Post-infection reactive arthritis

Introduction to reactive arthritis after intestinal infection Reactive arthritis is joint inflammation induced by extra-articular infection, not caused by direct infection of the joint by the pathogen. Reactive arthritis after intestinal infection is arthritis after intestinal infection. Aho first proposed the concept of reactive arthritis in 1973. Reactive arthritis includes both Reiter's syndrome and rheumatic fever. In contrast, "arthritis after intestinal infection" has evidence of pathogenic microbial infection, there is no pathogen in the affected joint, and there may be no substantial difference between reactive arthritis and post-infection arthritis. basic knowledge The proportion of illness: the incidence rate is about 0.004%-0.005% Susceptible people: no specific people Mode of infection: non-infectious Complications: ankylosing spondylitis

Causes of reactive arthritis after intestinal infection

(1) Causes of the disease

The pathogens causing intestinal infection include Yersinia (10% to 20%), Yersinia pseudotuberculosis (5%), Shigella dysenteriae (1% to 2%), Shigella flexneri ( 1% to 2%), Salmonella enteritidis (1% to 2%), Salmonella typhimurium (1% to 2%), Campylobacter jejuni.

(two) pathogenesis

Intestinal infection of the above bacteria can cause arthritis, especially in patients with HLA-B27 positive, HLA-B27 and all types of reactive arthritis have strong correlation, HLA-B27 positive, severe disease, duration Long, the relative risk of onset is 50 times that of HLA-B27-negative patients. The pathogenesis of arthritis after intestinal infection is unknown, and may be similar to the incidence of ankylosing spondylitis.

Prevention of reactive arthritis after intestinal infection

1. Eliminate and reduce or avoid the disease factors, improve the living environment, improve the development of good habits, prevent infection, pay attention to food hygiene, and rational diet.

2. Pay attention to exercise, increase the body's ability to resist disease, do not fatigue, excessive consumption, quit smoking and alcohol.

3. Early detection and early diagnosis and early treatment, establish confidence in the fight against disease, adhere to treatment.

Complications of reactive arthritis after intestinal infection Complications ankylosing spondylitis

Some patients can develop typical Reiter syndrome, and a small number of patients can develop ankylosing spondylitis.

Symptoms of reactive arthritis after intestinal infection Common symptoms Joint swelling, back pain, joint migration pain, swelling erythema nodules

The symptoms of primary enteritis in patients are mild or even insignificant. Arthritis can occur from 1 day to several weeks after the onset of enteritis. In the northern hemisphere, it usually starts in autumn. The prevalence is similar between men and women, but after Shigella infection. Arthritis is more common in men. The age of onset is mostly around 30 years old. Reactive arthritis is similar to the joint manifestation of Reiter syndrome. For example, there is a history of intestinal infection 1 to 2 weeks before onset, and then the patient suddenly has joint swelling and pain. Involved in the knees, ankles, toe joints and ankle joints, sometimes involving the wrist and knuckles, often asymmetry of less joint inflammation, sometimes manifested as migratory joint pain, also common periarthritis or tendon attachment inflammation, 30 % of patients had lower back pain in the acute phase. The joint symptoms lasted from 2 weeks to 12 months, with an average of 20 weeks. Within 5 years, there were less than 20% of patients with signs of ankle arthritis. HLA-B27-negative Yersinia enteritis Post-arthritis often has nodular erythema, intestinal Yersin infection, induced arthritis is 10 times more than other pathogen infections, compared with sexually transmitted diseases, Reiter syndrome, prognosis of reactive arthritis after intestinal infection Usually better, maybe with the latter There is less chance of re-infection. After 5 to 10 years of follow-up, it is found that Yersinia and Shigella, infection-induced arthritis occur in more than 20% of patients with arthritis, and some patients can develop typical Reiter syndrome. A small number of patients can develop ankylosing spondylitis.

Examination of reactive arthritis after intestinal infection

During the active period of the disease, white blood cells rise, erythrocyte sedimentation rate increases, C-reactive protein is positive, HLA-B27 positive rate is 50% to 80%, rheumatoid factor and antinuclear antibody are negative, synovial fluid examination, clear or turbid appearance, white blood cell liter High, multinucleated, synovial histopathological examination showed non-specific vasculitis, stool culture is valuable for the diagnosis of reactive arthritis, however, due to the application of antibiotics or the natural elimination of infection, when joint symptoms appear, Bacterial culture is often negative, so it is emphasized that bacterial culture should be carried out in the case of precursor infection. In addition, the relevant bacterial serological agglutination test should be performed. For example, the diagnosis of Yersinia arthritis depends on the titer of the antibody is greater than 1:160. Usually in the acute phase, its potency can be as high as 1:20480. Generally, the highest peak is 2 weeks after infection, and it begins to decrease after one month. The diagnosis of Salmonella infection requires an antibody titer of 1:160. Streptococcus agalactiae infection may have resistance. The "O" titer is elevated, usually 500 units.

X-ray examination may have mild, temporary osteoporosis or normal, no bone erosion and periostitis changes such as Reiter syndrome, 3% to 20% of acute reactive arthritis with X-ray ankle joint Inflammation, and many patients have no history of arthritis.

Diagnosis and diagnosis of reactive arthritis after intestinal infection

Diagnostic criteria

1 The interval between the prodromal infection and the onset of arthritis is from 1 day to several weeks;

2 Self-limiting, acute arthritis usually subsides from 2 weeks to 5 months, occasionally more than one year, and it is rare to become chronic;

3 clinical typical symptoms are usually asymmetry of heavy joint inflammation, which may be associated with tendon attachment inflammation;

4 can be associated with extra-articular appearance, such as carditis, enteritis and various types of skin damage;

5 rheumatoid factor negative;

6 is closely related to HLA-B27.

Differential diagnosis

Distinguish from Reiter's syndrome, ankylosing spondylitis.

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