Reiter syndrome
Introduction
Introduction to Reiter Syndrome Reiter syndrome is characterized by aseptic urethritis, conjunctivitis and polyarthritis. It can be contaminated with skin and mucous membranes and other organs. It often has fever before onset and is more common in adult males. basic knowledge Sickness ratio: 0.05% Susceptible people: more common in adult males Mode of infection: non-infectious Complications: Arthritis Ankle Arthritis
Cause
Cause of Reiter Syndrome
The etiology and pathogenesis of Reiter syndrome are still unclear, and can be summarized as the following hypotheses.
1. Infection theory
Reiter was suspected to be an infection caused by spirochete in the case of the case reported by Reiter for the first time. Reiter was suspected to be an infectious disease caused by spirochete. Most of the patients with this syndrome were young men, and often had symptoms of urinary tract infection and unclean sexual intercourse or treatment. History, so some people suspected that the intrinsic and gonorrhea, the fourth sexually transmitted diseases, as mentioned above, the intrinsic may be secondary to non-bacterial urethritis or dysentery caused by various pathogens, has occurred from several cases of urethritis Chlamydia is isolated from the synovial fluid. Some patients with pathogenicity may be isolated from their urethral secretions. The patients of the genus B. genus, Mycoplasma and Chlamydia are associated with diarrhea. Some of them open the door to raise the stool. Shigella, Salmonella, Yersinia and Campylobacter, and the incidence of dysentery is higher in the epidemic, but not related to Shigella dysenteriae, suggesting that reactive arthritis is associated with certain components of certain specific microorganisms. It is known that, in addition to sexually transmitted diseases, dysentery bacilli, Mycoplasma pneumoniae, Chlamydia, B. sylvestris, and even viruses are related to the intrinsic, especially the dysentery More closely, but so far there is no more evidence of intrinsic infection has a direct relationship, because not associated with infection who are suffering from the disease-causing intrinsic.
2. Genetics and immunology
Because the intrinsic patients have increased ESR, C-reactive protein is positive, IgG, IgA and 2 globulin are increased, and aseptic hyaline inflammation can occur after non-bacterial urethritis or enteritis, suggesting that immune factors have a certain pathogenesis. Role, but it has not been confirmed that the intrinsic body fluid or cellular immune abnormalities exist in the same way as systemic lupus erythematosus. Intrinsic arthritis may not be caused by antibody or T cell-mediated reaction. Recently, some patients have been diagnosed in synovial membrane. To Chlamydia, it may be suggested that certain bacterial components hidden in the joint induce inflammation.
Early reports of non-gonococcal urethritis and Shigella, Salmonella, Yersinia and Campylobacter infection in patients with reactive arthritis, histocompatibility antigen HLA-B27 was significantly increased, and reported with HLA-B27, In addition to susceptibility to this disease, ankylosing spondylitis, acute iritis, and the incidence of juvenile rheumatoid arthritis are also high, indicating that the occurrence of this syndrome is related to HLA-B27, but some HLA-B27-positive people are prone to tonic Sexual spondylitis, and some are prone to Reiter syndrome, which may be related to the different subtypes of HLA-B27. The use of monoclonal antibodies and two-dimensional polyacrylamide gel analysis revealed that HLA-B27 consists of at least two sub- Group composition, patients with HLA-B27-negative Reiter syndrome may have another cross-reactive antigen such as HLA-B27 antigen, or the arthritis pathogen of this disease carries a component that mimics HLA-B27 antigen and is recognized. .
In the early stage of intrinsic, synovial histology is similar to mild suppurative infection, and there are localized inflammatory reactions in the superficial and vascular areas, characterized by marked hyperemia in the inflammatory area, edema, neutrophil and lymphocyte infiltration, and lesions for more than two weeks. It can be seen that plasma cells and various connective tissue cells proliferate, and occasionally necrosis of synovial cells; in most cases, local red blood cells ooze out.
The pathological features of chronic arthritis, which lasted for several months, are villus-like synovial hyperplasia, vasospasm formation and articular cartilage-grade bony erosion. Microscopic examination showed non-specific inflammatory reaction, lymphocyte and plasma cell infiltration; lymphatic and plasma cells in some cases Lesions are often similar to rheumatoid arthritis. Skin lesions are characterized by stratum corneum hyperplasia, similar to skin keratosis and acanthosis, blisters on the epidermis, epithelial cells filled with epithelial cells, neutral polynuclear leukocytes and lymphocytes, and microabscesses The changes in the outer layer of lymphocytes and plasma cells in the dermis, mucosal pathological changes similar to skin lesions, but no skin keratosis.
Because the cause of this syndrome is unclear, the name and diagnostic criteria are not uniform, and there is still no systematic study on its prevalence and morbidity. A few studies indicate that Reiter syndrome is a non-racial rheumatic disease that is inflammatory in young men. Among the joint diseases, this disease is the most common cause. It is reported that about 1% of patients with non-specific urethritis and Reiter syndrome; more than about 3% of non-specific urethritis develop reactive arthritis, Noer is Reiter syndrome occurred in 9 of 420 patients infected with Shigella, with an incidence of 1.5%. HLA-B27-positive patients with non-specific urethritis had a higher incidence, and about 20% had an intrinsic sign.
Prevention
Reiter Syndrome Prevention
1. Reduce or avoid the disease factors, improve the living environment and space, develop good living habits, prevent infection, pay attention to food hygiene, and rationally allocate meals.
2. Pay attention to exercise, increase the body's ability to resist disease, do not fatigue, overwork, and quit smoking and alcohol.
3. Early detection, early diagnosis, early treatment, establish confidence in the fight against disease, adhere to treatment.
Complication
Reiter syndrome complications Complications arthritis and arthritis
Common complications of this disease:
1. Chronic or recurrent arthritis, joint deformation, the patient eventually changes work or stops working due to disability;
2. Eye disease and skin damage;
3. Chronic back pain, limited progressive spinal activity;
4. Osteoarthritis;
5. Ankle arthritis.
Symptom
Symptoms of Reiter Syndrome Common symptoms In the morning, the upper and lower eyelids adhere to the urethra to secrete mucus or... Penile superficial ulcer diarrhea, leukocytosis, labia minora and vestibule also... Urethral tract with erythema and edema, oral ulcer, scleral outer inflammation, periostitis
Most of the Reiter syndrome occurs in adult males. Individuals can be seen in women. They often have unclean sexual intercourse, history of sedation or urethritis, history of diarrhea, and dysentery, arthritis and conjunctivitis. It has a complete type of the whole body. Only one of the two cases after arthritis or arthritis is called incomplete type. The intrinsic is a systemic disease. Most patients have fever and weight loss. Some patients may have skin and mucous membrane lesions. A small number of lesions, often with lymph nodes and splenomegaly, can also affect the gastrointestinal, cardiovascular, lung and nervous system.
Joint
Joint lesions are usually the second or third features of intrinsic urethritis, urinary tract, diarrhea or conjunctivitis 2 to 4 weeks after emergence, or mixed with these symptoms, occur in weight-bearing large joints such as knees, ankle joints, but It refers to the small joints of the toes are often involved, arthritis is more common and asymmetrical, varying in severity, often accompanied by obvious redness, heat, pain, a small number of joint inflammation can last for several weeks or longer, a small number of patients in the acute phase There are back pains, ankle joints and spinal tenderness. The spinal joints are often "experienced", passing through certain segments from one site and involving another. Acute arthritis prolonged or responded to chronic arthritis. Report 1 course of 20 years [20] patients have obvious knee and surgical segment deformation, large and small muscle muscle atrophy, inflammation of the tendon attachment point called enthesopathy, which may be the outstanding performance of Reiter syndrome, plantar tendon In the case of membranous inflammation, there is obvious achilles tendon tenderness. X-ray examination shows that the heel bone attached to the plantar fascia is villous calcification. Due to periostitis, sporadic strip swelling and tendon end disease may occur at the lower end of the humerus. Tibia, plantar Tendon attachment points.
2. Genitourinary system
Most of them are male urethritis, dysuria, dysuria, mucus or purulent secretion in the urethra, erythema with erythema and edema, sometimes urethritis can be asymptomatic, unclean sexual intercourse, usually after sexual intercourse To the occurrence of urethritis about a few days to around January, in addition to urethritis, often accompanied by prostatitis, the prostate can be enlarged, soft and tender; prostate secretions contain many pimples; occasionally prostate abscess, women can have Urinary tract disease, cervicitis or cystitis, the symptoms are often mild, limited to dysuria or a little vaginal discharge.
3. Eye performance
Conjunctivitis is usually the first symptom of the eye. The general symptoms are mild, often accompanied by a slight burning sensation. In the morning, the upper and lower eyelids are stuck. Most of them are bilaterally affected. About 5% to 10% of the first cases may have iritis; the disease develops. Or recurrence 20% to 50% of iritis, a small number of uveitis, scleral inflammation, corneal ulcers; also have optic neuritis, retinitis and spotted retinal edema, but rare, about 3% can cause permanent vision damage.
4. Skin and mucous membranes
Superficial ulcer of the penis, especially in the urethra, the penile glans lesions fuse to form a ring or fan-like edge called ring balanitis, buccal mucosa and tongue mucosa can be seen basal erythema-like painless superficial ulcer, lesion diameter About a few mm to more than 1 cm, often do not pay attention to the occurrence of ulcers, but oral ulcers after Campylobacter infection may have pain.
Skin damage is most common in the palms and soles of the feet, but it can also occur in any part of the limbs, trunk or scalp. The skin lesions begin to be small papules, which quickly develop into pustules, but the ulcers contain only keratinized, single herpes diameter. About a few mm, a plurality of appearances can be grouped together, and a thicker area is covered with a thicker keratinized enamel. Finally, the skin becomes scarred without leaving scars, and skin keratinization can also occur on the fingers, toes, and Can lead to finger, toe nails off, the above skin lesions called pyrexic skin keratosis (keratodrmia blennorrhagicum), often occurs several weeks after the appearance of other symptoms of Reiter syndrome, generally lasts for several weeks after the self-resolved, a case reported chronic In the patient, there was atrophic scar after the junction was detached [20], and the connective tissue was found on the chest and back of the other side, which was slightly itchy.
Female Reiter syndrome is rare, and female genital skin and mucous membrane rash are rare. Edwards (1992) reported [11] a female patient who started fingertip redness, tenderness and nail separation, and had vaginal secretions, mucosal damage and Underarm pustules, Candida albicans culture positive, vaginal secretions appeared 4 years later, accompanied by painless oral ulcers, followed by female genital, perineal red scarring plaques, skin lesions gradually subsided after MTX treatment, but reduced After the amount of rash recurrence, the female genital skin appears pink scaly papules, diameter 1 ~ 2mm, clear boundary, small labia and vestibule also have scattered white round and ring papules, the edge is clear, the diameter is about 2 ~ 4mm, the entire external reproduction Visible clear spatial boundaries, apical erosive papules, skin and labia minora biopsy consistent with Reiter syndrome.
Examine
Reiter syndrome check
1. The peripheral white blood cell count is usually increased by (10 ~ 18) × 109 / L (10 000 ~ 18 000 / mm3), individual can exceed 20 × 109 / L (20 000 / mm3), there are a few cases of white blood cell count Not elevated; those with longer duration may have anemia; in most cases, erythrocyte sedimentation rate increases.
2. Urethral secretions contain a large number of white blood cells, mostly polynuclear white blood cells, often pyuria, also visible hematuria.
3. The synovial fluid is turbid. In some cases, it is obviously purulent. The white blood cell count is usually (2~5)×109/L (20005000/mm3). It can be as high as 10×109/L. Most of the early stage is multinucleated white blood cells. When the inflammatory reaction subsides, the proportion decreases, and it becomes lymphocyte-based; the sugar content in the synovial fluid is normal, but the sugar content can be reduced when the number of white blood cells is particularly high; the synovial complement level is usually the main cell; the sugar in the synovial fluid The content is normal, but the sugar content can be reduced when the number of white blood cells is particularly high; the synovial complement level is usually higher than other exudates; the protein content is increased; the protein complement binding rate is similar to joint degeneration, rheumatism and rheumatoid arthritis.
4. The urethra, prostate secretion gonococcus culture was negative; no bacteria were found in the blood and serum; the conjunctival exudate was sterile or only non-pathogenic.
5. Most of the leukocyte histocompatibility antigen HLA-B27 is positive.
Diagnosis
Diagnosis and identification of Reiter syndrome
diagnosis
The diagnosis of typical cases is generally not difficult, but there are certain difficulties in the diagnosis of atypical incomplete cases. The main diagnostic criteria include:
(1) urethritis, arthritis, and conjunctivitis triad occur simultaneously or in a short period of time.
(2) Characteristic damage of skin and mucous membranes.
(3) fever, leukocytosis, increased erythrocyte sedimentation rate, elevated serum immunoglobulin, C-reactive protein and positive, leukocyte histocompatibility antigen HLA-B27 positive.
(4) examination of urethral secretions, conjunctival secretions, synovial fluid and stool pathogens.
(5) X-ray characteristic performance.
(6) Excluding rheumatoid arthritis, ankylosing spondylitis, gonorrhea, psoriatic arthritis, enteropathic arthritis and Behcet's syndrome.
Differential diagnosis
Rheumatoid arthritis
Its arthritis performance and even X-ray findings are similar to the intrinsic, so Cecil has included Reiter syndrome in the clinical form of rheumatoid arthritis, but generally rheumatoid arthritis does not have urethra, conjunctivitis. And skin and mucous membrane damage.
2. Ankylosing spondylitis
Patients with intrinsic chronic spinal disease must be differentiated from ankylosing spondylitis. There is no significant difference between the two eyes and X-ray findings, but if there is a history of periarthritis with urethritis, especially purulent catarrhal skin Retinal syndrome is supported by keratosis.
3. Gonorrhea arthritis
Neisseria gonorrhoeae arthritis is limited to the synovial membrane; it does not invade the joint, so the joint gonococcal culture is negative, but the urethral purulent secretion culture is positive, while the intrinsic can not find gonorrhea, although the intrinsic ring balanitis However, the pericardial balanitis and urethral redness and swelling of different gonorrhea diseases [13] are characterized by intrinsic skin damage and pyloric keratosis, and gonorrhea is characterized by vascular pustular skin disease.
4. Pustular psoriasis
Pustular psoriasis and Reiter syndrome, the purulent keratosis of the skin are very similar in clinical and histological, such as psoriasis involving the conjunctiva, it is more confused, but psoriasis without urethra History of inflammation and dysentery.
5. Baisai syndrome
Reiter syndrome has urethritis and arthritis, while Behcet's syndrome does not; intrinsic oral and genital damage is erosion and scarring after blister rupture, while Behcet's disease is deeper ulcer; intrinsic rarely occurs For women, the latter is more common in women; the intrinsic is rare in China, and Behcet's disease is not uncommon.
