Prostate secretions contain many purulent cells
Introduction
Introduction Prostate secretion contains many pustule cells, which is one of the typical manifestations of Reiter syndrome. It is a type of disease characterized by fever, skin and mucous membrane damage, urethritis and conjunctivitis. More common in adult males. The term reactive arthritis (ReA) was first proposed by Aho in 1974. Since then, a series of clinical and laboratory studies have been carried out on this disease, and its name has gradually been recognized. Currently, reactive arthritis refers to acute non-suppurative arthritis secondary to infection in other parts of the body. Reactive arthritis after intestinal or genitourinary infection is most common. In recent years, there have been many reports on streptococcal infection and reactive arthritis after infection with Chlamydia pneumoniae, and are considered to be two different types of reactive arthritis.
Cause
Cause
1. Infection theory
Shigella flexneri, Salmonella, Yersinia and Campylobacter. In addition, the morbidity rate of dysentery is higher [. However, it has nothing to do with Shigella dysenteriae, suggesting that reactive arthritis is associated with certain components of certain specific microorganisms. At present, in addition to sexually transmitted diseases, dysentery bacilli, Mycoplasma pneumoniae, Chlamydia, B. sylvestris, and even viruses are related to the intrinsic, especially the infection of Shigella dysenteriae, but so far There is more evidence that the intrinsic is directly related to the infection, because the pathogens that are not associated with the infection are all suffering from the intrinsic disease.
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 synovitis can occur after non-bacterial urethritis or enteritis, suggesting that immune factors have a certain pathogenesis. effect. However, it has not been confirmed that the intrinsic body fluid or cellular immune abnormalities are as common as systemic lupus erythematosus. Intrinsic arthritis may not be caused by antibodies or T cell-mediated responses. Recently, Chlamydia has been found in the synovium of some patients, and it may be suggested that certain bacterial components hidden in the joint induce inflammation.
Examine
an examination
Related inspection
Urine routine blood routine prostatic fluid culture prostate B ultrasound examination prostate tumor marker (PSA)
Laboratory tests are not specific for the diagnosis of reactive arthritis. However, it is meaningful to judge the extent of the disease, estimate the prognosis and guide the medication. The main laboratory inspection projects include:
Hematology
ESR and C-reactive protein can be significantly increased in acute phase reactive arthritis, and can be reduced to normal in patients with chronic phase. Blood routine examination showed an increase in white blood cells, lymphocyte counts, or mild anemia. In some patients, elevated white blood cells or microscopic hematuria can be seen in the urine, and proteinuria rarely occurs.
2. Bacteriology examination
Mid-stage urine, stool and throat swab culture can help detect reactive arthritis-related pathogens. However, negative culture results often occur due to differences in culture methods, bacterial characteristics, and timing of materials. Therefore, the determination of anti-bacterial and bacterial protein antibodies in serum is important for identifying bacterial types. At present, in the diagnosis of reactive arthritis, microorganisms capable of performing conventional antibody detection include Salmonella, Yersinia, Campylobacter, Chlamydia, Neisseria gonorrhoeae, Borrelia burgdorferi, and Streptococcus hemolyticus. In addition, methods for detecting Chlamydia and viruses by PCR are also of great interest in the diagnosis of reactive arthritis.
3.HLA-B27 determination
HLA-B27 positive has certain reference significance for the diagnosis, disease judgment and even prognosis of reactive arthritis. However, a negative HLA-B27 assay does not exclude reactive arthritis. Recently, several studies have analyzed the relationship between HLA-B27 subtype and disease, but there is no consistent conclusion.
4. Autoantibodies and immunoglobulins
Rheumatoid factor, anti-peripheral factor and anti-nuclear antibody were negative in patients with reactive arthritis, while serum immunoglobulin IgG, IgA, IgM were increased. These indicators are useful for the diagnosis and differential diagnosis of reactive arthritis.
Joint fluid examination: Joint fluid examination is of great significance for the diagnosis of reactive arthritis and the identification of other types of arthritis. In the synovial fluid of reactive arthritis, white blood cells and lymphocytes may be elevated, and mucin is negative. The joint fluid culture was negative. The bacterial protein components can be detected in the synovial membrane and synovial fluid of some patients by PCR, indirect immunofluorescence and electron microscopy.
Diagnosis
Differential diagnosis
1. Rheumatoid arthritis: its arthritis performance and even X-ray findings are similar to the intrinsic, but general rheumatoid arthritis does not occur at the same time 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 The performance of purulent catarrhal keratosis is supported by the intrinsic.
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 is not found in gonorrhea. Although there are ring balanitis in the intrinsic, but the balanitis of the foreskin and the redness and swelling of the urethra. Intrinsic skin lesions and pyelonegic keratosis are characteristic features, and gonorrhea is characterized by vascular pustular skin disease.
4. Pustular psoriasis: pustular psoriasis and pyelomyma keratosis are very similar in clinical and histology, such as psoriasis involving the conjunctiva, it is more confused, but silver There is no history of urethritis and dysentery.
5. Baisai syndrome: Baisai syndrome without urethritis and arthritis, intrinsic oral and genital damage is smashed and scarred after blister rupture, while Behcet's disease is a deep 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.
