Pain in the joints urethritis conjunctivitis triad

Arthritis urethritis conjunctivitis triad typical for

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Chlamydial arthritis is considered a complex and dangerous pathology. develops most often in conjunction with damage to the eyes and genitourinary system. Modern medicines can effectively fight the disease. It is important not to bring it to a neglected state and to treat it in a timely manner and with adequate methods. Symptoms and treatment of the disease should be under the vigilant supervision of a physician.

Essence of pathology

Chlamydial arthritis is an acute autoimmune articular disease that develops against the background of an infectious lesion or after suffering chlamydia. As a rule, peripheral joints are most affected. The pathogenic microorganism of chlamydia Clamidia trachomatis is considered to be the culprit of the appearance of the disease when it provokes urogenic chlamydia.

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One of the most dangerous consequences of the pathology is Reiter's disease, when, along with chlamydial arthritis, damage to the genitourinary system and an inflammatory reaction of the mucous membrane of the eyes are observed. A classic triad is formed: urogenital, articular and ophthalmic lesions. It should be noted that their simultaneous development is rarely observed. Most often, lesions occur sequentially, at large intervals, showing the so-called incomplete form of the disease.

Despite the fact that the pathology is generated by the penetration of a pathogenic microorganism, it cannot be considered an infectious disease. Chlamydia does not penetrate directly into the joint. The mechanism of the origin of pathology is associated with disorders of the immune system.

The fact is that in response to the appearance of an infection in the human body, antibodies are produced to destroy penetrating foreign antigens. Some protein elements of articular tissues are in many ways similar to similar components of chlamydia. Antibodies incorrectly recognize the object of influence and the cells of the articular connective tissues are mistaken for a foreign body, attacking them like an infection. As a result, an inflammatory process is provoked, which becomes the cause of reactive arthritis, in particular, the chlamydial variety.

Pathogenesis of the disease

Articular lesions according to statistics develop in 4 - 5% of patients with chlamydia. They can appear both during the course of the underlying disease, and after its termination, when antibodies still remain in the body. In general, the scheme of the pathogenesis of the disease consists of several stages:

• infectious-toxic stage, when urethritis develops, and the immune system recognizes chlamydial antigens;
• autoimmune stage - antibodies are actively produced to destroy the antigens of the infection;
• arthritic phase - antibodies mistakenly recognize connective tissue cells as an enemy, causing an inflammatory reaction of the articular synovial membrane.

The whole chain of events has a duration of about 20 - 60 days, depending on the state of the immune system. This is the time that antibodies need to recognize the object of attack. Further, the process develops quite quickly. Quite often, damage to the knee joint develops. The characteristic areas of damage include: ankle, shoulder, temporomandibular joints, as well as small joints of the hands and feet. As a rule, monoarthritis (damage to one joint) or oligoarthritis (2-3 joints) is fixed. In rare cases, there is polyarthritis with damage to a significant number of joints. A typical lesion is asymmetrical (unilateral manifestation).

Chlamydial arthritis begins with an acute attack, when the swelling of the joint grows rapidly, and the person's condition deteriorates sharply. One of the first to suffer is the muscular system around the joint when the muscles lose their volume. Almost simultaneously, an inflammatory reaction develops in other articular elements, provoking the corresponding diseases:

• bursitis (lesion of the articular bag);
• tendinitis (tendon);
• fascitis (muscle elements);
• periostitis (periosteum).

Depending on the course of the disease, it is classified according to several indicators. By the nature of the flow, the following varieties are distinguished:

• acute phase (up to 90 days);
• protracted form (up to 10 - 12 months);
• chronic type (more than 12 months);
• recurrent arthritis (recurrence of the acute phase every 5 to 6 months).

The following periods are distinguished according to the severity of the manifestation:

• low;
• medium;
• high intensity;
• The period of remission, when symptoms do not appear.

In addition, it is customary to subdivide the disease according to the degree of consequences:

• maintain full functionality;
• partial disability;
• disability (loss of ability to work).

Symptomatic manifestations

This arthritis in the form of Reiter's disease begins to appear usually 35-50 days after the onset of chlamydia. First, the genitourinary system is affected, and then there are problems with the eyes and the musculoskeletal system. When chlamydial arthritis develops, the symptoms are especially pronounced in men. Women's disease occurs with more hidden signs. In general, manifestations fall into 3 categories:

• urogenital;
• ophthalmic;
• articular.

The main signs of disorders of the genitourinary system (urogenital tract):

• burning sensation and pain when urinating;
• frequent urge to urinate;
• pain in the lower abdomen;
• urethral or vaginal discharge with purulent impurities.

The next chronic disease is the appearance of signs of eye damage (symptoms of conjunctivitis, blepharitis, iridocyclitis, uveitis). The following manifestations are noted:

• increased lacrimation;
• redness, conjunctiva;
• photophobia;
• feeling of a foreign body in the eye.

Signs of articular lesions are the last to appear. First of all, inflammation develops in such areas: knee, ankle, supnya. The development of pathology extends the process to the spine in the sacroiliac region, as well as to the shoulder, hands, temporomandibular zone. The following characteristic symptoms appear:

• asymmetric localization of lesions;
• inflammatory signs (edema, redness, rise in temperature at the site of the lesion);
• pain syndrome (small at rest and with increased movement in the joint);
• signs of synovitis (effusions in the joint cavity);
• signs of general intoxication (fever, general weakness, headache, fatigue).

Complications of the disease can affect different organs. The pathogenic process can spread to the skin (keratoderma), nail plates, oral mucosa (ulcerative stomatitis), nerve fibers (polyneuropathy, encephalitis). Damage to other organs can cause such dangerous diseases as cystitis, pyelonephritis, prostatitis, balanitis, balanoposthitis.

Principles of treatment

Treatment of chlamydial arthritis must be started at an early stage, when the pathology has not spread too far, and the destruction of the joint has not become irreversible. The most commonly used scheme of conservative treatment:

Chlamydial arthritis is one of the rather dangerous consequences of infection. The disease can become one of the stages of Reiter's disease, which will directly affect important organs. Only timely and effective treatment will help get rid of a serious problem.

Urethritis, conjunctivitis, arthritis

Have you been trying to heal your JOINTS for years?

• Causes of disease
• Signs and symptoms
• Diagnosis and treatment

Reiter's disease (or syndrome) develops as a consequence of some inflammatory infectious diseases of the genitourinary system or intestines. The disease manifests itself with complications on the joints (arthritis), on the genitourinary system (urethritis) and on the visual organs (conjunctivitis). The onset of the development of the disease occurs at a young age, cases of the disease in children are rare.

Causes of disease

The causes and mechanism of the development of the disease have not been fully studied. It is assumed that the disease is transmitted at the genetic level, and infectious diseases of the urinary or digestive systems can also affect the development of the syndrome. Most of those who applied to the hospital with Reiter's syndrome initially observed signs of urethritis, which manifests itself after an exacerbation of infectious chronic diseases or sexual contact. In some cases, the disease can develop against the background of acute enterocolitis (salmonella, shigellosis origin).

The damage to the joints in developing arthritis is not directly related to infections, but to autoimmune diseases. During the development of the disease, the immune system begins to recognize the cells of its own body as aggressive hostile environments and begins to attack them, gradually destroying them. Self-destruction of cartilaginous and bone tissues occurs with the development of chlamydial arthritis.

Signs and symptoms

Reiter's disease is characterized by manifestations of urethritis, conjunctivitis and arthritis. In addition, lesions of the mucous membranes, kidneys, liver, myocardium, central nervous system, aorta, and others are possible. Symptoms of the disease can occur in a different sequence, but more often it is urethritis.Urethritis in Reiter's syndrome can have various forms - from acute inflammation with purulent discharge to mild with a slow and sluggish course, close to the chronic form. With a sluggish process, the patient in the morning experiences discomfort during urination and some difficulty in emptying the bladder. On the part of the visual organs, the disease is expressed by inflammation of the conjunctiva of the eyes, moreover, immediately bilateral and quickly passing.

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Arthritis of the joints begins to manifest itself from the acute phase approximately 1-4 weeks after the first signs of urethritis. A patient with arthritis suffers from fevers, chills, pain in the affected areas, swelling and hyperemia. If the joints of the fingers swell, then, as a rule, the entire finger swells, becoming bluish in color and resembling a sausage in appearance. The defeat of arthritis is asymmetrical, more often pathologies develop in the ankle, knee joints and toes.

Typical manifestations of this disease are lesions of the mucous membrane and skin. Red spots appear on the soles and palms with hyperkeratosis in the center - keratoderma. In some cases, psoriasis-like rashes and changes in the nail plate occur. On the mucous membranes of the mouth, tongue, head of the male genital organ, erosions appear that do not disturb the patient in any way. Such external changes appear during the acute phase of the disease and disappear as the remission of the disease is achieved.

Other possible symptoms of Reiter's disease:

• atrophy of the muscles in close proximity to the affected joint;
• inguinal lymphadenitis;
• myocarditis;
• pericarditis;
• kidney lesions - pyelonephritis, glomerulonephritis, amyloidosis, polyneuritis,
• Violations of the rhythm of the heart and conduction are possible due to myocardial damage, psychosis and encephalomyelitis.

The duration of the disease is mainly from 3 to 6 months. The syndrome is completely cured, except in cases where the infection in the genitourinary system persists, then relapses of the disease are not excluded. Complications are possible with the syndrome: in men, urethritis is often complicated by prostatitis, in women - by adnexitis or cervicitis.

Diagnosis and treatment.

In the presence of triple signs - urethritis, conjunctivitis and arthritis - the diagnosis is not difficult. With insufficiently pronounced symptoms of one or another component, they resort to radiography of the affected joint. A laboratory study of the synovial fluid will show the presence of an inflammatory process. Moreover, a general blood test will not bring any results, since there will be no deviations in the biochemical composition of the blood. After examining the urine, you can see traces of pus.

Treatment of Reiter's syndrome is carried out in a complex manner according to the symptoms of the concomitant triad. Manifestations of urethritis are treated with antibacterial drugs of the tetracycline group. In the treatment of arthritis, non-steroidal anti-inflammatory drugs are used, such as aspirin, diclofenac, voltaren, indomethacin and others. In the active stage of the disease, glucocorticoids are prescribed. In chronic or protracted arthritis, derivatives of gold or quinoline salts are prescribed, in some cases, with an active autoimmune process, immunosuppressants.

To prevent Reiter's syndrome, hygiene should be observed, cystitis, urethritis, and other diseases of the genitourinary system should be treated in time. If chlamydia is detected, both partners are subject to treatment. It is important to remember that you cannot prescribe treatment yourself, otherwise you can only harm your body. Be sure to consult a doctor for appropriate examinations and prescriptions.

Chlamydial arthritis and its treatment

One of the most common types of post-infectious arthropathies is chlamydial arthritis. This disease is associated with a previous chlamydial urethrogenital infection and ranks first (seventy percent) in frequency of occurrence among reactive arthropathies (ReA). For a long time, it was believed that chlamydial infection only triggers an abnormal immune response and provokes an inflammatory process. However, recently, with microscopic studies of the articular effusion, it has become possible to isolate the pathogen - chlamydia.

Etiology of the disease

Chlamydial arthritis occurs in people who are quite young (from twenty to fifty years old) and have an active sex life. Chlamydia are bacteria capable of intracellular reproduction, which makes their detection quite difficult. Chlamydial bacterium is transmitted through sexual contact from a sick person to a healthy one, and a contact route of transmission through hygiene items, underwear, etc. is also possible.It is believed that chlamydial arthritis is more common in males, although this may be due to the brighter clinic of chlamydial infection in men. Women are characterized by erased forms of chlamydial infection, or carriage.

The mechanism of development of chlamydial arthritis is still not fully understood. It is believed that the proteins of the cell wall of chlamydia are similar in structure to the cells of the cartilaginous membrane of the joints. A genetic predisposition for the HLA system also has a certain role. When the chlamydial pathogen persists in the blood, especially in a chronic inflammatory process, the immune system begins to produce antibodies to chlamydia, and, due to the similar composition, against its own cells. The autoimmune process starts. Inflammation in the joint that has arisen without the direct participation of the pathogen is called aseptic.

Clinical picture

The symptoms of chlamydial arthritis are not particularly specific among other ReA. Against the background of a current or previous chlamydial urogenital infection (urethritis, cystitis, cervicitis, etc.), there is an acute pain in the joint, increasing swelling, the temperature of the skin changes at the site of the lesion, and redness is noted. The symptoms of general intoxication join - high fever, chills, headache. The lesion is often asymmetric, in the form of mono- or oligoatritis, large joints are more often involved: ankle, knee, but in the absence of timely treatment, small ones join, the disease captures an increasing number. A characteristic feature of chlamydial arthritis is the presence of effusion in the joint cavity.

According to the course of the disease, they are distinguished:

• acute stage - a period of vivid clinical manifestations, rapid development, lasting no more than three months;
• protracted - sluggish stage, can last for a year;
• recurrent - periodically occurring periods of exacerbation and subsidence of chlamydial arthritis;
• chronic - prolonged, more than a year, course of the disease.

Chlamydial arthritis captures not only cartilaginous surfaces, but spreads to tendons, muscles, articular bag, causing bursitis, synovitis, muscle atrophy, enthesitis. A frequent complication is chlamydial spondylitis - damage to the vertebrae. It is characterized by severe back pain, impaired mobility.

Extra-articular manifestations form a triad characteristic of Reiter's disease: chlamydial urethritis, chlamydial arthritis and conjunctivitis. There is a slight soreness and discomfort during urination, redness and swelling of the urethral mucosa, scanty mucous discharge from the urethra.

There may be pain in the lower abdomen. Dysuric disorders are manifested by frequent urination and imperative urges. Chlamydial conjunctivitis is accompanied by redness of the mucous membrane of the eyelids, conjunctiva, a feeling of "sand", the development of iridocyclitis and uveitis is possible. On the part of the skin and mucous membranes - chlamydial stomatitis, ulceration, rash, hyperkeratosis. In severe systemic cases, damage to the heart, lungs, kidneys, nervous system (polyneuropathy) is possible.

Diagnostic measures

The presence of chlamydial arthritis is established through a thorough history taking: they reveal a connection with a sexually transmitted infection, the presence of characteristic complaints from the urinary system and pathognomonic symptoms of an inflammatory process in the joint.

In the general blood test, general inflammatory changes can be detected: increased ESR, leukocytosis, thrombocytosis, anemia. In the general analysis of urine, proteinuria (presence of protein), leukocyturia, microhematuria is detected. Biochemical analysis has no specific abnormalities, rheumatoid factor is absent, indicators of acute phase proteins may increase: fibrinogen, seromucoid, CRP. To detect the pathogen, a smear from the urethra in men or the cervical canal in women is used, but since the microorganism has an intracellular localization, it cannot always be detected with microscopy. More informative is a serological study by enzyme immunoassay, or using a polymerase chain reaction - class M immunoglobulins are detected for chlamydial antigens in the blood or synovial fluid.

On radiographs or computed tomography in chlamydial arthritis, changes in the epiphyses of bones, deformations and the degree of destruction of cartilage, narrowing of the joint space are visible. Magnetic resonance imaging is considered the best diagnostic method, which allows you to see not only bone changes, but also lesions in soft tissues, muscles, etc. Mandatory for chlamydial lesions consultation of a urologist, venereologist, ophthalmologist.

Chlamydial arthritis treatment

Therapy for the disease of chlamydial etiology should be long-term and aimed not only at treating the symptoms of chlamydial arthritis, but also at destroying the focus in the genitourinary tract.The duration of taking antibiotics (at least a month) is due to the fact that chlamydia are located inside the cells and it is quite difficult to act on it. The drugs of choice are tetracyclines, in particular doxycycline, and antibacterial agents from the macrolide group (clarithromycin, azithromycin) are also prescribed. Given the development of dysbacteriosis with prolonged use of antibiotics, simultaneous antifungal therapy and the use of biological products are recommended. Treatment of chlamydial infection must be carried out simultaneously with the sexual partner. During therapy, it is recommended to refrain from sexual intercourse.

The second group of drugs used in chlamydial arthritis are non-steroidal anti-inflammatory drugs (NSAIDs) - indomethacin, diclofenac, nemisulide, voltaren, arcoxia. They relieve pain, reduce swelling and inflammation, and lower the temperature. NSAIDs are used both internally and externally in the form of gels, ointments, as the basis for physiotherapy. In rare cases, when NSAIDs are ineffective, connect glucocorticosteroids in a short course. By stopping the symptoms of chlamydial arthritis, NSAIDs do not significantly affect the mechanism of development of a pathological immune response. For this, there is a third group of drugs - immunosuppressants (methotrexate, sulfasalazine), which suppress the autoimmune reaction in the body. In parallel, chlamydial conjunctivitis is treated: washing and instillation of anti-inflammatory solutions (sofradex). Phytotherapy has a good restorative effect in chlamydial arthritis, because herbs (chamomile, sage, calendula) can be used for a long time. Additionally, vitamins, tincture of Eleutherococcus, chondroprotectors (inoltra, chondroetin, artra) are prescribed. Physiotherapy and massage give a good effect in the treatment of chlamydial arthritis. Physical therapy is mandatory, the purpose of which is to prevent contractures, restore mobility, and improve limb function.

Forecast and prevention

The outcome of chlamydial arthritis in cases of timely access to a doctor and early prescription of therapy is favorable and can lead to a complete recovery. After a course of antibiotics, a control test for chlamydia should be taken several times within three months to make sure that there is no persistent chlamydial infection and to avoid relapses. It must be remembered that late detection of chlamydia can lead to infertility. Specific prevention of chlamydia infection has not been developed. To prevent chlamydia infection, you must:

• have one verified sexual partner;
• use condoms;
• in cases of increased sexual activity, be tested for sexually transmitted infections at least once every six months;
• observe personal hygiene - do not use someone else's towel, linen, hygiene items;
• lead a healthy lifestyle, give up smoking and alcohol, treat chronic foci of inflammation (not only chlamydia), harden and strengthen the immune system.

Urethritis, pain in the joints of the legs, conjunctivitis with chlamydia, Reiter's disease

Reiter's disease is caused by a chlamydial infection, chlamydia. There are two forms of the disease: urogenital and enterocolitis.

Reiter's disease is one of the most common causes of acute and subacute arthritis in young men. The disease usually begins with urethritis (inflammation in the urethra), which is extremely mild clinically. Dysuric phenomena are rare. At the same time, there may be signs of cystitis or prostatitis.

Usually after a few days or at the same time, joint pains with swelling appear. The process begins with an asymmetric lesion of the ankle or knee joints. Then other joints of the legs and arms become inflamed.

Inherent ladder-shaped type of lesion from the bottom up. Exudative manifestations predominate in the joints, involvement of periarticular tissues is typical.

There is also eye damage by the type of conjunctivitis (rarely iritis, iridocyclitis or uveitis).

In Reiter's disease, other clinical symptoms can also be detected: sacroiliitis, ulcerative stomatitis, glossitis, balanitis, keratoderma, nail damage.

In some patients, the classic triad of urethritis, arthritis, conjunctivitis, may be absent, and the disease manifests itself with only two syndromes. In such cases, Reiter's incomplete disease is referred to.

Diagnosis of Reiter's disease, criteria

Leukocytosis is noted in the blood, a significantly increased ESR, in 60-75% of cases the HLA-B27 antigen is detected.

When making a diagnosis, they are guided by diagnostic criteria (Sharp):

"Urethritis, pain in the joints of the legs, conjunctivitis with chlamydia, Reiter's disease" F section Diagnosis of pain in the joints