Adhesion of upper and lower eyelids in the morning
Introduction
Introduction Reiter syndrome eye manifestations, conjunctivitis is usually the first symptom of the eye, the general symptoms are mild, often accompanied by a slight burning sensation, adhesions in the upper and lower eyelids in the morning, mostly bilateral involvement. Reiter syndrome is reactive arthritis. 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. Common microorganisms that cause reactive arthritis include the intestinal tract, genitourinary tract, pharyngeal and respiratory infections, and even viruses, chlamydia and protozoa. Most of these microorganisms are negative for Gram staining and have the property of adhering mucosal surfaces to host cells.
Cause
Cause
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 infectious disease caused by spirochetes, as the case was first reported by Reiter in the blood. Most of the people suffering from the symptoms are young males, and often have urinary tract infection symptoms and unclean sexual intercourse or history of treatment, so it is suspected that the intrinsic is related to gonorrhea and fourth sexually transmitted diseases. As mentioned earlier, the intrinsic may be secondary to non-bacterial urethritis or dysentery caused by various pathogens. Chlamydia has been isolated from several synovial fluids with urethritis, and some patients with schizophrenia, mycoplasma and chlamydia pathogens and diarrhea can be isolated from their urethral secretions. Some open the door to the stool to cultivate Shigella dysenteriae, Salmonella, Yersinia and Campylobacter.
In addition, the prevalence 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.
Early reports of non-gonococcal urethritis and Shigella, Salmonella, Yersinia, and Campylobacter infection in patients with reactive arthritis, HLA-B27 significantly increased. Other reports of HLA-B27, in addition to susceptible to this disease, ankylosing spondylitis, acute iritis, juvenile rheumatoid arthritis incidence is also higher, indicating that the occurrence of this card is related to HLA-B27. However, some HLA-B27 positive patients are prone to ankylosing spondylitis, while others are susceptible to Reiter syndrome. This 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 subpopulations. 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 may be recognized by a component that mimics HLA-B27 antigen.
In the early stage of intrinsic, synovial histology was similar to mild suppurative infection, and there were localized inflammatory reactions in the superficial and vascular areas, characterized by marked hyperemia, edema, neutrophils and lymphocytic infiltration in the inflammatory area. More than two weeks after the lesion, pulp cells and various connective tissue cells proliferated, and occasionally necrosis of synovial cells; in most cases, local red blood cells ooze out.
The pathological features of chronic arthritis over several months are villus-like synovial hyperplasia, vasospasm formation and articular cartilage-grade bony erosion. Microscopic examination showed non-specific inflammatory response, lymphocyte and plasma cell infiltration; lymphatic and plasma cells in some cases Lesions are often similar to rheumatoid arthritis. Skin lesions are characterized by hyperplasia of the stratum corneum, similar to skin keratosis and acanthosis, blisters on the epidermis, epithelial cells, neutral polynuclear leukocytes and lymphocytes, and microabscess-like changes. Infiltration of lymphocytes and plasma cells in the outer layer of the dermis. Mucosal pathological changes are similar to skin lesions, but no keratosis of the skin.
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 have shown that Reiter syndrome is a rare rheumatic disease. This disease is the most common cause of inflammatory joint disease in young men. It has been reported that about 1% of patients with non-specific urethritis develop Reiter syndrome; more than about 3% of non-specific urethritis develop reactive arthritis. Noer developed Reiter syndrome in 9 of 420 patients with Shigella infection, with an incidence of 1.5%. If HLA-B27-positive patients have non-specific urethritis, the incidence is higher, and about 20% of the symptoms occur.
Examine
an examination
Related inspection
Ophthalmology examination lacrimal lactoferrin
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
Eyelid edema: Eyelids, commonly known as eyelids, are divided into upper and lower parts. The eyelid skin is the thinnest part of the whole body skin, and the subcutaneous tissue is loose, so it is prone to fluid accumulation and edema. Pathological orbital edema: pathological orbital edema is divided into inflammatory eyelid edema and non-inflammatory eyelid edema. In addition to eyelid edema, the former also has local red, heat, pain and other symptoms, caused by acute inflammation of the eyelids, eyelid trauma, or inflammation around the eyes. Most of the latter have no local redness, heat, swelling and other symptoms. Common causes are allergic diseases or allergies to eye drops, heart disease, hypothyroidism, acute and chronic nephritis, and idiopathic neurovascular eyelid edema.
Eyelid drooping: also known as "hanging down." Due to insufficiency or disappearance of the levator palpebral function, or some or all of the upper jaw can not be lifted, the upper jaw is in a drooping position. Divided into complete and partial, monocular or binocular, congenital and acquired, true and false.
Can be congenital or acquired.
1 congenital: mainly due to oculomotor nucleus or levator dysplasia, is autosomal dominant inheritance.
2 acquired: due to oculomotor nerve paralysis, lifting diaphragmatic injury, sympathetic disease, myasthenia gravis and mechanical snoring movement disorders, such as inflammatory swelling or new organisms.
The eyelids are swollen and pale green: green tumors are usually found in the hard edges of the sputum. The eyelids are swollen and pale green. The mass develops abnormally quickly. In the short term, the eyelids can be filled, and the sinus and brain are involved. The anterior and submandibular lymph nodes are often swollen. There is also a green pigmentation on the surface of the lumps. In the later stages of the disease, all important organs and limb bones are involved; in the late stage, death is often caused by anemia and infection.
