Chlamydial arthritis is a rheumatic pathology characterized by a combined lesion of the urogenital tract, joints, and mucous membranes of the eyes. Simultaneous damage to these structures is rarely diagnosed. The disease is clinically manifested gradually, provoking dysuric disorders, conjunctivitis, arthralgia, joint stiffness. Chlamydial arthritis occurs as a result of an autoimmune process that develops against a background of urogenital infection.
To detect pathology, laboratory methods are used – PCR, synovial fluid research, serological reactions. To establish the damage that has occurred in the synovial membrane, articular capsule, ligament-tendon apparatus, radiography, MRI, and CT help. In therapy, drugs of various clinical and pharmacological groups are used – antibiotics, NSAIDs, immunomodulators, glucocorticosteroids. With timely access to medical help, the prognosis for a full recovery is favorable.
The leading etiological agent of chlamydial arthritis is chlamydia. These pathogens of urogenital chlamydia – Chlamidia trachomatis – are small bacteria that parasitize human cells. After penetration into the body, they are in it for a long time, without any manifestation. But with a sharp decrease in immunity, pathogenic microorganisms begin to multiply actively, releasing toxic products of their vital activity into the surrounding space. Chlamydia is most often sexually transmitted, and arthritis of the same name is diagnosed in 80% of men and 15-20% of women. Pathology is detected in children extremely rarely.
The role of infectious agents in the etiopathogenesis of reactive aseptic arthritis is the molecular similarity of their antigens with human autoantigens. Having penetrated the joints, microorganisms begin to multiply intensively, but this is not the reason for the development of the inflammatory process. After they are detected by the immune system, specific proteins are produced – antibodies necessary for the destruction of pathogenic bacteria. But the similarity of the protein structures of microorganisms with the tissues of cartilage, synovial membranes, ligaments, tendons leads to an attack by antibodies of the body’s own cells. This becomes the impetus for the development of chlamydial arthritis, which has an autoimmune etiology. Thus, the inflammatory process in the joints is not caused by the infectious agents themselves, but by the reaction of the immune system to their invasion.
Chlamydial arthritis does not develop in every infected person. The penetration and persistence of microbes is facilitated by the anatomical and histological uniqueness of articular tissues. Migration of antigen-presenting cells from the systemic circulation is facilitated:
- fenestrated (with thin endothelium and pores in endotheliocytes) synovial capillaries;
- the presence of cell adhesion molecules.
Chondrocytes and synoviocytes fixate antigens, which leads to various immunological reactions – cell growth factors, cytokines, inflammatory mediators are produced, and the concentration of toxic oxygen radicals and nitric oxide increases. Chlamydial arthritis is diagnosed in patients hereditarily predisposed to it, having a special structure of articular tissues.
Chlamydial infection is asymptomatic for a long time. In the future, it can be clinically manifested in women by cervicitis, salpingitis, adnexitis, cystitis, proctitis, sluggish endometritis, adhesions in the pelvic organs. Pharyngitis, conjunctivitis, uveitis are also found. Women often have pulling dull pains in the lower abdomen, especially during sexual intercourse. The symptomatology of chlamydia in men is different. They often suffer from conjunctivitis, uveitis, urethritis, balanitis or balanoposthitis, prostatitis, proctitis and epididymitis during sexual activity.
Chlamydial arthritis is often accompanied by intraarticular symptoms. These are specific signs of myocarditis, pericarditis, rhythm disturbances, conduction, relative aortic valve insufficiency, bronchiolitis. Pathogenic microorganisms provoke the development of pyelonephritis, erythema nodosum, renal amyloidosis. Typical symptoms of articular pathology:
- pain in one or more joints, aggravated during movement or when lifting weights;
- painful sensations of various variability at rest with the progression of pathology;
- swelling, redness of the skin in the affected joints;
- the skin is constantly hot to the touch due to the involvement of soft tissues in the inflammatory process;
- pain on palpation;
- the development of protective contractures – the restriction of passive movements in the joint, its inferior flexion or extension;
- spasms of skeletal muscle in the affected area;
- accumulation of pathological exudate in the joint;
- morning swelling and stiffness of movements.
Symptoms of chlamydial arthritis are mild at the stage of remission. During relapses, their intensity increases significantly. Often there are signs of general intoxication of the body – the body temperature rises, sweating intensifies, chills and cold sweat appear. A person suffers from gastrointestinal upsets – excessive gas formation, nausea, and lack of appetite. Headaches, dizziness, weakness, fatigue, sleep disorders can occur.
Chlamydial arthritis is characterized by asymmetric joint damage. First, one joint is damaged, most often an ankle or knee. If the patient does not seek medical help, then soon he will be diagnosed with polyarthritis – multiple joint damage to the joints. Often the skin of the palms and soles of the keratoderma type is affected. Actualization of the dermis occurs with the formation of dense plaques. With chlamydial arthritis, the structure and color of the nail plates also change, the lymph nodes increase, especially of the inguinal localization.
A rheumatologist, venereologist, urologist, ophthalmologist, gynecologist are often connected to the diagnosis of articular pathology. Suspicion of the development of chlamydial arthritis occurs when the patient is examined for characteristic external signs – redness of the eyes, swelling of the affected joints and lymph nodes. Expanded general clinical studies of blood and urine are prescribed. After a three-glass test, Addis-Kakovsky, Nechiporenko tests, pus is detected in the urine, which indicates the presence of pathogenic microorganisms (leukocyturia). When examining the prostatic secretion, an increased concentration of leukocytes is detected against a background of a decrease in the number of lecithin bodies. In the blood of a patient with chlamydia, the number of alpha and beta globulins, fibrin, seroglycoids, and C-reactive protein is always increased. Moreover, the analysis for the presence of rheumatoid factor is negative. Be sure to conduct cytological studies of the following biological samples:
- scrapings of the urethra, cervix;
- part of the lacrimal secretion of the conjunctiva;
- synovial exudate;
- the secret of the prostate.
Chlamydial intracellular cytoplasmic inclusions are found in the samples. By the method of polymerase chain reaction, the DNA of an infectious agent in biological material is detected. To establish the presence of microorganisms in the blood can be one of the serological reactions.
After taking synovial fluid using puncture from joints affected by pathology, changes in its qualitative and quantitative composition are detected. The mucinous residue is friable, the concentration of leukocytes and the proportion of neutrophilic granulocytes are increased. Cytophagocytic macrophages, chlamydial antigens and antibodies are detected in the blood, increased compliment activity.
Paraarticular asymmetric osteoporosis, narrowing of the joint spaces, erosive destruction of bones are determined by x-ray photographs. Most often, feet and vertebral bodies undergo degenerative changes. A third of patients are diagnosed with inflammation of the sacroiliac joints.
The main methods of treatment
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To exclude re-infection, simultaneous therapy of the sexual partner is performed. The main goals of treating chlamydial arthritis are:
- the destruction of pathogens – chlamydia, activated bacteria and (or) fungi of conditionally pathogenic biocenosis;
- reduction, and then complete elimination of the severity of articular and extra-articular clinical manifestations;
- therapy of negative consequences.
To eliminate infectious agents, patients are prescribed antibiotic therapy with doxycycline. Treatment regimens include antibacterial agents from other groups. These are fluoroquinolones (Lomefloxacin, Ofloxacin, Ciprofloxacin), macrolides (Erythromycin, Clarithromycin, Azithromycin), semi-synthetic penicillins with clavulanic acid (Panclav, Augmentin, Amoxiclav).
After antibiotic therapy, eubiotics – Hilak Forte, Bifidumbacterin, Lactobacterin, Linex, Acipol – are used to stimulate the growth of beneficial lactobacilli and bifidobacteria. Since chlamydia affects the internal organs together with the joints, patients are recommended to take hepatoprotectors (Essential Forte, Karsil, Essliver Forte), proteolytic enzymes (Pancreatin, Trypsin, Chymotrypsin).
The activity of pathogenic fungi often increases against the background of a changed composition of the intestinal, vaginal microflora. To correct this condition, antimycotic drugs are used, usually fluconazole, nystatin, clotrimazole.
To normalize the immune response to the introduction of infectious agents, immunocorrective therapy is performed. Used drugs with interferon or those that stimulate its production. Adaptogens (ginseng, eleutherococcus) are prescribed for patients, which increase the body’s resistance to external and internal negative factors. For the same purpose, a course intake of balanced complexes of vitamins and minerals (Centrum, Vitrum, Selmevit, Complivit, Multitabs) is recommended.
Severe attacks of chlamydial arthritis are stopped by detoxification, antihistamine therapy. In especially difficult cases, extracorporeal hemocorrection is used (plasmapheresis, cascade filtration of plasma, cryoapheresis). To eliminate the articular symptoms of chlamydial arthritis, drugs of various clinical and pharmacological groups are used:
muscle relaxants – Baklosan, Sirdalud, M >
basic means – sulfosalazine, methotrexate to eliminate rheumato >
- ointments with analgesic and anti-inflammatory effects (Finalgel, Nise, Fastum, Voltaren, Nurofen);
- chondroprotectors – Teraflex, Structum, Arthra for the regeneration of cartilage, ligaments, tendons.
Therapy is supplemented by physiotherapeutic procedures – this is phonophoresis with one of the proteolytic enzymes, electrophoresis with analgesics, magnetotherapy, laser therapy, UHF therapy. At the rehabilitation stage, patients are shown massage, daily exercise therapy or gymnastics.
Chlamydial arthritis responds well to therapy, especially with timely access to medical care. Subject to all medical recommendations, he is completely cured within a few weeks.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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