack of suitable selective methods. The culturing methods, which are used routinely in microbiological laboratories, are insufficiently sensitive. There is a need for a standardised DNA-based technique, with improved sensitivity, for the detection of Y. enterocolitica in clinical, food and environmental samples.

Ankylosing Spondylitis.

The seronegative spondyloarthropathies are a group of autoimmune inflammatory diseases lacking rheumatoid factor or antinuclear antibody in their serum. They include ankylosing spondylitis (AS), reactive arthritis, psoriatic arthritis, spondylitis associated with Crohn's disease and ulcerative colitis, and undifferentiated spondyloarthropathies. Inflammation mostly affects the axial joints, entheses, and extra-articular structures such as uveal tract, gastrointestinal tract, mucocutaneous tissue, and heart. Uveitis is the most common extra-articular manifestation. Spondyloarthropathies, especially AS, have a strong association with the presence of Human Leukocyte Antigen (HLA)-B27 gene. AS happens earlier in HLA-B27 patients and men are more prone to the disease. Uveitis, typically unilateral non-granulomatous acute anterior uveitis, occurs in up to 50% of the patients with AS. HLA-B27 positivity correlates with more frequent flare-ups. Conjunctivitis and scleritis are rare ocular manifestations of AS. To establish the diagnosis of AS, at least one clinical and one radiologic parameter are required for definitive diagnosis. Magnetic resonance imaging (MRI) or bone scan can help early detection of the axial skeleton inflammation. The course of eye and joint involvement are not correlated. Short-term treatment with topical corticosteroids and cycloplegic agents control the uveitis attack. In resistant cases, local or systemic therapy with corticosteroids are recommended. NSAIDs, disease-modifying anti-rheumatic drugs (DMARDs), methotrexate, azathioprine, anti-IL-17A monoclonal antibodies, and TNF-α antagonists are effective treatments for ocular and systemic manifestations of AS. If not treated adequately, uveitis may become recalcitrant and extend posteriorly. Functional impairment due to joint destruction can also occur as a result of under-treatment.

Molecular determinants of peaceful coexistence versus invasiveness of non-Typhoidal Salmonella: Implications in long-term side-effects

The genus Salmonella represents a wide range of strains including Typhoidal and Non-Typhoidal Salmonella (NTS) isolates that exhibit illnesses of varied pathophysiologies. The more frequent NTS ensues a self-limiting enterocolitis with rare occasions of bacteremia or systemic infections. These self-limiting Salmonella strains are capable of subverting and dampening the host immune system to achieve a more prolonged survival inside the host system thus leading to chronic manifestations. Notably, emergence of new invasive NTS isolates known as invasive Non-Typhoidal Salmonella (iNTS) have worsened the disease burden significantly in some parts of the world. NTS strains adapt to attain persister phenotype intracellularly and cause relapsing infections. These chronic infections, in susceptible hosts, are also capable of causing diseases like IBS, IBD, reactive arthritis, gallbladder cancer and colorectal cancer. The present understanding of molecular mechanism of how these chronic infections are manifested is quite limited. The current work is an effort to review the prevailing knowledge emanating from a large volume of research focusing on various forms of NTS infections including those that cause localized, systemic and persistent disease. The review will further dwell into the understanding of how this pathogen contributes to the associated long term sequelae.

Reactive Arthritis After Intravesical Bacillus Calmette-Guérin Therapy.

Reactive arthritis (ReA) is a sterile arthritis that occurs in genetically predisposed individuals secondary to an extra-articular infection, usually of the gastrointestinal or genitourinary tract. Sterile arthritis associated with instillation of intravesical bacillus Calmette-Guérin (iBCG) therapy used for bladder cancer can also be included under ReA based on the pathogenic mechanism. Similar to spondyloarthritis, HLA-B27 positivity is a known contributor to the genetic susceptibility underlying iBCG-associated ReA. Other genetic factors, such as HLA-B39 and HLA-B51, especially in Japanese patients, can also be involved in the pathophysiology of iBCG-associated ReA. The frequencies of ReA- and ReA-related symptoms are slightly different between Japanese and Western studies. Proper understanding of possible complications, their epidemiology and pathogenesis, and their management is important for the rheumatologist when noting symptomatic patients using iBCG. Herein, we will review the most current information on ReA after iBCG therapy.

Statistically based algorithm for differential diagnosis of arthropathies based on quantitative osteoscintigraphy

Background. EULAR experts include osteoscintigraphy of joints in the list of promising methods for the diagnosis of joint diseases. However, the method remains little used in rheumatology in our country.Aim of the study – to develop an algorithm for differential diagnosis for the most common arthropathies based on quantitative osteoscintigraphy.Materials and methods. 3 hours after the injection of pyrophosphate labeled with Tc-99m, scintigraphy of skeletal bones was performed according to the “whole body” program. The joint/adjacent bone uptake ratio was calculated. The CHAID algorithm was used for classification tree constructing.Results. The study included 266 patients aged 46.6±14.3 years, 134 men (50.4%). Axial spondyloarthritis (including ankylosing spondylitis) was diagnosed in 40 patients, peripheral spondyloarthritis (including reactive arthritis) – in 87, rheumatoid arthritis– in 45, osteoarthritis – in 68, psoriatic arthritis – in 26 people. A total of 2279 joints were included in the analysis. A classification tree algorithm for differential diagnosis of arthropathies was constructed. Key indicators for identifying subgroups in the algorithm were the intensity of radiopharmaceutical uptake in the wrist, knee and hip joints. The significance level of differences between the resulting groups at all points of the algorithm branching, taking into account the Bonferroni adjustment, was p=0.001 or less. In the training sample, 51.5% of the observations were correctly classified. According to results of the cross-validation, the expected rate of correct classifications in the actual application of the algorithm is 38.0%.Conclusions. An algorithm for differential diagnosis of the most common inflammatory diseases of the joints has been developed. It allows the use of quantitative osteoscintigraphy data in the diagnosis of arthritis.

A Worthwhile Measurement of Early Vigilance and Therapeutic Monitor in Axial Spondyloarthritis: A Literature Review of Quantitative Sacroiliac Scintigraphy

Background: Back pain a common cause for hospital visits. Nuclear skeletal scintigraphy, at a high sensitivity, provides a functional imaging for detecting bone diseases. Sacroiliitis is an inflammation of the sacroiliac joint. Bone scan with quantitative sacroiliac scintigraphy (QSS) has been a useful inflammation indicator for sacroiliac joints. However, QSS has been ignored in the rehabilitation practice. Objective: To present the background, mechanisms, and current clinical applications of bone scan with QSS in spondyloarthropathy (SpA). Methods: The authors performed a literature review of QSS through database searching of MEDLINE, Embase, CINAHL, HaPI, Cochrane Review, and citation mining. Studies were included if they had QSS in the methodology performed in adult patients with various diseases. Any articles, including the authors’, that can be performed in a clinical setting were enrolled. Articles explicitly referencing QSS were retained for screening. Results: QSS appearance of SpA, including ankylosing spondylitis, may give rise to early detection. The specificity of sacroiliitis based on QSS increases from 73% to 97%. After investigating the relationship between serum C-reactive protein and sacroiliac joint inflammation in patients with SpA, there appeared to be a significant difference between serum C-reactive protein in serum and in sacroiliac ratio (particularly the middle part of the both joints), indicating a systemic inflammatory response to flair-up of SpA, for example, serum C-reactive protein as an indicator of inflammation. Sacroiliitis also occurs in post-streptococcal reactive arthritis. The involvement of sacroiliac joints in the development of post-streptococcal reactive arthritis had been demonstrated a significant correlation between anti-streptolysin O titres and QSS in patients with post-streptococcal reactive arthritis. Lower extremity periostitis acts as a human model in the study of bottom-up processing for periostitis-induced sacroiliac pain. The use of QSS can also monitor sacroiliac joint dysfunction before and after laser therapy. Improvements of the sacroiliac joint after convalescing of foot periostitis have been reported. Conclusions: Bone scan using QSS is a good screening measurement in scintigraphy rehabilitation for early detection of SpA and raises awareness of physicians toward the next step of diagnosis.