Disease of Reuters
Contents:
Description:
Disease of Reuters - the combined defeat of urinogenital bodies (usually in the form of a nonspecific uretroprostatit), joints (reactive oligo-or monoarthritis) and an eye (conjunctivitis), developing at the same time or consistently.
Symptoms of the Disease of Reuters:
1. Preferential young men at the age of 20-40 years (80% of cases) get sick, is more rare - women, is extremely rare - children. The beginning of a disease is most often shown by defeat of urinogenital bodies (an urethritis, cystitis, prostatitis) in several days (sometimes month) after sexual infection or the postponed coloenteritis. The urethritis is shown by not acceptable feelings at an urination, burning, an itch, a hyperemia around an outside opening of an urethra, scanty allocations from an urethra and a vagina. Allocations usually have mucous character. It should be noted that the urethritis does not happen extremely expressed as, for example, at gonorrhea and it can be shown only by small mucopurulent allocations from an urethra or only a dysuria in the mornings. Perhaps even lack of the dysuric phenomena. At 30% of men urogenital clamidiosis proceeds asymptomatically. Such patients often have only an initial leukocyturia or increase in quantity of leukocytes in the smear painted across Gram taken from the tampon entered on depth of 1-2 cm into a front part of an urethra.
2. Damage of eyes occurs soon after an urethritis, is more often shown by conjunctivitis, is more rare an iritis, an iridocyclitis, a uveitis, a retinitis, retrobulbar neuritis, a keratitis. It should be noted that conjunctivitis can be slight, proceed 1-2 days and remain unnoticed.
3. The leading symptom of a disease is damage of joints which develops in 1-1.5 months after an acute urinogenital infection or its aggravation. Asymmetric arthritis with involvement of joints of the lower extremities - knee, talocrural, metatarsophalangeal, interphalanx is most characteristic. Joint pains amplify at night and in the morning, skin over them is hyperemic, the exudate appears. Consecutive involvement of joints in several days is characteristic "ladder" (from below up). For urigenous arthritis (a disease of Reuters) of a patognomonichna periartikulyarny hypostasis of all finger and a sosiskoobrazny defiguration of fingers with cyanotic-crimson coloring of skin, and also pseudo-gouty symptomatology when involving joints of a thumb of foot.
The Achilles tendon inflammation, bursitis in heels are rather often observed that is shown by severe calcaneal pains. Perhaps bystry development of calcaneal spurs.
Some patients can have backbone pains and develop sarkoileit.
More than at 50% of patients total disappearance of joint symptomatology, at 30% - an arthritis recurrence is noted, arthritis gets a chronic current with restriction of function of joints and an atrophy of adjacent muscles from 20%. At some patients flat-footedness as the result of damage of joints of a tarsus develops. Joints of upper extremities are surprised seldom.
At 30-50% of patients mucous membranes and skin are surprised. On a mucous membrane of an oral cavity and in the field of a balanus there are erethistic ulcers, the balanitis or a balanoposthitis develops. Stomatitis, a glossitis are characteristic. Damage of skin is characterized by emergence of small red papules, sometimes erythematic spots. The keratodermia is extremely characteristic - drain ochach of a hyperkeratosis against the background of a dermahemia with cracks and a peeling it is preferential in the field of feet and palms. The centers of a hyperkeratosis can be observed on skin of a forehead, a trunk.
Are possible painless increase in lymph nodes, especially inguinal; at 10-30% of patients signs of damage of heart (a myocardial dystrophy, myocarditis), damage of lungs (focal pneumonia, pleurisy), a nervous system (polyneurites), kidneys (nephrite, an amyloidosis of kidneys), long subfebrile body temperature.
Etiologies of Reuters:
The most frequent infestant is the gram-negative bacterium of Chlamydia trachomatis. Chlamydias - the obligate intracellular parasites having the sizes of 250-300 nanometers. Under unfavorable conditions (influence of antibiotics, himiopreparat and so forth) chlamydias can be transformed to L-forms which have the smallest ability to anti-gene irritation of immunocompetent cells and are capable to long intracellular parasitizing. All this promotes the chronic course of an infection. It is the most widespread infection, sexually transmitted and being in 60% of cases the reason of not gonococcal uretrit at men. Chlamidia uretrita have a recurrent or chronic current. Cause a chronic cervicitis, a salpingitis, an adnexitis, cystitis in women of a chlamydia. The women having these diseases are chlamydia carriers, but seldom have urigenous arthritises.
Chlamydia trachomatis is transferred sexual and not sexual (household infection) way and it is found intracellularly in an epithelium of an urethra, a conjunctiva and cytoplasm of cells of synovia.
The syndrome of Reuters can be caused by shigellas, salmonellas, iyersiniya and to develop after the postponed coloenteritis. Some specialists specify that the ureaplasma can cause a disease of Reuters. Genetic predisposition which marker are HLA histocompatibility antigens - B27 (At 75-95% of patients) matters.
Treatment of the Disease of Reuters:
Treatment only concerning damage of joints - the brightest and most of all disturbing patient of display of a disease, does not yield results and promotes long and chronic disease. To same gives use of drugs of penicillin and cephalosporins. Simultaneous treatment of the patient and his sexual partner has to be carried out.
