Reactive arthritis: diagnosis and medical treatment

2021-07-20 05:05 PM

Reactive arthritis is aseptic arthritis that occurs after an infection, mainly urogenital, respiratory, digestive, ... The disease causes damage to joints and other organs such as the eyes, system Genitourinary system, digestive system…

The term "reactive arthritis" was introduced in 1969 as arthritis that develops shortly after or during an infection elsewhere in the body, but in which the bacteria are not from the joint. The original definition did not specify pathogens that were accepted as causes of reactive arthritis, and in 1999 a panel of experts identified a specific list of possible gastrointestinal and urogenital pathogens. considered the cause. These include Chlamydia trachomatis, Yersinia, Salmonella, Shigella, and Campylobacter. Escherichia coli, Clostridioides (formerly Clostridium) difficile, and Chlamydia pneumoniae have been added to the list. Reactive arthritis triggered by a sexually transmitted disease is also called acquired reactive arthritis.

Additional pathogens, alternative terms, and diagnostic and therapeutic strategies for reactive arthritis were then proposed. However, no newer diagnostic or therapeutic methods or alternative names have been fully confirmed. Another problem is that many of the studies generating these methods involve patients seen in rheumatology clinics or monitoring disease outbreaks after exposure to common pathogens; Such patients are not likely to be representative of affected patients in the general community. So the definition of reactive arthritis is still evolving.

Reactive arthritis is aseptic arthritis that occurs after an infection, mainly urogenital, respiratory, digestive,... The disease causes damage to joints and other organs such as eyes, system Genitourinary tract, digestive system, ... are common in young age, the incidence in men and women is the same.

The pathogenesis of reactive arthritis is unknown. Reactive arthritis is aseptic arthritis that occurs after an infection in the body where no bacteria are found in the joint. Genetic factors play an important role in the pathogenesis of reactive arthritis, 30-70% of patients with reactive arthritis are positive for leukocyte antigen HLA-B27.

Definite diagnosis

Apply diagnostic criteria of Amor (1983)

Aseptic inflammation of one or several asymmetrical joints.

Diarrhea or dysentery.

Inflammation of the eye conjunctiva.

Urethritis, cervicitis.

Inflammation and ulceration of mucous membranes and skin.

HLA-B27 (+) or family history of ankylosing spondylitis.

Tests find the causative agent either directly or indirectly.

Reactive arthritis is diagnosed when 4/7 of the above symptoms are present.

Diagnostic criteria of the European group of seronegative Lymphoma (1990)

Pain, inflammation of the vertebrae.

Or synovitis (mainly joints in the lower extremities and asymmetrical). Accompanied by one of the following syndromes:

Have a family history of ankylosing spondylitis.

Psoriatic arthritis.

Intestinal disease.

Pelvic pain.

Soft tissue disease around joints.

Osteoarthritis of the pelvis.

Genital urethritis.

Special oath of reactive arthritis

Reiter's syndrome is diagnosed in the presence of a triad: arthritis, urethritis, and conjunctivitis.

Differential diagnosis

Infective arthritis: arthritis alone, infection status, joint fluid testing, blood culture, ...

Gout: acute, progressive arthritis, responding to colchicine, ...

One-joint rheumatoid arthritis: common in women, middle-aged, progressive arthritis, rheumatoid factor positive, ...

Arthritis in Acquired Immune Deficiency Diseases (AIDS): poor physical condition, positive HIV test, history of injecting drug use, ...

Painkiller treatment

You can choose from one of these pain relievers:

Acetaminophen (paracetamol, Dolodon, Tylenol, ...) 0.5g x 2-4 tablets/24 hours.

Floctafenin (Idarac) 200mg x 2 tablets/24 hours.

Non-steroidal anti-inflammatory drug treatment

Choose one of the following drugs (note absolutely do not combine drugs in the group because they do not increase the therapeutic effect but have many unwanted effects):

Diclofenac (Voltaren) 50mg x 2 tablets/day divided into 2 or 75mg x 1 tablet/day after a full meal. 75mg/day intramuscular injection can be used for the first 2-3 days when the patient is in severe pain, then switch to oral.

Meloxicam (Mobic) tablet 7.5mg x 2 tablets/day after eating or as an intramuscular injection 15mg/day x 2-3 days if the patient has a lot of pain, then switch to oral route.

Piroxicam (Felden) 20mg tablet or tube, take 1 tablet/day orally after eating or inject 1 ampoule intramuscularly for the first 2-3 days when the patient has a lot of pain, then switch to oral.

Celecoxib (Celebrex) tablets 200mg dose 1 to 2 tablets / day after a full meal. Should not be used in patients with a history of cardiovascular disease and with greater caution in the elderly.

Slow-acting drug treatment

Sulfasalazine (Salazopyrin) 1000-2000mg/24 hours, treatment lasts 1-3 months.

Methotrexate: 7.5-20mg/week: 1-3 months long-term treatment: in case of polyarthritis and severe joint damage.

Tumor necrosis factor-alpha (TNF) inhibitor: infliximab (Remicade): indicated in cases of severe joint damage or treatment-resistant to non-steroidal anti-inflammatory drugs and corticosteroids.

Corticosteroid drug treatment

Corticosteroids: systemic corticosteroid therapy in severe disease progression unresponsive to non-steroidal anti-inflammatory drugs or in patients dependent on corticosteroids, dose 1-1.5mg/kg/24 hours and reduce the dose gradually according to the patient's progress and response. Systemic corticosteroid therapy only for a short time, when the disease is controlled, it is necessary to switch to non-steroidal anti-inflammatory drugs.

Treatment of topical corticosteroids: injection of joints, injection of tendon attachment points (hydrocortisone acetate, Depo-Medrol, Diprospan, ...).

Antibiotics (only applicable for treatment when the cause of the disease is identified, the state of urinary tract infections, etc.): tetracycline (0.5 x 4 tablets/day), doxycycline (100mg x4-6 tablets) /day), quinolones (0.5 x 1-2 tablets/day) are used for up to 1-3 months.

Prevention

Early treatment of infectious conditions (infections of the genitourinary system, respiratory system, digestive system...).