Wright syndrome

Introduction to Wright syndrome Reiters Syndrome is a special clinical type of reactive arthritis characterized by the triad of arthritis, urethritis and conjunctivitis. It is often characterized by sudden acute arthritis with a unique extra-articular joint. Skin and mucous membrane symptoms. It is currently believed that the disease has two forms: sexually transmitted and dysentery. The former is mainly found in young men between the ages of 20 and 40. In most cases, the genitals are infected with Chlamydia trachomatis. Wright syndrome women, children and the elderly are rare, they usually get dysentery after intestinal bacterial infection, mainly Shigella, Salmonella, Yersinia and Campylobacter. The onset of Wright syndrome is associated with infection, genetic markers (HLA-B27) and immune disorders. The pathological changes of the synovium are non-specific inflammation. The disease is more common in young men, and the incidence rate in foreign countries ranges from 0.06% to 1%. There is no statistical report on this in China. basic knowledge The proportion of sickness: 0.0001% - 0.0002% Susceptible people: more common in young men Mode of infection: non-infectious Complications: Myocarditis, pleurisy

Cause of Wright syndrome

Pathogenic bacteria infection (40%):

Most of the Wright syndrome in the United Kingdom and North America occurs after sexual intercourse, called sexual acquired, and its pathogen is Chlamydia trachomatis or Mycoplasma. There are reports of synovial or synovial biopsy specimens in patients with Wright syndrome, 33 % to 69% of patients have higher chlamydia-specific antibody responses. In Europe, Africa, the Middle East, the Far East and China, it occurs after bacterial dysentery infection, called post-dysentery type, usually negative by intestinal Gram. Caused by bacilli infection, including Fusarium, Shigella, Salmonella, Helicobacter pylori and Yersinia, more than 90% of patients reported having a history of dysentery or diarrhea before onset, and those with positive stool culture were blessed. Shigella dysenteriae, the disease can also occur in human immunodeficiency virus (HIV) infection, and Wright syndrome is the most common and first discovered, but so far there is no more evidence that the disease and infection have Direct relationship.

Immune abnormality (30%):

Because Wright syndrome patients have increased erythrocyte sedimentation rate, C-reactive protein, IgG, IgA and 2: globulin increased, and non-bacterial urethritis or enteritis can occur after aseptic synovitis, suggesting that immune factors in the pathogenesis It has a certain role, but it has not been confirmed that the disease has the same general humoral or cellular immune abnormalities as systemic lupus erythematosus.

Genetics (20%):

The positive rate of HLA-B27 in Wright syndrome patients is 80%-90%, the incidence of HLA-B27 positive patients is as high as 20%, and the incidence of serum-negative spondyloarthropathy in patients' families increases, indicating the occurrence of this disease. Related to HLA-B27, but some HLA-B27-positive people are prone to ankylosing spondylitis, and some are susceptible to Wright syndrome, which may be related to HIA-B27 subtype, which is thought to be caused by bacteria. The bacterial component encoded by the plasmid reacts with the HLA-B27 antigen, or the component of the arthritis pathogen carrying the simulated HLA-B27 antigen is recognized and causes disease. It is also considered that the bacteria have the same amino acid as HLA-B27. sequence.

Wright syndrome prevention

Personal prevention:

1 life rules, pay attention to nutrition, exercise to enhance their immune function.

2 pay attention to the environment and personal hygiene, often take a bath and change clothes.

3 prevention of urethritis, cervicitis, prostatitis and other diseases, once it occurs, should be actively treated.

Wright syndrome complications Complications Myocarditis pleurisy

Common complications of Wright syndrome are mainly systemic symptoms, which usually cause fever, weight loss, fatigue, and sweating several weeks after infection. The heat type is medium to high heat. 1 to 2 peaks per day, mostly not affected by antipyretics. It usually lasts for 10 to 40 days and can be relieved by itself. It can also cause the following diseases: cervicitis, infection, ulcers, myocarditis, pleurisy, and the like.

Wright syndrome symptoms common symptoms triad diarrhea urinary frequency urinary pain abscess heel pain purulent secretion tendonitis

Clinical manifestation

Wright syndrome is more common in men, the age of onset is 20 to 40 years old, often has a history of unclean sexual intercourse or diarrhea. Typical patients have arthritis, urethritis, and conjunctivitis. Most patients have acute onset and arthritis is multiple. Asymmetry, light and heavy, most of the following limbs, the most common is knee, ankle, metatarsophalangeal joints, fingers, toe joints can also be involved, red, swollen, hot, pain, muscles near the joint will shrink, Arthritis persists for 1 to 3 months, and many recurrences, recurrent episodes and severe arthritis can cause joint deformation.

Wright syndrome check

Laboratory inspection

1. Pathogen culture: feasible urethral swab culture, when the condition can be taken by cervical brushing cells, direct fluorescent antibody and enzyme-linked immunosorbent assay, when the intestinal symptoms are not obvious or mild, stool culture is helpful to determine the microbial infection that induces the disease. It can provide a basis for diagnosis of suspected reactive arthritis, but it should be noted that most patients have been infected for a few weeks before the visit, and the pathogen culture is often negative.

2. Inflammatory index: In the acute phase, there may be increased white blood cells, increased erythrocyte sedimentation rate, and elevated CRP. Chronic patients may have mild positive cell anemia, and complement levels may increase.

3. Synovial fluid and synovial membrane examination: Synovial fluid has mild to severe inflammatory changes, synovial viscosity decreases, white blood cells are mild to moderately elevated, mainly neutrophils, and large macrophages may appear, including Nuclear dust and vacuoles of whole white blood cells, sometimes called Wright cells, are not specific to Wright syndrome, and synovial biopsy shows non-specific inflammatory changes, but usually more than rheumatoid arthritis. Infiltration of neutrophils, immunohistochemistry, PCR or molecular hybridization techniques can identify infectious agent antigens in synovial membranes and synovial fluid.

4. HLA-B27 detection: HLA-B27 antigen is associated with central axis arthritis, carditis and ocular mesangitis. Therefore, the antigen positive is helpful for the diagnosis of this disease.

Diagnostic identification of Wright syndrome

Diagnostic criteria

Typical arthritis, non-gonococcal urethritis and conjunctivitis triads are not difficult to diagnose. For patients with seronegative, asymmetrical oligoarthritis, especially young patients, this disease should be highly suspected, although there is a diagnosis of pre-infection. Very important, but because it is often hidden, it is easy to be ignored by doctors and patients themselves, and heel pain and other symptoms of tendon disease, finger toe inflammation, various forms of mucosal lesions increase the possibility of this disease.

Differential diagnosis

1. Bacterial arthritis: mostly monoarthritis, acute onset, often accompanied by high fever, fatigue and other symptoms of infection, joints have more obvious red, swollen, hot, painful inflammation, synovial fluid is severe inflammation Sexual changes, white blood cell count is often greater than 50.000 / ml, neutrophils are more than 75%, the pathogen can be found in synovial culture.

2. Acute rheumatic fever: This disease belongs to the category of generalized reactive arthritis. Most of the patients are in adolescents with poor medical conditions. The incidence is relatively acute. There are many cases of streptococcal infection in the 2~3 weeks before onset. Sore throat, fever and migratory arthritis of the extremities and major joints. After the joint swelling and pain subsided, bone erosion and joint deformity were not left behind. The patient was also often accompanied by carditis, and the peripheral blood leukocytes were increased, and the anti-chain "O" was observed. Raise.

3. Gouty arthritis: mostly in middle-aged and elderly men, initially manifested as recurrent acute arthritis, most often involving the first metatarsophalangeal joint and the tibial joint, which is characterized by redness, swelling and severe pain in the serum. Uric acid is elevated and urate crystals are present in the synovial fluid.

4. Psoriatic arthritis: This disease occurs in middle-aged people, and the onset is slower. Wright syndrome is mainly differentiated from asymmetrical oligoarthritis in five clinical types. This type is often involved. End finger joints, metacarpophalangeal joints, metatarsophalangeal joints, knee and wrist joints, etc., a small number of joints can be left behind, psoriatic arthritis patients often have psoriasis skin and nails Lesion.

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