Reiter's disease with damage to internal organs. Features of the manifestation of Reiter's syndrome in humans

Reiter's disease or Reiter's syndrome is infectious, inflammatory disease, which affects the genitourinary system, mucous membranes, joints and skin.

Basically, this disease is formed if the body becomes infected with chlamydia through unprotected sexual contact. However, it happens that this disease appears as a result of enterocolitis caused by Shigella or Salmonella.

Note! The reasons why in men and women enterocolitis or chlamydia is concentrated on the epidermis, mucous membranes or joints have not yet been established .

Today, doctors believe that the main factor in the manifestation of Reiter's syndrome is a genetic predisposition to autoimmune diseases.

This can be confirmed to some extent by the fact that Reiter's syndrome often develops before AIDS in HIV-infected men and women.

For some reason not working properly immune processes promotes the transformation of urogenital or intestinal infection V serious illness, during which tissues and organs undergo pathological changes.

Specifics of the formation of the disease

In the case of Reiter's disease, tissues and organs are progressively involved in the inflammatory process. In this case, the symptoms do not appear together, but in a sequential order.

The infection process begins from the genitourinary organs, then it moves to the mucous membrane of the eyes. After this, along with the blood flow, the infection enters the joints.

Note! The first stages of the development of the disease take a couple of days, but their specific feature is that they are difficult to detect.

The first manifestations of the disease can be detected only if a person consults an orthopedist with a complaint of joint pain. Only then can the doctor notice the consistent relationship between arthritis, urethritis and conjunctivitis.

And only in this case may the doctor suspect that the patient is developing Reiter's disease.

There are two stages in the formation of the disease:

1. stage (infectious) - chlamydia lives only in the genitourinary system, through which it enters the body. First stage occurs during infection, its symptoms are quite scanty - only in infected areas. The first stage lasts from two to thirty days.
2. stage (immunopathological) begins when the chlamydial infection leaves genitourinary system, spreading to the mucous membranes and joints. During this period, autoimmune processes occur that have varying degrees expressiveness. In this case, much depends on the strength of the immune system during infection and on the genetics responsible for the development of autoimmune diseases.

Also, relying on the level of activity (the degree of severity of the signs of the syndrome, the speed of spread, the level of intoxication, etc.), three stages of Reiter’s disease are distinguished.

A special treatment method is applied to each degree of the syndrome.

Symptoms

Due to the fact that in Reiter's disease tissues and organs are affected sequentially, it makes sense to list those symptoms that can be detected without interacting with other signs.

Signs of damage to the genitourinary organs:

• a minimal amount of mucus secreted from the urethra in men and from the vagina in women;
• cutting pain and itching when urinating;
• V morning hours there is a delay in urination or a feeling that the bladder has not completely emptied).

With Reiter's disease, the symptoms of infection in the genitourinary organs are mild, unlike sexually transmitted diseases, so they are often not given due attention.

In 30% of cases there is no urinary disorder, so the only obvious symptom is slight discharge. But often such minimal manifestations are not for men and women a compelling reason to see a doctor.

Symptoms of infection of the mucous membranes:

• swelling of the eyelids;
• irritation of the mucous membrane of the eye;
• redness of the proteins of the visual organ;
• clear mucus discharge from the eyes;
• Sometimes vasodilation occurs in the sclera.

Also, the patient is often plagued by symptoms such as inflammation in the cornea and iris, optic neuritis and other disorders.

Symptoms of joint infection:

1. painful sensations in the ankle, interphalangeal knee joint etc.;
2. skin redness near the joints (toes become purple);
3. severe pain in the evening and morning;
4. swelling of the affected area;
5. the joint becomes smooth and spherical.

Reiter's disease affects the joints unevenly and in stages, starting with the fingers lower limbs, as in the photo, pathological processes spread to the heel tendon, metatarsal joints, ankles, etc.

Note! Significant symptom The disease lies in asymmetric inflammation, for example, on the left leg the pathology affects the toes and heel, and on the right – Achilles tendon and plus.

It should be noted that the symptoms of Reiter's syndrome rarely affect the upper extremities, because With this disease, the hands are practically not affected. Inflammation in the hand area can only develop if the disease is advanced and left untreated. Generally, joints are affected sacral region spine and iliac joint.

Diagnostics

In the process of diagnosing the disease, it is very important to collect an anamnesis, in particular if Reiter's syndrome is in an advanced state. This way the doctor will be able to determine the symptoms, namely the sequence of their appearance, which is characteristic of this disease.

Note! Due to the fact that the primary and most significant signs of the disease are problems in the genitourinary system, you should not hide behind modesty at a doctor’s appointment, but you must definitely report such signs. After all, this significant factor, allowing the diagnosis of Reiter's disease.

After determining the symptoms, the next phase of diagnosing the disease is identifying the pathogen. For these purposes, the patient is given a blood sample and samples of the conjunctiva, urine, cervix and urethral mucosa are taken for analysis. In some cases, a semen analysis is performed to determine the extent of the infection.

At the second immunopathological stage of the disease, in which joint damage occurs, it is necessary to examine the synovial substance. The fluid is taken through a puncture. This research method makes it possible to distinguish infectious arthritis from rheumatoid.

This procedure is very important if Reiter's disease is accompanied by complications in the form of heart pathologies (myocarditis). In the process of examining the synovial substance, special antibodies can be identified that indicate chlamydial infection.

Thanks to X-rays, specific abnormal processes operating in the joints with Reiter's disease are revealed: asymmetrical reduction of joint spaces, heel spurs, erosion of the fingers, osteoporosis and other complications characteristic of this disease.

Consequences

If the disease is not treated, the following complications may occur at its advanced stage:

• arthritis becomes chronic, with the muscle tissue surrounding the damaged joints atrophying and motor functions are violated;
• the occurrence of flat feet, heel spurs and other deviations that appear due to deformation or weakening of the ligamentous system;
• damage to the kidneys, heart, lungs and dysfunction of the nervous system;
• mucosal erosion oral cavity and genitals;
• skin lumps on the feet, forehead, palms and torso;
• cracking and peeling of the skin.

Treatment

Reiter's disease is difficult process to get rid of it you need complex treatment, participation in which different doctors will take part.

Despite the level of infection and the degree of tissue damage, the patient should consult a vertebrologist, ophthalmologist, gynecologist (for women) or urologist (for men) and a rheumatologist. This is necessary so that the treatment of Reiter’s disease covers all pathologies that often cause relapse of the disease or complications.

Drug therapy

Treatment medicines divided into 2 types:

• antibacterial;
• anti-inflammatory.

Antibacterial treatment

The main goal of this therapy is to eliminate the infection, causing inflammation. The most effective treatment for Reiter's disease is the use of several groups of antibiotics.

Note! Each antibiotic is taken for 14 to 20 days.

The optimal sequential antibiotic treatment is as follows:

1. Tetracyclines (Doxycycline);
2. Fluoroquinolones (Lomefloxacin, Ofloxacin, Ciprofloxacin);
3. Macrolides (Azithromycin, Clarithromycin, Erythromycin).

Anti-inflammatory treatment

The main goal of such therapy is to suppress the inflammation that occurs in joints that are affected by mycoplasma or chlamydia. Anti-inflammatory therapy consists of non-steroidal drugs such as Meloxicam, Diclofenac, Nimesulide, etc.

The specificity of NSAID therapy for Reiter's disease is permanent shift medicines(once every two weeks) so that the body does not have time to get used to the drug.

Other types of drug treatment can be used to eliminate complications or for complex and severe symptoms. Hormonal, antiallergenic, immunomodulatory treatment - these types of therapy are also often used for Reiter's disease.

In case of severe inflammation of the joints, the doctor may prescribe punctures. During this procedure, synovial substance is removed from the joint, which is replaced by glucocorticosteroids that have a prolonging effect.

Note! In addition to therapy that eliminates inflammatory processes in the joints, it is important to treat the pathological diseases accompanying Reiter's syndrome ( respiratory diseases, cholecystitis, prostatitis) and other adverse events that complicate the course of the underlying disease, the recovery process and contribute to the occurrence of complications.

The disease, which is called Reiter's syndrome, is an autoimmune pathological process. This disease is associated with inflammation that occurs in the joints, conjunctiva of the eyes, as well as in genitourinary tract(in the urethra and prostate gland in men, in the vagina, cervix in women). Traditionally, medicine classifies Reiter's disease as a group of sexually transmitted diseases. This happens because trigger factor The development of the disease usually becomes chlamydial. Although it is noted that such a pathology can also develop after illness with other diseases: colitis caused different bacteria, ureaplasma inflammation urethra.

There are different forms of the disease according to their course pathological process:

• Acute (lasts up to six months);
• Subacute (lasts no more than a year);
• Chronic (lasts more than a year).

The disease is most often diagnosed in men childbearing age, it is slightly less common in women. It is rarely observed in children, although such cases do occur.

Why is this pathology dangerous?

Based on the knowledge of the points of application of the destructive influence of one’s own immunity in such patients, medicine has established that The joints, genitals, and eyes are the first and most affected(triad arthritis – urethritis – conjunctivitis). However, in severe cases, other parts of the body are affected: kidneys, heart, large vessels, lungs, nerve fibers.

Reiter's syndrome can be complicated by:

1. Arthrosis up to complete immobility of the joint;
2. Uveitis, inflammation of other parts of the organ of vision, blindness;
3. Erectile dysfunction, infertility;
4. Disturbances in the functioning of other organs.

Specific manifestations and complications of Reiter's syndrome. Reiter's diagnostic triad is highlighted in red.

Causes of Reiter's syndrome

The fundamental factor contributing to the occurrence and development of the disease is infection - the presence of microorganisms. However, he is not the only one important role play:

• Genetic predisposition to this disease;
• Functioning disorders immune system.

Due to the peculiarities of the development mechanism of this disease Its stages are distinguished:

1. Infectious. At this time, the patient has symptoms of the main lesion - colitis or urethritis. This period can also be characterized as a non-sterile stage: there is an infection in the body.
2. Immune pathology. The patient coped with the microorganisms, but they affected his immune system. As a result of perverted reactions, it begins to attack its own tissues, causing inflammation. The stage is sterile; there are no more microbes in the body or they remain in small quantities.

Manifestations of the disease

Like many autoimmune pathologies, Reiter's syndrome is characterized by a whole complex of signs from different systems organs. They can appear simultaneously or sequentially.

Often The first thing the patient complains about is symptoms of urethral inflammation:

• Increased urination;
• His soreness;
• Slight mucous nature;
• Swelling and redness of the external opening of the urethra.

Sick women:

• Are experiencing;
• Its frequency is also noted;
• Point to .

Clinical examination reveals swelling and hyperemia of the walls of the vagina and cervix.

It is noted that urethritis in Reiter's disease is mild and can be asymptomatic.

Manifestations of eye damage often smoothed out:

1. Feeling of “sand” in the eyes;
2. Pain when blinking, drooping eyelids;
3. Redness, conjunctiva;
4. Photophobia;
5. Minor discharge may occur.

The inflammatory process can spread to the cornea and iris.

Chlamydial arthritis is difficult to distinguish clinically from Reiter's syndrome. since their signs are similar.

Characterized by asymmetrical involvement small joints fingers and toes, knee, ankle, sacroiliac, intervertebral.

• The skin over the joint turns red;
• She is hot to the touch;
• The organ is increased in size;
• There is pain with movement and at rest, which is more pronounced at night and in the morning.

Signs of damage to the skin and mucous membranes are found in a third of patients, mainly the oral cavity and penis are affected, the following are detected:

• Reddish spots on the skin;
• Ulcerative violations of the integrity of the mucous membranes (mouth);
• Hyperkeratoses, cracks and peeling of the skin of the palms and feet;
• Peeling, thickening and splitting of nails is possible.

In patients suffering from a severe form of the disease, it is also noted disorders of the nervous system:

• Irritability;
• Anxiety;
• Sleep disorders;
• Depressive states.

What is needed to make a diagnosis?

If Reiter's syndrome is suspected, consultations with specialized specialists are required: urologist, gynecologist, dermatovenerologist, rheumatologist and ophthalmologist.

When diagnosing a disease, the doctor is guided by the following criteria:

1. History of enterocolitis or sexually transmitted infection.
2. The presence of damage to small and large joints of the legs.
3. Signs inflammatory process in the genital tract.
4. Establishing the chlamydial nature of the disease by identifying the pathogen in biological material and/or in the blood.

Additional diagnostics

The doctor prescribes to a patient with suspected such pathology:

• General clinical blood and urine tests.
• Analysis of prostate secretions.
• Cytological microscopic studies genital organs and urethra.
• Puncture of affected joints with microscopy of inflammatory fluid.
• Serological blood tests to detect anti-chlamydial antibodies.
• X-ray.
• Analysis for identifying pathogen DNA in pathological material.

How to deal with Reiter's syndrome?

Since there is an infectious beginning, treatment should include an antibacterial component.

Therapy is also needed:

1. Immunocorrective. They use immunomodulators, interferon inducers, ultraviolet irradiation blood, antihistamines.
2. Anti-inflammatory (non-steroidal anti-inflammatory drugs, cytostatics).
3. Symptomatic (antifungal medications, hepatoprotectors, multivitamins).

For chlamydia, antibacterial drugs from different pharmaceutical groups are used:

• Macrolides;
• Fluoroquinolones;
• Tetracyclines.

They are treated in long courses of 14-21 days (up to 6 weeks). Changing the antibiotic is indicated every 2-3 weeks.

Symptoms of joint inflammation can be relieved by using non-steroidal anti-inflammatory drugs and glucocorticoids, the latter also being administered intra-articularly. Non-drug remedies to combat the signs of arthritis can only be used after consultation with a doctor, prescription and implementation. basic treatment. Decoctions and infusions are used locally medicinal herbs in the form of wet compresses and baths.

The intake of infusions and herbal decoctions internally should be limited, this should be agreed upon with the attending physician. They may not be combined with basic chemotherapy drugs.

Physiotherapy is effective when prescribed after acute inflammation has subsided:

1. magnetic therapy;
2. massage;
3. laser therapy;
4. radon baths;
5. mud therapy.

If the joints are affected, the patient is prescribed physical therapy; specially designed exercises can be performed both during the period of exacerbation and during the subsidence of the process.

It is necessary to undergo antibiotic therapy not only for the patient who consults a doctor, but also for his sexual partner. Even in the absence of complaints from the latter, since chlamydial infection is characterized by a latent course.

If dysfunctions of the nervous system are expressed, it is necessary to prescribe drugs that correct them. Use:

• Sedatives;
• Tranquilizers;
• Antidepressants;

Conjunctivitis usually does not require special therapy, and its symptoms subside after starting treatment antibacterial agents. However, if it is severe, you can use the latter in the form of ointments, applying them directly to the mucous membrane of the eyes; sometimes local corticosteroid drugs are needed.

Skin manifestations of the disease are also treated with local medications: ointments with glucocorticoids, keratolytics. To alleviate inflammation on the mucous membranes, you can use rinses and baths with antiseptic solutions.

The prognosis for unadvanced cases of Reiter's syndrome is positive If the patient follows the doctor’s recommendations, the disease is treatable and there are no relapses. In advanced cases of the disease, disabling complications are possible, since it is possible to get rid of the infection in the body, but it will not be possible to eliminate the consequences (decreased visual acuity, arthrosis, impaired function of the lungs, kidneys, heart).

How to prevent the problem?

Prevention of any disease will be effective if you know the cause of the disease and destroy it or weaken its influence. The main problem medicine is that most often pathology is caused by more than one factor: they usually act in combination. In addition, we have not yet learned to influence many causes of diseases, for example, in Reiter's syndrome - genetic predisposition, the characteristics of the reactivity of the immune system of a particular person.

Yet This disease can be prevented by paying attention to the prevention of sexually transmitted infections. It is also necessary to promptly identify and adequately treat urethritis and colitis.

Video: Reiter's syndrome in the program “Live Healthy!”

Reiter's disease, or syndrome, is a combined lesion of the urinary system, organ of vision and musculoskeletal system. The disease is autoimmune in nature and occurs after a urogenital or intestinal infection. The pathological process develops more often in men young and associated with chronic course chlamydia.

Causes

Reiter's disease develops when the immune system malfunctions. As a result of failures in the immune mechanisms of response to foreign antigens - pathogens of intestinal and urogenital infections - the body produces antibodies against its own tissues. First of all, the connective tissue of the joints suffers, which is destroyed by circulating immune complexes(CEC).

Trigger disease is infectious process occurring in the urogenital or digestive tract. In the majority clinical cases pathology develops against the background of chlamydial infection caused by the intracellular bacterium Chlamydia trachomatis. Reiter's syndrome due to chlamydia is more often diagnosed in men of sexually active age - 20-40 years. Women usually become carriers of chlamydia; they rarely develop joint disease. IN last years The role of infection with ureaplasma, which, like chlamydia, has similar antigenic markers with the connective tissue of the joints, has been proven to play a role in the formation of the disease.

Basic clinical manifestations Reiter's syndrome

Reiter's syndrome can occur after a previous intestinal infection, and the incidence is equally common in men, women and children. The greatest role in the development of pathology is played by damage to the digestive tract by Shigella, Yersinia, and Salmonella. Autoimmune inflammation of the joints due to an infectious process in 80% of patients develops with hereditary predisposition, which is caused by the histocompatibility antigen – HLA-B27.

Clinical picture

The occurrence of Reiter's disease is necessarily preceded by a urogenital or intestinal infection. Sometimes damage to the urinary or digestive system is asymptomatic, and a connection with the infectious process cannot be established. However, in most clinical cases, a clear sequence of all symptoms of the disease is revealed - damage to the intestines or genitourinary organs, inflammation of the eyes, large and small joints.

Eye damage is accompanied by redness of the mucous membrane

The main cause of autoimmune damage to the musculoskeletal system is chlamydia, caused by the intracellular bacterium Chlamydia trachomatis. The disease is transmitted through sexual intercourse with a sick sexual partner. Chlamydia penetrates the cylindrical epithelium of the urethra (urethritis), prostate gland (prostatitis), and cervix (cervicitis), causing an inflammatory process. 10-14 days after infection, women experience pain in the lower sections abdomen, scanty mucopurulent discharge, pain when urinating. Due to the chronic course of chlamydia, the menstrual cycle, appear uterine bleeding, discomfort occurs during sexual intercourse.

In men, chlamydial infection is manifested by itching and burning in the penis area, redness and swelling of the urethral opening, scanty mucous discharge, and pain when urinating. As a result of chronicity venereal disease involved in the inflammatory process prostate and epididymis, which causes the development of prostatitis and epididymitis. Due to chlamydia, Reiter's disease develops in men 20 times more often than in women, who are usually carriers of the infection and serve as sources of infection for sexual partners.

Keratoderma of the feet is accompanied by peeling of the skin

Intestinal infection is manifested by symptoms from gastrointestinal tract. After eating poor quality food or water, nausea occurs, one-time or repeated vomiting, diarrhea, spasmodic pain in the abdominal area. Intoxication of the body develops, which is accompanied by fever, chills and sweating, headache, aching bones and muscles, decreased appetite and loss of body weight. An intestinal infection may be mild, manifested by increased bowel movements and mild abdominal pain.

1-2 weeks after the occurrence of a urogenital or intestinal infection, damage to the organ of vision occurs. The most common symptoms are conjunctivitis, less commonly iritis, iridocyclitis, uveitis, and keratitis. Clinical signs damage to the organ of vision includes:

• redness of the mucous membrane;
• lacrimation;
• photophobia;
• pain, feeling of “sand” in the eyes;
• decreased visual acuity.

In some cases, conjunctivitis may occur in a latent form with minor clinical manifestations and remain undiagnosed.

The main symptom of Reiter's disease is damage to the musculoskeletal system. Characterized by inflammation of one (monoarthritis) or several (oligoarthritis) joints, which is aseptic in nature.

This means that the inflammatory process develops without the participation of pathogenic microflora, but occurs as a result of the destructive effects of the CEC. Features of damage to the musculoskeletal system in Reiter's syndrome:

• involvement of the knee in the inflammatory process, ankle joints and joints of the foot, less often joints of the upper extremities;
• inflammation of the lumboiliac joints – sacroiliitis;
• unilateral arthritis - inflammation of one of the paired joints;
• constant pain aching character, aggravated by movement and at night;
• local signs inflammation - redness and swelling of the skin over the joint, increased local temperature;
• formation of inflammatory effusion in the joint cavity - synovitis;
• involvement of soft tissues surrounding the joint in the inflammatory process – rearthritis.

Inflammation of the foot joint - swelling and redness of the tissues

To make a diagnosis of Reiter's syndrome, it is necessary to identify a previous infection of the intestines or genitourinary system, against the background of which damage to the musculoskeletal system develops. In addition to eye inflammation, the disease can involve the skin and mucous membranes in the pathological process. Found in the oral cavity ulcerative stomatitis and glossitis, ulcerations appear on the head of the penis - balanitis and balanoposthitis.

Keratoderma forms on the feet and palms, which is characterized by areas of keratinization of the skin, peeling and cracks. Nails become brittle, crumble, and turn yellow. In severe cases of the disease, damage to internal organs develops: heart (myocarditis), kidneys (glomerulonephritis), lungs (pleurisy, pneumonia), nervous system (meningoencephalitis, polyneuropathy).

Diagnostics

To diagnose Reiter's syndrome clinical significance has established a chronological connection between joint damage and a previous infectious process in the genitourinary or digestive system. In favor of the disease is eye damage, asymmetric inflammation of the joints of the lower extremities, sacroiliitis, detection of chlamydia and the young age of the patients. To confirm the diagnosis and carry out treatment, prescribe additional methods examinations.

1. General analysis blood - increase in ESR, leukocytosis due to neutrophils, shift leukocyte formula to the left.
2. Biochemical analysis blood – high levels of sialic acids, seromucoid, C-reactive protein, absence of rheumatoid factor.
3. Serological analysis blood - specific antibodies to the infection that caused the disease.
4. Blood PCR– detection of genetic material of the infectious agent (chlamydia, yersinia, salmonella).
5. General urine analysis - an increase in the number of leukocytes (leukocyturia) and erythrocytes (microhematuria), the appearance of protein (proteinuria), an increase in density indicators.
6. Study synovial fluid– increase in protein content, leukocytes, increase in viscosity and turbidity, pathogenic flora not determined.
7. A smear from the urethra, vagina or cervix - detects chlamydia or ureaplasma.
8. Stool culture to detect pathogens of intestinal infections - Yersinia, Shigella, Salmonella.
9. Genetic analysis determination of the HLA-B27 gene confirms a predisposition to rheumatic pathology.
10. X-ray of the joints in direct and lateral projections, the spine in the area of ​​the lumbar-iliac joints - narrowing of the joint space, the phenomenon of osteoporosis (rarefaction bone tissue), erosive-destructive changes in cartilage.
11. CT scan(CT) or magnetic resonance imaging (MRI) - detection of pathological changes in the bones and surrounding soft tissues(muscles, ligaments, fascia).
12. Arthroscopy - examination of the joint cavity using endoscopic technology, allows you to examine the affected structures of the joint and obtain a biopsy synovial membrane.

X-ray of the joint helps to identify pathological changes in the bones

After diagnosis, a treatment regimen is prescribed that is aimed at eliminating the infection and preventing autoimmune inflammation of the connective tissue.

Treatment tactics

Treatment of Reiter's syndrome is aimed at the infectious and autoimmune link in the development of the disease. The duration of therapy is at least 3-6 months. To eliminate intestinal or urethral infections, combination antibiotic therapy is used - 2-3 drugs of different pharmacological groups in maximum daily doses for 3-6 weeks. Elimination of infection prevents the chronic course of articular syndrome and repeated exacerbations of the disease.

Groups of antibiotics for the treatment of Reiter's syndrome:

• tetracyclines (doxycycline);
• fluoroquinolones (ciprofloxacin, lomefloxacin, ofloxacin);
• macrolides (clarithromycin, erythromycin, roxithromycin).

To reduce inflammation in the joints and eliminate pain, non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed. Preference is given to selective drugs that selectively inhibit the COX-2 enzyme and do not damage the gastric mucosa. These include celecoxib, movalis, rofecoxib, nimesulide. If selective agents are ineffective, non-selective drugs are prescribed - ibuprofen, indomethacin, diclofenac with parallel administration of omez or nolpaza to protect the mucous layer of the digestive tract. With significant inflammation, intense pain syndrome and symptoms of synovitis, the disease is treated with glucocorticoids: prednisone, kenalog, diprospan.

Delagil is included in the basic therapy of autoimmune diseases

Autoimmune inflammation of the connective tissue of the musculoskeletal system and other body systems is prevented by prescribing basic medications that have an immunosuppressive (cytotoxic) effect. Basic therapy for the disease includes:

• D-penicillamine;
• delagil;
• sulfasalazine;
• methotrexate;
• azathioprine;
• gold preparations.

Treatment of conjunctivitis is prescribed by applying antibiotics to conjunctival sac, therapy skin lesions ointments based on glucocorticoids. Patients are under the supervision of a rheumatologist, infectious disease specialist, urologist, gynecologist, ophthalmologist, dermatologist, depending on the manifestations of the pathology. During the period of subsidence of the acute process, physiotherapy (electrophoresis with lidocaine, phonophoresis with hydrokartisone, magnetic therapy), massage, and physical therapy are performed.

Reiter's disease - autoimmune disease With predominant defeat musculoskeletal system. With timely diagnosis and treatment, complete recovery is achieved in 80% of cases. Chronic disease develops in 20% of cases, which is associated with the characteristics of the immune system. The syndrome rarely causes joint destruction and disability, usually has a favorable outcome and responds well to therapy.

Reiter's disease belongs to the category of diseases of a rheumatic nature. The pathology is characterized by combined damage to the urogenital tract, the membranes of the eyes and joints. Infectious and inflammatory changes can develop both simultaneously and sequentially.

The most common provoking factor is infection human body chlamydia. In addition, the pathological process can be caused by the occurrence or lack of treatment of a number of other ailments.

Clinical picture includes a large number of external manifestations. The most common are redness of the eyes and photophobia, pain and burning during bowel movements. Bladder and swelling of the diseased joint.

To make a correct diagnosis, a whole complex of diagnostic procedures, including laboratory and instrumental studies, supplemented by a thorough physical examination.

Treatment of Reiter's syndrome is carried out mainly by conservative therapeutic methods, which are based on the use of antibacterial agents and other medications.

Etiology

This disease is a response to improper functioning of the immune system, causing the body to produce antibodies aimed at fighting own cells. Against this background, first of all, we are struck connective tissues joints subject to destruction by circulating immune complexes.

The pathogenesis of the disease is an infectious process that is localized in the organs of the digestive or urogenital system. Most often, the disease develops due to the penetration of chlamydia into the human body, however pathogenic bacterium could also be:

• shigella;
• salmonella;
• ureaplasma;
• Yersinia.

In addition, Reiter's disease is often a complication of inadequate treatment or complete absence therapy for a disease such as or. Also quite often the disease is preceded by and. In addition, it is worth noting that the syndrome can also occur against the background genetic predisposition. In some situations, it is not possible to determine the cause of the disease.

However, today it is not known why the above-mentioned unfavorable factors cause progression of the infectious-inflammatory process in some people, but not in others.

It is noteworthy that in the vast majority of situations, this syndrome is diagnosed in men in the age category from 20 to 40 years. Patients are several times less likely to be female and extremely rarely - children.

Classification

Reiter's syndrome in children and adults has several stages:

• infectious- characterized by the influence of a pathogenic agent in the gastrointestinal tract or genitourinary system. This stage begins from the moment of infection and is expressed limitedly, that is, only in foci of infection. Can last from 2 days to 1 month;
• immunopathological- is expressed in an immunocomplex reaction with step-by-step damage to the eyes and joints. Intensity level autoimmune reactions is dictated by several factors, namely the state of the patient’s immune system at the time of infection and family history.

Based on etiological factor the disease happens:

• sporadic- this means that the pathological process is a response to a previous genitourinary infection;
• epidemic- infectious- inflammatory lesion organs of vision, joints and internal organs develops during the course of enterocolitis, regardless of its nature.

In addition, Reiter's disease has several variants of its course:

• spicy - characteristic symptoms lasts for no more than 6 months;
• protracted- the pathological process lasts up to a year;
• chronic- clinical manifestations have been present for more than a year.

Symptoms

The incubation period from the moment of infection of the gastrointestinal tract or genitourinary tract until the appearance of the first symptoms of this disease varies from 3 days to 2 months.

Since the disease affects several segments of the human body, it is natural that in each specific case the clinical picture will be different. The first signs are changes in the genitourinary system. Males most often have:

• mucous discharge from the urethra;
• itching and pain - occur during the process of urination;
• redness around the external opening of the urethra;
• increased urge to visit the toilet to empty the bladder;
• pain and discomfort during sexual contact;
• pain in the lower parts of the anterior abdominal wall.

In women, symptoms include:

• clear and foul-smelling vaginal discharge;
• burning and pain when passing urine;
• discomfort that appears during sex;
• frequent urination;
• unpleasant sensations, localized in the lower abdomen.

A short period of time after the onset of symptoms from the genitourinary system, patients begin to develop signs of inflammatory eye damage. In such cases, the clinical picture of Reiter's disease in men and women will include:

• increased tearfulness;
• decreased visual acuity;
• increased sensitivity to the light;
• redness of the conjunctiva;
• pain and discomfort in the eyes;
• the appearance of mucous or purulent discharge.

It is worth noting that similar manifestations only the first few days can remain unnoticed, after which they gradually increase their intensity.

Involvement of joints in Reiter's disease makes itself felt one and a half months after the onset of symptoms of damage to the genitourinary tract. Often, with this syndrome, the pathology involves from 1 to 3 joints, only in in rare cases the disease covers many segments. In most situations, the lower extremities succumb to inflammation, and the following symptoms are expressed:

• pain syndrome;
• asymmetrical joint damage;
• the skin located above the joint acquires a red or bluish tint;
• swelling of the skin in the area of ​​localization of inflammation;
• stiffness of movement in the morning or after sleep;
• formation of transverse-longitudinal flatfoot.

In addition to typical manifestations of Reiter's syndrome, the symptomatic picture may also include:

• swelling of the tendon in the heel area;
• the appearance on the skin of red spots or purple nodules that rise above the skin;
• skin rashes;
• thickening and peeling of the skin of the feet and palms;
• the formation of painful ulcers on the mucous membranes of the mouth or genitals;
• inflammatory damage to the lungs, kidneys and heart muscle.

All of the above symptoms are typical for both adults and children.

Diagnostics

Establishment process correct diagnosis is based on laboratory and instrumental studies, but not the last place in diagnosis is occupied by activities carried out directly by a rheumatologist. Thus, primary diagnosis includes:

• studying the medical history - this is necessary to confirm the fact of a previous genitourinary or intestinal infection;
• collection and analysis of life history;
• a thorough physical examination aimed at assessing the condition of the eyes, skin and reproductive organs. This should also include establishing the range of motion, the presence of pain and swelling of the joints;
• a detailed survey of the patient - to compile a complete symptomatic picture of the course of Reiter's disease in children and adults.

Laboratory research is limited to:

• general clinical blood test - in this case, pay attention to ESR;
• blood biochemistry;
• urine samples according to Nechiporenko;
• PCR tests;
• serological tests, in particular ELISA, RNGA and RSK;
• microscopic examination of a scraping taken from the mucous membrane of the organs of vision, cervix or urethra;
• bacterial culture of the joint fluid of the affected joint.

Instrumental diagnosis of Reiter's disease only involves performing radiography of the joints, as well as CT and MRI.

Treatment

Therapy for such a syndrome is always complex and lasts from about 3 months to a year. The main goals of treatment for Reiter's disease are:

• elimination of the infectious agent;
• relief of signs of inflammation;
• suppression of the autoimmune process.

Medicinal treatment tactics involve the use of:

• antibacterial agents for a period of 3-8 weeks;
• hepatoprotectors;
• NSAIDs;
• glucocorticosteroids;
• immunosuppressants - to suppress immune reaction. Such medications are used from 4 months to a year, and in severe cases, lifelong use is indicated;
• immunomodulators;
• interferon drugs;
• adaptogens;
• multivitamins.

The following physiotherapeutic procedures are also involved in the treatment of Reiter's disease:

• impulse therapy;
• drug electrophoresis;
• magnetic therapy;
• mud therapy;
• laser therapy;
• diathermy;
• hydrogen sulfide and radon baths.

In addition, patients with Reiter's disease are also shown:

Possible complications

Despite the fact that such a disease often ends full recovery, in some situations the following complications may develop:

• mobility impairment spinal column;
• complete loss of vision;
• atrophy of the muscles located near the affected joint;
• formation;

Prevention and prognosis

Given the fact that almost all cases develop Reiter's syndrome due to chlamydia and other infections, the main preventive measures are aimed at avoiding infection. Thus, pathology requires compliance with the following preventive measures.

Reiter's syndrome is a disease characterized by a combination of lesions of the joints, genitourinary organs, skin and mucous membranes, as well as the eyes. These manifestations of the disease can develop simultaneously or sequentially.

Joint damage is most often expressed in the form of arthritis (in the absence of rheumatoid factors). Men with Reiter's syndrome experience urethritis, women with this disease suffer from cervicitis. In addition, Reiter's syndrome is characterized by skin and eye lesions such as dermatitis, conjunctivitis and erosions of the oral mucosa.

80% of people with Reiter's syndrome are young men (20-40 years old). The disease is much less common in women and Reiter's syndrome is extremely rare in children.

Causes of the disease

The cause of Reiter's syndrome is the penetration of an infectious agent into the body; the most common pathogen is chlamydia (Chlamydia trachomatic), which belongs to the class of gram-negative bacteria.

The main causative agent of the disease is the bacterium Chlamydia trachomatic.

This infection widespread, the route of infection is most often sexual, however, you can also become infected through household contact with a carrier of the infection. Chlamydial infections have a chronic, relapsing course.

Clinical picture of the disease

It is customary to distinguish two stages of the pathological process in Reiter's syndrome:

1. Early infectious;
2. Late, which is characterized by impaired immune status.

The main symptoms of Reiter's syndrome:

• Urethritis, prostatitis. In women - cervicitis, adnexitis, salpingitis.
• The joints are affected, most often the large ones.
• Conjunctivitis.
• Skin rashes of a polymorphic nature. On skin Reiter's syndrome most often manifests itself as psoriasiform lesions, keratoses located on the palms and soles, and chronic balanoposthitis. Somewhat less frequently, patients with Reiter's syndrome experience hemorrhagic erosions and ulcerative lesions of the oral mucosa.
• With Reiter's syndrome, symptoms characteristic of damage to internal organs are often observed - myocarditis, nephritis, disruption of the gastrointestinal tract.

The course of Reiter's syndrome is usually chronic. Remissions can be long, lasting months and years.

At the onset of the disease, the main symptoms as a whole do not appear in all cases. About half of people with Reiter's syndrome first experience urethritis, and other signs of the disease appear after 1-3 months.

Damage to the genitourinary organs

Thus, initial symptom Reiter's syndrome is urethritis. It is manifested by nonbacterial pyuria, dysuria, and hematuria. Urethritis is often complicated by cystitis, vesiculitis, and prostatitis.

Urethritis with Reiter's syndrome does not manifest itself as clearly as with gonorrhea. Quite often the symptoms are vague and do not cause subjective disorders.

Eye lesions

Eye damage occurs in about a third of patients with Reiter's syndrome. The disease manifests itself as redness of the eyes and the appearance of photophobia. Sometimes there is inflammation of the iris (iridocyclitis) or cornea (keratitis).

Joint damage

Reiter's syndrome is also characterized by damage to large joints. The disease most often manifests itself as inflammation of the synovial membrane of the joint with the formation of moderate effusion. There is slight swelling of the soft tissues and limited joint mobility.

Less common are arthralgia (the appearance of joint pain in the absence of objective symptoms of joint damage) or, on the contrary, severe arthritis that causes tissue deformation.

Reiter's syndrome is characterized by inflammation of the cross-iliac joint (sacroiliitis) and damage to the intervertebral joints. Sometimes inflammatory processes in the joints are accompanied by fever and fever.

Skin reactions

For Reiter's syndrome skin manifestations observed in half of the sick. The nature of the rash can be varied, however, the most typical reactions are:

• Circinar balanitis, manifested by the appearance of superficial erosions on the glans penis.
• Erosion of the oral cavity, including those located on the tongue.
• Keratosis on the palms and soles. Keratoderma is manifested by the appearance of red spots located on the soles and palms. The spots transform first into pustules and then into thick, crusty plaques or horny papules. Widespread keratoderma, as well as psoriasiform rashes, are characteristic of severe Reiter's syndrome.
• Sometimes patients with Reiter's syndrome experience subungual hyperkeratosis, thickening of the nails, and increased fragility.

Damage to internal organs

With Reiter's syndrome, the cardiovascular system is most often affected from internal organs. Patients with Reithar syndrome often experience peri- and myocarditis, aortic insufficiency.

Less common are pleurisy, pyelonephritis or glomerulonephritis, phlebitis, neuralgia, neuritis, and various disorders in the functioning of the gastrointestinal tract. In severe forms of Reiter's syndrome, patients often complain of functional disorders of the nervous system, manifested by depression, irritability, insomnia, etc.

Establishing diagnosis

Diagnosis of Reiter's syndrome is made by following criteria:

1. The presence of chronological connections between infection with intestinal or genitourinary infection and the appearance of arthritis symptoms.
2. The presence of acute asymmetric arthritis affecting the joints of the lower extremities (most often, the joints of the toes become inflamed).
3. The presence of inflammatory phenomena in the genitourinary organs.
4. Detection of chlamydia in scrapings of the epithelium from the urethra or cervical canal (in women).
5. Even in the absence of chlamydia in the scraping, Reiter's syndrome can be diagnosed if there is inflammation in the urogenital area, and antibodies to chlamydia are detected in the blood serum in a titer of 1 to 32 or more.

Diagnosis of Reiter's syndrome is made based on the following laboratory research:

• General blood analysis. In patients with Reiter's syndrome, there is an increase in ESR, moderate leukocytosis, and moderate manifestations of hypochromic anemia.
• Urine tests. In the Nepochiporenko and Addis-Kakovsky tests, leukocyturia is detected. When conducting a three-glass test, leukocytes are found mainly in the first portion.
• To identify Reiter's syndrome, a study of prostate secretions may be prescribed. A warning sign is a decrease in the number of lecithin grains and the detection of more than a dozen leukocytes in the field of view.
• When conducting biochemical research In the blood with Reiter's syndrome, there is an increase in the content of alpha and beta globulins, fibrin, and sialic acids.
• The determining factor in making a diagnosis is the detection of chlamydia. To detect infection, scrapings from the mucous membranes of the urethra (cervical canal in women) are examined, and sperm and prostate juice are analyzed.
• In case of severe joint damage, a synovial fluid analysis is prescribed.

In addition, to identify Reiter's syndrome, X-ray examinations joints. Patients are found to have asymmetrical periarticular osteoporosis and narrowing of the joint spaces.

Treatment methods

Treatment for Reiter's syndrome should be comprehensive. You cannot limit yourself only to therapeutic measures for joint damage (as a rule, it is this symptom that worries patients most). Treatment for Reiter's syndrome should be simultaneously prescribed to the patient's sexual partner.

Treatment has two directions:

1. Conducting antibacterial therapy to get rid of chlamydial infection.
2. Anti-inflammatory therapy carried out to relieve joint damage.

When treating Reiter's syndrome it is necessary long-term treatment antibiotics (4-6 weeks), while maximum doses drugs. It is optimal to use antibiotics of different pharmacological groups (2-3 types) alternately, the course of treatment with each drug is 15-20 days.

The following groups of antibiotics are used to treat Reiter's syndrome:

• Tetracyclines (mainly doxycycline for intravenous administration).
• Fluoroquinolones (Ciprofloxacin, Ofloxacin, Lomefloxacin). Antibiotics of this group are prescribed in short courses (no more than 2 weeks).
• Macrolides (Erythromycin, Azithromycin, Roxithromycin).

Besides antibacterial drugs Immunomodulatory therapy and the use of proteolytic enzymes may be prescribed to facilitate the penetration of antibiotics to the area of ​​inflammation. To protect the body, antifungal agents, multivitamins and hepoprotectors are prescribed simultaneously with antibiotics.

To stop the inflammatory process in the joints, non-steroidal anti-inflammatory drugs, cytostatics, and glucocosteroids are prescribed. After stopping the acute process, physiotherapy procedures are prescribed that affect the area of ​​​​the affected joints - phonophoresis, UHF, infrared irradiation, etc.

When treating Reiter's syndrome, it is necessary to sanitize foci of inflammation in the genitourinary area.

For nervous disorders, sedatives and mild tranquilizers (Persen, tincture of valerian, motherwort) can be prescribed.

On early stages Rader's syndrome, the use of drugs is indicated physical therapy. The load should be gradually increased as the inflammatory process subsides.

In the remission stage of Reiter's syndrome, it is indicated Spa treatment(mud, radon, hydrogen sulfide baths).

In case of severe conjunctivitis, consultation with an ophthalmologist is necessary. As a rule, applications of antibacterial agents are prescribed - the use of erythromycin or tetracycline ointment.

For treatment skin rashes external treatment is used - keratolytic ointments, GCS agents in the form of creams. If the mucous membranes of the mouth are affected, rinses with antiseptic solutions are prescribed; for balanitis, baths are prescribed.

Treatment with traditional methods

Before you begin treatment for Reiter's syndrome traditional methods, you should consult your doctor. Folk remedies should be used as additional treatment without replacing traditional therapy.

1. To relieve the inflammatory process in the joints, it is recommended to warm up in a decoction of straw. 200 grams of straw should be boiled in five liters of water. After the broth has cooled to a tolerable temperature, the affected limbs should be immersed in it.
2. Inflamed joints can be treated with compresses of crushed black radish mixed with honey.
3. For oral administration, you can use an infusion of dandelion leaves or primrose herb. To prepare the infusion, you need to pour a teaspoon of the raw material into a glass of boiling water and leave until it cools. The infusion should be taken 50 grams four times a day.

Prognosis and prevention

In most cases, Reiter's syndrome has a favorable prognosis. Most patients recover or achieve long-term remission. However, in severe cases, Reiter's syndrome can cause severe joint damage that can be disabling.

Prevention of Reiter's syndrome involves preventing infection with chlamydia. Since this infection is most often transmitted sexually, sexual contact with untested partners without the use of a condom should be avoided.

Secondary prevention relapse of Reiter's syndrome lies in strict and consistent adherence to doctor's prescriptions.