Reactive polyarthritis is considered multiple inflammation of the articular tissue. Both sequential and simultaneous damage to several joints is possible. The main reason for the development of the pathological process is some immune disorders, metabolic pathologies, as well as some nonspecific and specific infections. Polyarthritis manifests itself in the form of pain, swelling, hyperemia and hyperthermia in the affected area. The diagnosis is made on the basis of laboratory tests, the results of CT, MRI, radiography, scintigraphy, cytological and microbiological studies of the joint fluid. Treatment is usually conservative.
Features
Reactive polyarthritis - simultaneous or sequential inflammation of the joints. It can act as an independent disease or develop as a result of otherdiseases, injuries, metabolic disorders and immune pathologies in a child. It is manifested by a pronounced pain syndrome, impaired functionality, swelling of the joints, local hyperthermia and hyperemia. The pain syndrome most often has a wave-like character, the pain intensifies in the morning and at night. The phenomena of the acute form of the disease are completely reversible; in a chronic disease, pathological changes develop in the joints that are irreversible. The main cause of reactive polyarthritis in children is a reaction to another inflammatory disease, in which the infection spreads to other organs and tissues, including articular ones.
What causes it?
Violation of functionality can be caused by both pain syndrome and changes in the structure of tissues. In mild types of this disease, the ability to work and mobility is preserved, in severe cases, it is completely lost or limited. The polyetiology of pathology determines the importance of correct clinical diagnosis and selection of adequate therapeutic methods, taking into account the cause, variant of the course of the disease and its form. Depending on the factors in the development of reactive polyarthritis, pediatric orthopedists, pediatricians, traumatologists, rheumatologists and other doctors can treat this process.
Risk group
Reactive polyarthritis most often develops in children after viral, bacterial, chlamydia and fungal infections. An inflammatory process in the joints can appear after an infectious lesion of the intestines in a child (salmonellosis,shigellosis), genitourinary infections (urethritis, cystitis), infections of the upper respiratory tract and respiratory tract (pneumonia, sinusitis, bronchitis, pharyngitis, tonsillitis). Most often, these pathological processes are observed in boys. A predisposing factor is a chronic focus of infection, excessive exercise, limb injuries and hypothermia.
Symptoms of the disease
Reactive polyarthritis begins with general symptoms of intoxication: malaise, weakness, hyperthermia, swollen lymph nodes, loss of appetite. In the future, changes in muscles and joints join these signs:
- pain in hands, feet, on movement and at rest;
- stiffness of movement;
- signs of an inflammatory process in the periarterial tissues - swelling, redness, fever;
- asymmetry of the lesion;
- dactylitis - inflammation in the fingers and toes.
Depending on the type of infectious agent, the pathology covers:
- eyes - in this case, the iris (iridocyclitis), conjunctiva (conjunctivitis) becomes inflamed, which manifests itself in the form of tearing, burning, redness, foreign body sensation;
- skin and mucous membranes - erosion in the genital area, mouth, keratoderma (nail detachment, keratinization of the skin);
- genitourinary system - burning during urination, soreness, pulling pains in the abdomen.
In the later stages of the development of reactive polyarthritis inchildren and adults are joined by dysfunctions of the heart, kidneys, lungs, central nervous system.
Varieties of disease
ICD code for reactive polyarthritis - M13.
This pathological process, which develops in childhood, has several varieties - rheumatic fever, Reiter's syndrome and infectious-allergic polyarthritis. Let's consider each type in more detail.
Rheumatic fever
This type of pathology occurs approximately 15–20 days after streptococcal tonsillitis. In this case, an acute onset is very characteristic with an increase in temperature up to 40 ° C, excessive sweating, chills, inflammation of the lymph nodes, severe weakness, and severe bleeding from the nose. After that, several large joints are involved in the process. The lesion, as a rule, is symmetrical, has a wandering character, moving to different joints, accompanied by pain, swelling, redness of the skin over the joint.
The symptoms of this variety of reactive polyarthritis are quite unpleasant.
Various pathologies from the side also join:
- CNS - headache, blurred speech, twitching of facial muscles, emotional instability, lack of coordination;
- heart (rheumatic heart disease) - palpitations, shortness of breath, arrhythmia, in severe stages - the formation of heart defects and the development of its insufficiency;
- of the skin - rheumatic nodules - painless dense rounded spots that are located under the skin of the joints, or pale pink round spots on the limbs andchild's torso, without itching, blanching on pressure.
Reiter's Syndrome
This type of reactive polyarthritis develops after a chlamydial urogenital infection in adults and children. At the same time, microorganisms enter the body through the urogenital canal and spread to other systems and organs. In childhood, this can be observed when infected with an infection from the mother during childbirth. The development of the pathological process is facilitated by an unfavorable sanitary background in living conditions, as well as the development of yersiniosis, salmonellosis, shigellosis. The genetic factor also plays a role. Clinically, this disease is manifested by three main symptoms: arthritis, conjunctivitis and urethritis.
Steps
Proceeds in three stages:
- Urethritis - the child is worried about itching, burning, painful urination, hyperemia in the urethra.
- Conjunctivitis, which occurs symmetrically in both eyes, often goes unnoticed.
- Arthritis - develops approximately 2 months after the onset of urethritis. This is characterized by asymmetric lesions of medium and small joints of the lower extremities. Arthralgia intensifies at night and in the morning, the periarticular tissue is hyperemic, an effusion is formed. Further, within a few days, there is a generalization of the pathological process from the bottom up. There is inflammation of the tendons and ligaments of the heel, pain appears in the spine.
Sucha kind of pathology, like Reiter's syndrome, may be accompanied by disorders in the work of the heart, lungs, kidneys, lymphatic and nervous systems. Symptoms and treatment of reactive polyarthritis are interrelated.
Infectious-allergic polyarthritis
This species appears approximately 8-10 days after infectious pathologies of the respiratory tract (pharyngitis, tonsillitis, sinusitis, tonsillitis caused by streptococci and staphylococci). The main predisposing factors are the weakening of the body, hereditary predisposition (if parents have rheumatism or asthma), allergies to staphylococci or streptococci, hormonal imbalance.
Clinically manifested by mild or moderate inflammation in the ankle and knee joints with severe effusion into the synovial cavity, which progresses every day. Other symptoms (pain, redness, fever in the affected area), as a rule, fade into the background and are of a secondary nature.
Features of each species
Infectious-allergic polyarthritis in children covers joints of various sizes at the same time. The disease occurs in children under two years of age who have contracted Haemophilus influenzae or Staphylococcus aureus from their mother. At the same time, the child is lethargic, he refuses to eat, breast. He may experience tearfulness, lameness. The pathological process can be subacute or acute. In boys from 3 to 10 years old, transient arthritis often occurs in large joints, which develops after tonsillitis, tonsillitis, pharyngitis.
Reiter's syndrome is transmitted to children in utero, through air, dishes, dirty hands, objects, contact with pets or birds.
Infection without provoking factors that reduce immunity may not manifest itself. They can be colds, hypothermia, stress. Conjunctivitis occurs first and is the only symptom for a long time (specialists often do not even suspect the development of the syndrome). Polyarthritis occurs after a few years and is less pronounced than in adults.
Characteristic features of reactive polyarthritis are:
- in addition to the hip, knee, ankle joints, often the lesion affects the joints of the big toes;
- small joints in the pathological process are involved somewhat less frequently, blush;
- characteristic soreness can be felt with pressure, not with movement, motor abilities are preserved;
- puffiness is pronounced;
- in children prone to allergies, there is a vivid inflammatory reaction with fever, dyspepsia, severe pain;
- Adolescents may develop sacroiliac joint disease in the form of spondyloarthritis.
Diagnostic measures
Diagnosis of reactive polyarthritis (ICD code 10 - M13) in children is based on anamnesis (causing factors, past infections), clinical examination, physical and laboratory research methods.
Laboratory techniquesinclude:
- general blood test to detect signs of an inflammatory process (leukocytosis, elevated ESR);
- bacteriological examination of urine, synovial fluid, smear from mucous membranes to determine the type of infectious agent;
- immunological analysis for the study of antibodies to certain microorganisms (after infection, it is possible that agents are not detected, but antibodies remain);
- urinalysis to detect pathologies of the genitourinary system;
- analysis of conjunctival fluids.
Physical methods involve the following diagnostic measures:
- X-ray, CT, MRI - determination of changes in joints, periarticular and bone tissues;
- biopsy - study of articular tissues;
- diagnostic arthroscopy is a type of endoscopy in which structural disorders in the joints are determined;
- Echocardiography, ECG to detect disorders of the heart and blood vessels;
- Ultrasound.
Treatment
Treatment of reactive polyarthritis is usually complex. It is aimed at eliminating the consequences of infection, symptoms of polyarthritis (pain, swelling, dysfunction of the joints), inflammation, comorbidities, prevention of autoimmune activity and complications.
Drug treatment for reactive polyarthritis includes:
- broad-spectrum antibacterial drugs that neutralize several categories of pathogens, as well asspecific drugs, the action of which is directed to a specific type of microbe;
- anti-inflammatory non-steroidal drugs that relieve pain and inflammation;
- analgesics;
- glucocorticoids - hormonal drugs that eliminate inflammation;
- immunosuppressors that suppress autoimmune processes;
- chondroprotectors that restore cartilage tissue;
- vitamins that increase the functionality of immunity;
- with the stressful nature of the onset of the disease - sedatives.
Reviews
The reviews of patients who suffered from this disease, as well as their parents, in the case of the development of pathology in children, speak of very unpleasant symptoms that last for a long time and are very painful. However, the sooner treatment for reactive arthritis of the joints is started, the better.
Patients note that with timely access to a doctor at the first symptoms, the disease can be prevented at an early stage, which will save from numerous negative consequences. Treatment, according to patients, is also a lengthy process that requires compliance with all medical prescriptions. The list of drugs is quite wide, and many of them cause many adverse reactions.
We looked at the symptoms and treatment of reactive arthritis. A photo of the diseased joint was submitted.
