Multiple inflammation of the joint tissue is considered reactive polyarthritis. Both sequential and simultaneous damage to several joints is possible. The main reason for the development of the pathological process is some immune disorders, metabolic pathologies, as well as some non-specific and specific infections. Polyarthritis manifests itself in the form of pain, swelling, hyperemia and hyperthermia in the area of lesions. The diagnosis is made on the basis of laboratory tests, the results of CT, MRI, radiography, scintigraphy, cytological and microbiological studies of the joint fluid. Treatment is usually conservative.
Features
Reactive polyarthritis is a simultaneous or sequential inflammation of the joints. It can act as an independent disease or develop as a result of other diseases, injuries, metabolic disorders and immune pathologies in a child. It manifests itself as severe pain, impaired functionality, swelling of the joints, local hyperthermia and hyperemia. The pain syndrome most often has a wavy character, the pain intensifies in the morning and night hours. The phenomena of the acute form of the disease are completely reversible; with a chronic disease in the joints, pathological changes that have an irreversible character develop. The main cause of reactive polyarthritis in children is a reaction to another disease of an inflammatory nature, in which the infection spreads to other organs and tissues, including articular.
What is the reason?
A functional impairment can be caused by both pain and changes in the structure of tissues. With mild types of this disease, disability and mobility is preserved, with severe types it is completely lost or limited. The polyetiological nature of the pathology determines the importance of proper clinical diagnosis and the selection of adequate therapeutic methods, taking into account the cause, variant of the course of the disease and its form. Depending on the development factors of reactive polyarthritis, the treatment of this process can be carried out by pediatric orthopedists, pediatricians, traumatologists, rheumatologists and other doctors of other specialties.
Risk group
Reactive polyarthritis most often develops in children after previous viral, bacterial, chlamydial and fungal infections. The inflammatory process in the joints can occur after an infectious lesion of the intestines in a child (salmonellosis, shigellosis), genitourinary infections (urethritis, cystitis), infections of the ENT organs and respiratory tract (pneumonia, sinusitis, bronchitis, pharyngitis, tonsillitis). Most often, these pathological processes are observed in boys. A predisposing factor is a chronic focus of infection, excessive stress, limb injuries and hypothermia.
Symptoms of the disease
Reactive polyarthritis begins with the general symptoms of intoxication: malaise, weakness, hyperthermia, swollen lymph nodes, loss of appetite. In the future, changes in muscles and joints join these signs:
- soreness in the hands, legs, when moving and at rest;
- stiffness of movements;
- signs of an inflammatory process in periarterial tissues - swelling, redness, fever;
- asymmetry of the lesion;
- dactylitis - inflammation in the fingers and toes.
Depending on the type of infectious pathogen, the pathology covers:
- eyes - in this case, the iris (iridocyclitis), conjunctiva (conjunctivitis) becomes inflamed, which manifests itself in the form of lacrimation, burning, redness, sensation of a foreign body;
- skin and mucous membranes - erosion in the genital area, mouth, keratoderma (detachment of nails, keratinization of the skin);
- genitourinary system - burning during urination, soreness, pulling pains in the abdomen.
At later stages of the development of reactive polyarthritis in children and adults, dysfunctions of the heart, kidneys, lungs, and central nervous system join.
Varieties of ailment
The ICD code for reactive polyarthritis is M13.
This pathological process that develops in childhood has several varieties - rheumatic fever, Reiter's syndrome and infectious-allergic polyarthritis. Consider each view in more detail.
Rheumatic fever
This type of pathology is observed approximately 15–20 days after streptococcal tonsillitis. At the same time, an acute onset is very characteristic with an increase in temperature up to 40 ° C, excessive sweating, chills, inflammation of the lymph nodes, severe weakness, severe nosebleeds. After this, several large joints are involved in the process. The lesion, as a rule, is symmetrical, has a wandering character, moving to different joints, is accompanied by pain, swelling, redness of the skin over the joint.
Symptoms of reactive polyarthritis of this species are rather unpleasant.
Various pathologies from the side also join:
- CNS - headache, blurred speech, twitching of the facial muscles, emotional instability, impaired coordination;
- heart (rheumatic heart disease) - palpitations, shortness of breath, arrhythmia, in severe stages - the formation of heart defects and the development of its insufficiency;
- skin - rheumatic nodules - painless, dense round spots that are located under the skin of the joints, or pale pink round spots on the limbs and trunk of the child, without itching, turning pale when pressed.
Reuters Syndrome
This type of reactive polyarthritis develops after chlamydial urogenital infection in adults and children. In this case, microorganisms enter the body through the urogenital canal and spread to other systems and organs. In childhood, this can be observed with infection from the mother during childbirth. The development of the pathological process is promoted by an unfavorable sanitary background in living conditions, as well as the development of yersiniosis, salmonellosis, shigellosis. A genetic factor also plays a role. Clinically, this disease manifests itself in three main symptoms: arthritis, conjunctivitis and urethritis.
Stages
It proceeds in three stages:
- Urethritis - the child is worried about itching, burning, painful urination, hyperemia in the urethra.
- Conjunctivitis, which occurs symmetrically in both eyes, often goes unnoticed.
- Arthritis - develops approximately 2 months after the onset of urethritis. In this case, asymmetric damage to the middle and small joints of the lower extremities is characteristic. Arthralgia intensifies at night and in the morning, periarticular tissue is hyperemic, and effusion is formed. Further, for several days, a generalization of the pathological process is observed from the bottom up. There is inflammation of the tendons and ligaments of the heel, there is pain in the spine.
This kind of pathology, like Reiter's syndrome, can be accompanied by disturbances in the work of the heart, lungs, kidneys, lymphatic and nervous systems. Symptoms and treatment of reactive polyarthritis are interrelated.
Infectious and allergic polyarthritis
This species appears approximately 8–10 days after infectious pathologies of the respiratory tract (pharyngitis, tonsillitis, sinusitis, tonsillitis caused by streptococci and staphylococci). The main predisposing factors are weakening of the body, a hereditary predisposition (if the parents have rheumatism or asthma), an allergy to staphylococci or streptococci, hormonal imbalance.
It is clinically manifested by a mild or moderate inflammatory process in the ankle and knee joints with a pronounced effusion in the synovial cavity, which progresses every day. Other symptoms (pain, redness, fever in the affected area), as a rule, fade into the background and are of a secondary nature.
Features of each kind
Infectious-allergic polyarthritis in children covers joints of various sizes at the same time. The disease occurs in children under two years of age who are infected by the mother with a hemophilic bacillus or Staphylococcus aureus. In this case, the child is lethargic, he refuses food, breasts. He may have tearfulness, lameness. The pathological process can occur subacute or acutely. In boys from 3 to 10 years, transient arthritis in large joints often occurs, developing after tonsillitis, tonsillitis, pharyngitis.
Reuters syndrome is transmitted to children in utero through air, dishes, dirty hands, objects, and in contact with pets or birds.
Infection without provoking factors that reduce immunity may not occur. They can be colds, hypothermia, stress. Conjunctivitis occurs first and for a long time is the only symptom (experts often do not suggest the development of the syndrome). Polyarthritis occurs after a few years and is less pronounced than in adults.
Characteristic features of reactive polyarthritis are:
- in addition to the hip, knee, ankle joints, often the lesion affects the joints of the big toes;
- small joints are involved in the pathological process somewhat less often, they turn red;
- characteristic soreness can be felt with pressure, and not with movement, motor abilities remain;
- swelling is pronounced;
- in children prone to allergies, there is a bright inflammatory reaction with fever, dyspepsia, severe pain;
- in adolescents, a sacroiliac joint in the form of spondylitis may occur.
Diagnostic measures
Diagnosis of reactive polyarthritis (ICD code 10 - M13) in children is based on anamnesis (provocative factors, infections), clinical examination, physical and laboratory research methods.
Laboratory techniques include:
- general blood test to identify signs of an inflammatory process (leukocytosis, elevated ESR);
- bacteriological examination of urine, synovial fluid, smear from mucous membranes to determine the type of infectious pathogen;
- immunological analysis for the study of antibodies to certain microorganisms (after infection, it is possible that agents are not detected, but antibodies remain);
- urinalysis to identify pathologies of the genitourinary system;
- conjunctival fluid analysis.
Physical methods include the following diagnostic measures:
- radiography, CT, MRI - determination of changes in the joints, periarticular and bone tissues;
- biopsy - examination of articular tissues;
- diagnostic arthroscopy - a type of endoscopy in which structural disorders in the joints are determined;
- Echocardiography, ECG for detecting disorders of the heart and blood vessels;
- Ultrasound
Treatment
The treatment of reactive polyarthritis is usually complex. It is aimed at eliminating the consequences of infection, symptoms of polyarthritis (pain, swelling, impaired joint function), inflammation, concomitant diseases, prevention of autoimmune activity and complications.
Drug treatment for reactive polyarthritis includes:
- broad-spectrum antibacterial medicines that neutralize several categories of pathogens, as well as specific drugs whose action is aimed at a specific type of microbe;
- anti-inflammatory non-steroidal drugs that relieve pain and inflammation;
- analgesics;
- glucocorticoids - hormonal medications that eliminate inflammation;
- immunosuppressants that suppress autoimmune processes;
- chondroprotectors that restore cartilage;
- vitamins that increase the functionality of the immune system;
- with the stressful nature of the onset of the disease - sedatives.
Reviews
In the reviews of patients who suffered from this disease, as well as their parents, in the case of the development of pathology in children, they speak of very unpleasant symptoms, which last a long and very painful. However, the sooner treatment of reactive joint polyarthritis is started, the better.
Patients note that with timely medical attention at the first symptoms, the disease can be prevented at an early stage, which will eliminate the many negative consequences. Treatment, according to patients, is also a long process that requires compliance with all medical prescriptions. The list of drugs is quite wide, and many of them cause many adverse reactions.
We examined the symptoms and treatment of reactive polyarthritis. A photo of the diseased joint was presented.