This article describes Reiter's syndrome: symptoms and treatment in women, its forms and causes of this disorder. It can occur after an infectious intestinal disease and one of its features is that the symptoms do not appear immediately, but in a delayed period. The danger of pathology lies in the fact that the process can become systemic. However, with timely diagnosis and treatment, the outcome of the disease is favorable - the manifestations of the syndrome disappear in 80% of patients.
Short description
Reiter's syndrome is an inflammation of the joints, which has an autoimmune nature and is accompanied by systemic manifestations. The starting factor for the development of this disorder is an acute intestinal infection. The prevalence of the disease among men is almost 2 times higher than in women, but the symptoms and manifestations of Reiter's syndrome in both sexes are similar. Most often, pathology is diagnosed in young people aged 20-40.
Against the background of an infectious disease, joint damage occurs in 2scenarios:
- reactive (sterile) arthritis - allergic inflammation of the inner layer of the joint bag;
- infectious arthritis, when germs get inside the joint.
In medicine, there is also another concept - Reiter's disease. It differs from the syndrome in that the main factor in its development is genitourinary infections (most often chlamydia), and the course of the disease is chronic and progressive. In many patients, the disease leads to the formation of multiple inflammation of the joints.
Reasons
The causes of Reiter's syndrome are associated with 2 factors:
- gastrointestinal infection (shigellosis, yersiniosis, salmonellosis, campylobacteriosis and others);
- genetic predisposition.
This pathology develops over a period of 1 week to 1 month after the cure for an infectious disease. If more time has passed, then this diagnosis is unlikely, the cause of inflammation of the joints lies in something else. In the acute period of the infectious process, the syndrome rarely occurs.
The prevalence of this pathology, according to medical statistics, is 1-4% of patients who have had an intestinal infection. The more severe this disease was, the higher the risk of complications in the form of inflammation of the joints. However, in about 10% of patients, arthritis occurs without any signs of intestinal infection.
This is due to the fact that such patients are often carriers of the HLA B27 antigen, which is of great importance in the development of autoimmune disorders. It is found in 80% of patients. Besides arthritis,pathologies such as:
- Ankylosing spondylitis, in which the mobility of the joints and spine is impaired due to fusion of the articular cavities;
- ulcerative colitis, or inflammation of the lining of the large intestine;
- Crohn's disease, or granulomatous inflammation of the gastrointestinal tract, accompanied by other, extraintestinal complications;
- inflammation of the choroid of the organs of vision, which often causes blindness.
Stages of the disease
Manifestations and symptoms of Reiter's syndrome in women go through 3 stages:
- At the first stage, a bacterial agent enters the body, which leads to the development of intestinal infection and enterocolitis.
- Then comes acute inflammation in the joints, which in most patients ends in recovery.
- If the patient has a genetic predisposition or impaired immunity, then arthritis can become chronic. There are systemic manifestations of the syndrome.
Enterocolitis, after which Reiter's syndrome develops in women, is accompanied by the following symptoms:
- liquid stool;
- loss of appetite, nausea, vomiting;
- flatulence;
- fever;
- abdominal pain;
- signs of general intoxication - headache and muscle pain, weakness.
In chronic enterocolitis, other signs join:
- alternating diarrhea and constipation;
- weight loss;
- fermenting food inintestines.
Features
Reiter's syndrome is characterized by the following features:
- joints are most often affected symmetrically;
- the process involves the spine and especially its lumbosacral part;
- the phalanges of the fingers and toes become inflamed, causing them to take on a "sausage-like" appearance;
- the joints of the lower extremities are most susceptible to damage;
- pain in the heels due to inflammation of the tendon and calcaneal insertion.
Some patients develop flat feet as a result of foot ligament damage. The involvement of the joints in the pathological process in many cases occurs according to the "bottom-up" scheme or according to the spiral symptom - opposite joints are affected along the ascending line of the spine.
Reiter's syndrome in women: manifestations and symptoms
In medicine, the classic triad of signs of the syndrome is noted, which are found in 30% of patients:
- arthritis;
- cervicitis - inflammation of the tissues of the cervix;
- pathology of the organs of vision.
In addition to arthritis, cervicitis causes significant discomfort. Its symptoms in Reiter's syndrome in women are as follows:
- large amount of vaginal discharge (mucous or purulent);
- itching, burning in the genitals;
- drawing pain in the lower abdomen and lower back;
- increased discomfort after urination and intercourse.
When joining other pathologies of the small pelvis (cystitis, cervical erosion, salpingo-oophoritis, endometritis)additional signs appear:
- frequent urination with pain;
- increased body temperature;
- bleeding after intercourse;
- severe pain in the lower abdomen.
Arthritis
Inflammation of the joints is the main characteristic feature of Reiter's syndrome in women. Arthritis symptoms are as follows:
- joint pain;
- their swelling due to edema;
- purple-bluish coloration of the skin in the area of the inflamed joint;
- decrease in physical activity, especially in the morning.
Usually, the number of affected joints does not exceed six. The joints of the following localization are most often inflamed:
- articulation of the bone of the lower leg and foot;
- knees;
- toes (especially thumbs);
- lumbosacral joint;
- articulation of sacrum and coccyx;
- hip joint.
In some cases, asymptomatic forms or an erased course of the disease are observed, in which the body temperature rises to 37.9 ° C, weakness is felt, appetite worsens.
Dermatological signs
Symptoms and manifestations of Reiter's syndrome in women are associated not only with inflammation of the joints. Some patients may experience the following dermatological disorders:
- Hyperkeratosis - keratinization of the skin, its painless thickening. Pathological foci more oftenonly appear on the soles of the feet and palms. Solitary papules or plaques can form anywhere on the body and resemble psoriasis in appearance.
- Deterioration of the condition of the nail plates - their staining in yellow, thickening and peeling off the soft tissues of the fingers.
- Lymphadenopathy - an increase in inguinal lymph nodes.
- In rare cases, myocarditis, glomerulonephritis develop, skeletal muscles and peripheral nerves become inflamed.
Eye injury
Manifestations of Reiter's syndrome on the part of the organs of vision are the development of diseases such as:
- conjunctivitis;
- inflammation of the iris, resulting in poor vision;
- damage to the connective tissue between the sclera and conjunctiva;
- inflammation of the membrane of the eye, in which the network of blood vessels is located.
Conjunctivitis is most often asymptomatic and lasts for several days. Inflammation can develop in only one eye or simultaneously in both. At the same time, patients are worried about pain, profuse lacrimation, photophobia.
Diagnosis
In order to detect infection and changes in the body, the following types of tests are prescribed for Reiter's syndrome:
- OAK - an increase in ESR, platelet count, immunoglobulin IgA and leukocytes is detected;
- biochemical blood test - an increase in the content of C-reactive protein, rheumatic factor, fibrin;
- OAM - leukocytes, protein can be detected;
- fecal analysis, coprogram.
Whenthe development of cervicitis syndromes shows a consultation with a gynecologist and taking a smear from the cervix to determine the cell culture.
Instrumental diagnosis of Reiter's syndrome consists in conducting the following types of medical examinations:
- X-ray of the joints, spine and sacroiliac joint. The pictures reveal swelling of the joints, and in the case of a protracted course of the disease, areas of bone destruction, narrowing of the gap between the joints.
- Synovial fluid sampling from the joint cavity. At the same time, nonspecific changes are found that are also characteristic of other types of arthritis - a decrease in viscosity, the presence of clots, a high concentration of leukocytes. This type of examination is carried out mainly for the differential diagnosis of gout and septic arthritis.
As an additional study, the attending physician may prescribe:
- ECG;
- FGDS;
- Ultrasound of the kidneys and abdomen;
- consultation of an ophthalmologist and dermatologist.
Drug therapy
The basis of the treatment of this syndrome is the following medications:
- Antibacterial agents. They are selected depending on the identified pathogen and its sensitivity to antibiotics. As drugs, drugs from the group of tetracyclines, "Ciprofloxacin" and others are prescribed. After treatment with antibiotics, the effectiveness of therapy is monitored after 4-5 weeks.
- Non-steroidal anti-inflammatory drugs - Diclofenac, Aceclofenac,"Naproxen", "Indomethacin", "Nimesulide" and others. They reduce the intensity of inflammation in the joints and spine, and also have an analgesic effect.
- Multivitamins - "Duovit", "Complivit", "Alphabet", "Vitrum" and others.
- Gastroprotectors - Omeprazole, De-Nol, Escape, Biogastron, Duogastron and others.
- Myospasmolytics - Tolperisone, Tizanidin, Tizalud.
Local funds
Ointments, creams or gels containing NSAIDs are used as topical therapy:
- Voltaren.
- Nise.
- Fastum.
- Diclofenac.
- Ortofen and others.
They have a therapeutic effect directly on the focus of inflammation. Topical application also reduces the risk of side effects that can occur with systemic NSAID treatment.
Hormonal drugs
With the progressive course of this disease and its vivid manifestations, the doctor may prescribe glucocorticoids - Betamethasone, Prednisolone. They are applied locally - an injection is injected into the joint cavity and into adjacent tissues. The duration of therapy is an average of 3 weeks. This treatment reduces inflammation.
If a large number of joints are involved in the pathological process, then hormonal preparations are administered to the patient intravenously. With systemic manifestations of the disease, kidney or heart damage, glucocorticoids are prescribed in short courses. For inflammation of the conjunctiva, eye drops or ointments with dexamethasone are used.
Non-drug treatment
Reiter's syndrome can also be treated with physiotherapy:
- Phonoresis with glucocorticoids and NSAIDs. The principle of this method is the impact of ultrasonic waves on the affected area, which contributes to the deep penetration of drugs and the maximum therapeutic effect.
- Diadynamic currents is a method of electrotherapy in which the joints and surrounding areas are affected by low-frequency pulsed currents. They have a stimulating effect on the nervous system and muscles. As a result, local blood supply, tissue metabolism improves, and an analgesic effect appears.
- Magnetic therapy. The magnetic field causes the occurrence of eddy currents in the synovial fluid and has a complex physical and biological effect. The effect of magnetotherapy is similar to the previous method.
- Laser therapy. The laser beam produces a thermal effect on the tissue. Swelling subsides, blood circulation and tissue nutrition improve, which stimulates their regeneration.
- Massage in the joints, preventing the development of muscle atrophy and helping to accelerate metabolic processes in tissues.
In case of a protracted course of the disease, the following recommendations should be followed:
- try to avoid factors that lead to exacerbation (infectious diseases, hypothermia, stress, smoking and alcohol abuse);
- follow a diet high in polyunsaturated fatty acids and fruits and vegetables;
- exercise withmoderate physical activity, physiotherapy exercises 1-2 times a week.
Complications and prognosis
Reiter's syndrome in women, the manifestations and symptoms of which are described above, can lead to the development of the following types of complications:
- deformation of the joints and their subluxation;
- muscular atrophy;
- osteoporosis;
- disruption of the heart and kidneys.
In the absence of systemic manifestations described above, and timely treatment, the outcome of the disease is favorable. In patients with the HLA B27 antigen, the prognosis is less favorable, as there are often violations of the functions of internal organs.
