This article describes Reiter's syndrome: symptoms and treatment in women, its forms and causes of this disorder. It can occur after an infectious intestinal disease and one of its features is that the symptoms do not appear immediately, but in a delayed period. The danger of pathology is that the process can become systemic. However, with timely diagnosis and treatment, the outcome of the disease is favorable - the manifestations of the syndrome pass in 80% of patients.
Short description
Reiter's syndrome is an inflammation of the joints, which is autoimmune in nature and is accompanied by systemic manifestations. The trigger factor for the development of this disorder is acute intestinal infection. The prevalence of the disease among men is almost 2 times greater than in women, but the symptoms and manifestations of Reiter's syndrome in both sexes are similar. Most often, pathology is diagnosed in young people 20-40 years old.
Against the background of an infectious disease, joint damage occurs in 2 scenarios:
- reactive (sterile) arthritis - an allergic inflammation of the inner layer of the joint bag;
- infectious arthritis when microbes enter the joint.
In medicine, there is also another concept - Reiter's disease. It differs from the syndrome in that the main factor in its development is genitourinary infections (most often chlamydia), and the course of the disease is chronic and progressive. In many patients, the disease leads to the formation of multiple inflammation of the joints.
Causes
The causes of Reiter's syndrome are associated with 2 factors:
- gastrointestinal infection (shigellosis, yersiniosis, salmonellosis, campylobacteriosis and others);
- genetic predisposition.
This pathology develops over a period of 1 week to 1 month after curing an infectious disease. If more time has passed, then this diagnosis is unlikely, the cause of joint inflammation lies in something else. In the acute period of the infectious process, the syndrome rarely occurs.
The prevalence of this pathology, according to medical statistics, is 1-4% of patients who have had an intestinal infection. The more severe this disease progressed, the higher the risk of developing complications in the form of inflammation of the joints. However, in about 10% of patients, arthritis occurs without any signs of intestinal infection.
This is due to the fact that such patients are often carriers of the HLA B27 antigen, which is of great importance in the development of autoimmune disorders. It is detected in 80% of patients. In addition to arthritis, pathologies such as:
- Ankylosing spondylitis, in which the mobility of the joints and spine is impaired due to contamination of the joint cavities;
- ulcerative colitis, or inflammation of the mucous membrane of the colon;
- Crohn's disease, or granulomatous inflammation of the gastrointestinal tract, accompanied by other, extraintestinal complications;
- inflammation of the choroid of the organs of vision, which often causes blindness.
Stages of the disease
The manifestations and symptoms of Reiter's syndrome in women go through 3 stages:
- At the first stage, a bacterial agent enters the body, which leads to the development of intestinal infection and enterocolitis.
- Then there is acute inflammation in the joints, which in most patients ends in recovery.
- If the patient has a genetic predisposition or immunity is impaired, then arthritis can go into a chronic form. Systemic manifestations of the syndrome occur.
Enterocolitis, after which Reiter's syndrome develops in women, is accompanied by the following symptoms:
- loose stools;
- loss of appetite, nausea, vomiting;
- flatulence;
- fever;
- abdominal pain;
- signs of general intoxication - headache and muscle pain, weakness.
In chronic enterocolitis, other signs join:
- alternating diarrhea and constipation;
- weight loss;
- fermentation of food in the intestines.
Features
For Reiter's syndrome, the following features are characteristic:
- joints are most often affected symmetrically;
- the spine and especially its lumbosacral part are involved in the process;
- the phalanges of the fingers and toes become inflamed, due to which they acquire a “sausage-like” appearance;
- joints of the lower extremities are most affected;
- heel pain occurs due to inflammation of the tendon and calcaneus.
Some patients develop flat feet as a result of damage to the ligaments of the feet. Involvement of joints in the pathological process in many cases occurs according to the “bottom-up” scheme or by the symptom of a spiral - the opposite joints are affected along the ascending line of the spine.
Reiter's syndrome in women: manifestations and symptoms
In medicine, the classical triad of symptoms of the syndrome, which are found in 30% of patients, is noted:
- arthritis;
- cervicitis - inflammation of the cervical tissue;
- pathology of the organs of vision.
In addition to arthritis, significant discomfort causes cervicitis. Its symptoms in Reiter's syndrome in women are as follows:
- a large number of vaginal discharge (mucous or purulent);
- itching, burning in the genitals;
- drawing pain in the lower abdomen and lower back;
- increased discomfort after urination and sexual intercourse.
With the addition of other pelvic pathologies (cystitis, cervical erosion, salpingoophoritis, endometritis), additional signs appear:
- frequent urination, accompanied by pain;
- increase in body temperature;
- spotting after sexual contact;
- severe pain in the lower abdomen.
Arthritis
Joint inflammation is a major feature of Reiter's syndrome in women. Symptoms of arthritis are as follows:
- joint pain;
- their swelling due to edema;
- crimson-cyanotic coloration of the skin in the area of ​​the inflamed joint;
- decreased motor activity, especially in the morning.
Usually the number of affected joints does not exceed six. The joints most commonly inflamed are as follows:
- articulation of the leg and foot bones;
- knees;
- toes (especially the toes);
- lumbosacral joint;
- joint of the sacrum and tailbone;
- hip joint.
In some cases, asymptomatic forms or an erased course of the disease are observed, in which the body temperature rises to 37.9 ° C, weakness is felt, and appetite worsens.
Dermatological signs
Symptoms and manifestations of Reiter's syndrome in women are associated not only with joint inflammation. The following dermatological disorders may occur in some patients:
- Hyperkeratosis - keratinization of the skin, its painless thickening. Pathological foci most often appear on the soles of the feet and palms. Single papules or plaques can form on any part of the body, in appearance they resemble psoriasis.
- Deterioration of the condition of the nail plates - their staining in yellow, thickening and peeling from the soft tissues of the fingers.
- Lymphadenopathy - an increase in inguinal lymph nodes.
- In rare cases, myocarditis, glomerulonephritis develop, skeletal muscles and peripheral nerves become inflamed.
Eye damage
The manifestations of Reiter's syndrome from the side of the organs of vision are the development of diseases such as:
- conjunctivitis;
- inflammation of the iris, which leads to visual impairment;
- damage to the connective tissue between the sclera and conjunctiva;
- inflammation of the lining of the eye, in which the network of blood vessels is located.
Conjunctivitis is most often malosymptomatic and lasts several days. Inflammation can develop only in one eye or simultaneously in both. At the same time, patients are bothered by pain, profuse lacrimation, photophobia.
Diagnostics
In order to detect infection and changes in the body, the following types of tests are prescribed for Reiter's syndrome:
- KLA - an increase in ESR, platelet count, IgA immunoglobulin and white blood cells is detected;
- biochemical analysis of blood - an increase in the content of C-reactive protein, rheumatic factor, fibrin;
- OAM - white blood cells, protein can be detected;
- fecal analysis, coprogram.
With the development of cervicitis syndromes, consultation of a gynecologist and taking a smear from the cervix is ​​indicated to determine the cell culture.
Instrumental diagnosis of Reiter's syndrome is to conduct the following types of medical examinations:
- X-ray of joints, spine and sacroiliac joint. In the pictures, swelling of the joints is revealed, and with a prolonged course of the disease - areas of bone destruction, narrowing of the gap between the joints.
- Synovial fluid intake from the joint cavity. In this case, nonspecific changes are found, characteristic of other types of arthritis - a decrease in viscosity, the presence of clots, a high concentration of white blood cells. This type of examination is carried out mainly for the differential diagnosis of gout and septic arthritis.
As additional studies, the attending physician may prescribe:
- ECG;
- FGDS;
- Ultrasound of the kidneys and abdomen;
- consultation of an ophthalmologist and a dermatologist.
Drug therapy
The basis of the treatment of this syndrome is the following medications:
- Antibacterial agents. They are selected depending on the identified pathogen and its sensitivity to antibiotics. As drugs, drugs from the group of tetracyclines, Ciprofloxacin, and others are prescribed. After treatment with antibiotics, the effectiveness of therapy is monitored after 4-5 weeks.
- Nonsteroidal anti-inflammatory drugs - Diclofenac, Aceclofenac, Naproxen, Indomethacin, Nimesulide and others. They reduce the intensity of inflammation in the joints and spine, and also have an analgesic effect.
- Multivitamins - “Duovit”, “Complivit”, “Alphabet”, “Vitrum” and others.
- Gastroprotectors - Omeprazole, De-Nol, Escape, Biogastron, Duogastron and others.
- Myospasmolytics - Tolperisone, Tizanidine, Tizalud.
Local funds
As local therapy, ointments, creams or gels are used, which include NSAIDs:
- Voltaren.
- Nise.
- "Fastum."
- Diclofenac.
- Ortofen and others.
They have a therapeutic effect directly on the site of inflammation. Topical application also reduces the risk of side effects that may occur with systemic treatment of NSAIDs.
Hormonal drugs
With the progressive course of this disease and its vivid manifestations, the doctor may prescribe glucocorticoids - Betamethasone, Prednisolone. They are applied locally - an injection is injected into the joint cavity and into adjacent tissues. The duration of therapy is an average of 3 weeks. Such treatment can reduce inflammation.
If a large number of joints are involved in the pathological process, then hormonal drugs are administered to the patient intravenously. With systemic manifestations of the disease, damage to the kidneys or heart, glucocorticoids are prescribed in short courses. With inflammation of the conjunctiva, eye drops or ointments with dexamethasone are used.
Non-drug treatment
Reuters syndrome can also be treated with physiotherapy:
- Phonoresis with glucocorticoids and NSAIDs. The principle of this method is the effect of ultrasonic waves on the affected area, which contributes to the deep penetration of drugs and the maximum therapeutic effect.
- Diadynamic currents are an electrotherapy method in which low-frequency impulse currents act on joints and surrounding areas. They have an exciting effect on the nervous system and muscles. As a result, local blood supply and metabolism in tissues improve, and an analgesic effect is manifested.
- Magnetotherapy. The magnetic field causes eddy currents in the synovial fluid and has a complex physical and biological effect. The effect of magnetotherapy is similar to the previous method.
- Laser Therapy The laser beam produces a thermal effect on the tissue. Swelling subsides, improves blood circulation and tissue nutrition, which stimulates their regeneration.
- Massage in the joints, preventing the development of muscle atrophy and contributing to the acceleration of metabolic processes in the tissues.
With a prolonged course of the disease, it is necessary to adhere to the following recommendations:
- try to avoid factors that lead to exacerbation (infectious diseases, hypothermia, stress, smoking and alcohol abuse);
- follow a diet that contains a large amount of polyunsaturated fatty acids, as well as fruits and vegetables;
- perform exercises with moderate physical activity, physiotherapy exercises 1-2 times a week.
Complications and prognosis
Reiter's syndrome in women, the manifestations and symptoms of which are described above, can lead to the development of the following types of complications:
- deformation of joints and their subluxation;
- muscle atrophy;
- osteoporosis;
- violation of the heart and kidneys.
In the absence of systemic manifestations described above, and timely treatment, the outcome of the disease is favorable. In patients with the HLA B27 antigen, the prognosis is less favorable, since dysfunction of the internal organs is often observed.