Wright syndrome scleritis
Introduction
Introduction to Wright Syndrome Sclerotherapy Reiters syndrome (RS) is a kind of "reactive arthritis" after suffering from enteritis or genitourinary inflammation in a genetically susceptible population. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: keratitis, retinitis, glaucoma, optic neuritis
Cause
The cause of Wright syndrome scleritis
(1) Causes of the disease
The cause of RS is related to a particular genetic background and to specific infections, after Shigella, salmonella, yersinia, and campylobacter enteritis, or After the inflammation of the genitourinary tract of Chlamydia trachomatis or mycoplasma, RS was first described by Reiter in 1916 as non-specific (non-gonococcal) urethritis, acute polyarthritis and conjunctivitis. This typical triad occurs in only a few cases. , severe RS, psoriasis or psoriatic arthritis and acquired immunodeficiency syndrome (AIDS) occur simultaneously, indicating that these diseases are related to immune factors, in many cases, urethritis as a trigger, or As a manifestation of this syndrome, it is unclear that in a patient with a particularly susceptible genetic background, it may be associated with a variety of different microorganisms.
(two) pathogenesis
The pathogenesis is unclear.
Prevention
Wright syndrome scleritis prevention
Although some people think that RS can recur after sexual life, many patients can spontaneously aggravate, may be caused by allergic reactions in hypersensitive individuals, should pay attention to avoid contact with allergens as much as possible.
Complication
Wright syndrome scleritis complications Complications keratitis retinitis glaucoma optic neuritis
Other eye diseases that occur include keratitis, retinitis, secondary glaucoma, and optic neuritis.
Symptom
Wright syndrome scleritis symptoms common symptoms keratitis corneal ulcer fatigue sclera outer inflammation pericarditis appetite loss pre-auricular lymphadenopathy mucosal damage conduction block uveitis
Eye performance
The main eye lesions of RS are conjunctivitis and anterior uveitis. Occasionally, scleritis and scleral inflammation occur. Eye lesions usually appear after joint and genitourinary lesions. Lee et al. counted 113 patients with RS in diagnosis. Eye lesions occurred after an average of 2.9 years in RS.
(1) Scleritis: Scleritis occurs in very few patients with RS, often in the later stages of the disease or other eye diseases such as conjunctivitis or anterior uveitis. The most common type is diffuse anterior scleritis, although repeated Attack, but does not develop into necrotizing anterior scleritis. All patients have scleritis after several episodes of conjunctivitis and/or anterior uveitis, and are associated with moderate anterior uveitis. Diffuse or nodular anterior scleritis after anterior uveitis should be examined in detail for RS or AS.
(2) Scleral outer inflammation: scleral outer inflammation is also rare in RS, mostly simple or nodular scleral inflammation, mostly after several years of active RS.
(3) conjunctivitis: the most common eye lesion of RS is conjunctivitis, the incidence rate is 58%, conjunctivitis usually appears within a few weeks after arthritis or urethritis, and occasionally can be the first performance of RS, usually both eyes Mild onset, conjunctival sac mucus purulent secretion, conjunctival nipple and follicles, if not treated, conjunctivitis can last 7 to 10 days, bacterial culture is negative, occasionally small and no painful pre-auricular lymphadenopathy and Ryukyu sticks.
(4) anterior uveitis: 12% of patients with RS may have anterior uveitis, often unilateral non-granulomatous, accompanied by small to moderate white KP, anterior chamber and vitreous cell exudation, post-iris adhesion In addition to severe sudden uveitis, there is generally no anterior chamber empyema, due to post-iris adhesion (pupil locking), iris corneal adhesions and trabecular inflammation, can cause secondary glaucoma, anterior uveitis in recurrence More common in patients with RS, anterior uveitis often occurs in patients with HLA-B27-positive and/or sacroiliitis. In the differential diagnosis of various anterior uveitis, the possibility of RS should be considered.
(5) Other ocular lesions: In patients with RS, keratitis often occurs concurrently with conjunctivitis or occasionally with anterior uveitis, but can also be produced separately, manifested as epithelial keratopathy or further development, fused into corneal ulcers, Sometimes corneal stromal infiltration or small vasospasm, occasional optic disc edema and recurrent retinal edema, similar to AS uveitis, RS rarely occurs in the posterior segment of the eye.
2. Non-eye performance
RS should be considered a syndrome, not just a combination of three special manifestations. The syndrome can be expressed as a quadruple, or only two of the three main manifestations. Some typical performances may be meaningless or neglected. A variety of damages may also be misdiagnosed, systemic symptoms of fever, loss of appetite, weight loss, fatigue and palpitations.
(1) joint disease: the disease occurs in this disease at the latest and lasts for the longest time, usually acute attack, asymmetry, a small number of joint involvement, especially the lower limbs, knee, ankle, hip and other weight-bearing joints most common, other Joints such as wrists, fingers, toes, and spine can also be involved. About 20% of RSs develop hip arthritis and ascending spondylitis, which are prone to ligaments, tenosynovitis, and plantar fascia inflammation. Most joints eventually recover completely, a few Persistence or recurrence can develop into permanent sausage-like knuckle deformity.
(2) genitourinary tract: 90% of male patients can be found urethritis and prostatitis, cystitis, seminal vesiculitis, epididymitis, orchitis, etc., urethral stricture can also occur, female patients with cervicitis, non-specific vaginitis, common symptoms Not obvious.
(3) skin mucosa: about 50% of patients with RS have skin mucosal lesions, mostly whirlpool balanitis, another rare but characteristic skin lesion is seborrheic keratosis, generally without leaving scars and healing, However, recurrence, severe seborrheic keratosis can cause the body's epidermal detachment and death, 10% of RS has oral mucosal damage, the initial hairy herpes, later merged into patches, the boundary is unclear, painless Superficial ulcers healed in days to weeks, and a small number of patients developed subarachnoid and periungual dermatitis.
(4) Other lesions: Other rare manifestations include heart block, pericarditis, aortitis, amyloidosis, thrombophlebitis, pleurisy, non-specific diarrhea, meningitis and systemic arteritis, like AS, RS vasculitis is mainly aorta, when RS patients have some rare and serious clinical manifestations such as seborrheic dermatitis (buccal), thrush, hairy leukoplakia, persistent lymphadenopathy, severe systemic symptoms or When developing rapidly developing joint lesions, be alert to the possibility of AIDS and ask about the patient's sexual behavior and whether there is a history of drug abuse.
Examine
Wright syndrome scleritis examination
Severe RS has an ESR of up to 100 mm/h, but has no correlation with the severity and prognosis of the disease, and has a relatively high level of complement (representing a non-specific inflammatory response), often with anemia, leukocytosis, and elevated serum protein. CIC, RF and ANA negative and synovial fluid complement levels decreased, synovial/serum complement ratio decreased, synovial examination and synovial biopsy have almost no diagnostic significance for various inflammatory lesions.
Radiological examination can predict the degree of disease progression, often with joint space stenosis, osteoporosis, new bone reaction, tendon and ligament attachment osteitis (such as pelvis, humerus, humerus and phalanx), similar to AS Ankle arthritis and spondylitis are often asymptomatic and asymmetrical.
Diagnosis
Diagnosis and identification of Wright syndrome scleritis
The diagnostic attention of RS depends on clinical manifestations. The main clinical manifestations of RS are arthritis, non-specific urethritis or cervicitis, inflammatory eye disease and mucosal skin lesions, and at least 2 clinical manifestations of arthritis and other 3 items can be established. RS diagnosis, because most clinical manifestations are non-specific, it is difficult to diagnose suspected RS; few standards can fully meet or may meet the requirements of RS diagnosis. Like AS, whether HLA-B27 positive is associated with the severity of RS Related, it is not clear, only the possibility of RS, but can not be used as an indicator of RS diagnosis.
