Syndrome (disease) of Reuters
Syndrome (disease) of Reuters – the rheumatic disease which is characterized by the combined defeat of an urogenital path (uretrity and prostatitis), joints (mono - or polyarthritis) and mucous an eye (conjunctivitis), developing consistently or at the same time. The autoimmune process caused by an intestinal or urinogenital infection is the cornerstone of a syndrome of Reuters. Diagnostic criteria are communication with the postponed infection, laboratory identification of the activator and characteristic changes of blood, clinical simptomokompleks. Treatment includes antibiotic treatment of an infection and anti-inflammatory therapy of arthritis. The syndrome of Reuters tends to a recurrence and synchronization of process.
Syndrome (disease) of Reuters
In 80% of cases the disease of Reuters attacks young men from 20 to 40 years, is more rare - women and is exclusively rare – children. As the leading etiologichesky agent of a syndrome of Reuters serves the hlamidiya – the microorganism capable to long parasitizing in cells of the owner in the form of cytoplasmatic inclusions. Besides, the syndrome of Reuters can develop after the postponed colitis caused by a shigella, an iyersiniya, a salmonella and also to be provoked by an ureaplazmenny infection. It is supposed that the listed activators thanks to the anti-gene structure cause certain immunological reactions in genetically inclined persons.
During a syndrome of Reuters allocate two stages: the infectious, characterized by finding of the activator in an urinogenital or intestinal path, and immunopathological, followed by immunocomplex reaction with defeat conjunctivas and a sinovialny membrane of joints.
Classification of a syndrome (disease) of Reuters
Taking into account an etiofaktor disease forms differ sporadic and epidemic (postenterokolitichesky). The sporadic form, or a disease of Reuters, develops after the postponed urinogenital infection; epidemic – a syndrome of Reuters – after enterokolit of various etiologichesky nature (dysenteric, iyersiniozny, salmonellezny, undifferentiated).
The course of disease or a syndrome of Reuters can be sharp (up to 6 months), long (about one year) or chronic (1 years are longer).
Clinic of a syndrome (disease) of Reuters
For a disease (syndrome) of Reuters are specific defeat of an urogenital path, an eye, articulate fabrics, mucous and skin. At a disease of Reuters the first demonstrates uretrit, followed by dizurichesky frustration, poor mucous separated, feelings of discomfort and hyperaemia in an external urethra. At asymptomatic clinic existence of an inflammation is defined on the basis of increase in number of leukocytes in dab. After uretrity at a syndrome of Reuters the eye symptomatology more often having the conjunctivitis form develops, is more rare - Irit, a uveit, an iridotsiklit, a retinit, a keratit, retrobulbarny neuritis. The phenomena of conjunctivitis can be a little long and poorly expressed, imperceptible for the patient.
The defining sign of a syndrome of Reuters is jet arthritis which debuts 1-1,5 months later after an urogenital infection. For a syndrome of Reuters typically asymmetric involvement of joints of legs – interphalanx, plusnefalangovy, talocrural, knee. Are more expressed to Artralgiya in the morning and at night, skin in joints is hyperemic, in a cavity of joints the exudate is formed.
The syndrome of Reuters differs consecutive ladder (from proximal to disteel) in involvement of joints within several days. At urogenny arthritis hypostases, sosiskoobrazny defiguration of fingers develop; skin over them gets coloring of cyanotic-crimson color. At a disease of Reuters can develop tendinit, calcaneal bursit, sacral joints - sakroileit calcaneal spurs, defeat.
Mucous membranes and integuments at a syndrome of Reuters are surprised at 30-50% of patients. Ulcer changes mucous a mouth (glossit, stomatitis) and a penis are characteristic (balanit, balanopostit). On skin red papules, eritematozny spots, the keratodermiya centers – sites of hyperaemia of skin with giperkeratozy, a peeling and cracks mainly on palms and feet appear. At a syndrome of Reuters development of a limfadenopatiya, myocarditis, a miokardiodistrofiya, focal pneumonia, pleurisy, polyneuritis, nephrite and an amiloidoz of kidneys is possible.
At the complicated form of a syndrome of Reuters dysfunctions of joints, disorders of sight, erectile violations, infertility develop. In a late phase of a disease of Reuters kidneys, an aorta, heart can be surprised.
Diagnostics of a syndrome (disease) of Reuters
During diagnostics the patient with suspicion on a syndrome of Reuters can be directed to consultation of the rheumatologist, venereologist, urologist, ophthalmologist, gynecologist. All-clinical analyses at a syndrome of Reuters reveal gipokhromny anemia, growth of SOE and blood. In urine tests (trekhstakanny, by Addis-Kakovsky and Nechiporenko) the leykotsituriya is determined. The microscopy of a pro-static secret shows increase in leukocytes (> 10) under review and decrease in number of letsitinovy little bodies. Changes of biochemistry of blood at a syndrome of Reuters are characterized by increase α2-and β-globulins, fibrin, sialovy acids, a seromukoid; existence of the S-jet protein, negative test to the Russian Federation.
Cytologic researches of scrapes of an urethra, neck of a uterus, conjunctiva, sinovialny exudate, sperm, prostate secret with coloring according to Romanovsky-Gimz finds hlamidiya in the form of intracellular cytoplasmatic inclusions. In diagnostics of a syndrome of Reuters the activator DNA detection method in biomaterial (PTsR) is widely used. In blood chlamydial, etc. antibodies come to light by means of serological reactions – IFA, RSK, RNGA. A specific sign of a syndrome of Reuters is HLA 27 anti-gene carriage.
In the analysis of the sinovialny liquid taken by a joint puncture inflammatory changes – friability of a mutsinovy clot, (10-50×109/), over 70%, existence of tsitofagotsitiruyushchy macrophages, chlamydial antibodies and anti-genes, hyperactivity of a complement are defined, the Russian Federation does not come to light. At a radiographic research of joints symptoms of asymmetrical paraarticulary osteoporosis, reduction of the sizes of articulate cracks, erosive destruction of bones of feet, existence of calcaneal spurs and spurs of pyastny bones, bodies of vertebras come to light, at a third of patients - unilateral sakroileit.
At diagnostics of a syndrome of Reuters anamnestichesky data (communication of a disease with urogenital or intestinal infection) are taken into account; existence of symptoms of conjunctivitis, jet arthritis, skin manifestations; laboratory confirmation of the activator in epitelialny scrapes.
Treatment of a syndrome (disease) of Reuters
Tactics of treatment of a syndrome of Reuters provides performing antibiotic treatment (for both sexual partners), immunocorrections, an anti-inflammatory course and symptomatic therapy. Antibiotic treatment includes 2-3 consecutive courses (for 2-3 weeks) medicines from various pharmacological groups: tetratsiklinam (doxycycline), ftorkhinolonam (, , ciprofloxacin) and macroleads (, , erythromycin, etc.). At a chlamydial infection preference is given to doxycycline. Along with antibiotic treatment it is appointed antifungal medicines, polyvitamins, gepatoprotektor, proteolytic enzymes (Pancreatinum, trypsin, chymotrypsin).
Immunokorregiruyushchy therapy at a syndrome of Reuters includes use of immunomodulators (medicines of a timus), adaptogens, interferon inductors (sodium oxodihydroacridinylacetate, akridonuksusny acid in combinations with N-metilglyukaminom), and also UFOK, nadvenny and intravenous quantum therapy. At the heavy artralgichesky attacks and high activity of an inflammation dezintoksikatsionny and antihistaminic therapy is carried out. For desintoxication at a disease of Reuters extracorporal haemo correction – carrying out a plasma exchange, cascade filtration of plasma and a krioaferez is shown.
For suppression of an intra articulate inflammation at a syndrome of Reuters NPVS (, , , to meloksika), glucocorticosteroids (beta metazones, Prednisolonum), basic medicines are used (, a methotrexate). In the presence of intra articulate exudate the medical puncture of a joint with introduction of the prolonged glucocorticoids is carried out (a beta metazone, methylprednisolonum). Compresses with dimethyl sulfoxide solution, anesthetics and anti-inflammatory ointments are locally imposed.
Subsiding of the phenomena of sharp arthritis at a syndrome of Reuters allows to connect physiotherapeutic sessions of a fonoforez with proteolytic enzymes, glucocorticoids, hondroprotektor; UVCh, diathermy, magnetotherapy, laser therapy, massage, mud cure, hydrosulphuric and radonic bathtubs. In a complex with therapy actually of a syndrome of Reuters treatment of other ekstragenitalny centers of an inflammation is carried out.
Forecast and prevention of a syndrome (disease) of Reuters
Dynamics of a current of a syndrome of Reuters mainly favorable. At the most part of patients in half a year the disease turns into permanent remission that, however, does not exclude an exacerbation of a disease of Reuters many years later. At a quarter of patients arthritis passes into a chronic phase, leading to dysfunction of joints, an atrophy of muscles, development of flat-footedness. As an outcome of a syndrome of Reuters can serve and other vistseropatiya.
Prevention of a syndrome (disease) of Reuters includes the prevention of intestinal and urogenital infections, performing timely etiotropny therapy of uretrit and enterokolit.