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Wojturska W, Nowakowski J, Pilch W, Biernikowicz M, Korkosz M. Reactive arthritis after vaccination against SARS-CoV-2: A case series and a mini-review. Hum Vaccin Immunother 2023; 19:2173912. [PMID: 36746791 PMCID: PMC10026907 DOI: 10.1080/21645515.2023.2173912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The rapid development of COVID-19 vaccines became essential for addressing the global pandemic. Reactive arthritis after vaccination has been a rare phenomenon. Here, we present a case series of three patients with joint inflammation possibly attributed to COVID-19 immunization (mRNA and live adenovirus vectored vaccine). Symptoms were alleviated using non-steroid anti-inflammatory drugs and glucocorticoids. After follow-up, the patients have not been diagnosed with any other rheumatic disease. Reactive arthritis after the COVID-19 vaccine is an unusual adverse effect and poses a negligible risk in comparison to the benefits of immunization, but it should be considered in differential diagnostics by a practicing rheumatologist who cares for patients with new-onset arthritis without apparent cause at the time of pandemic.
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Affiliation(s)
- Wiktoria Wojturska
- Students' Scientific Group of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Jarosław Nowakowski
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Weronika Pilch
- Students' Scientific Group of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Małgorzata Biernikowicz
- Students' Scientific Group of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Mariusz Korkosz
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
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2
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Marquez-Ortiz RA, Leon M, Abril D, Escobar-Perez J, Florez-Sarmiento C, Parra-Izquierdo V, Chalem P, Romero-Sanchez C. Colonoscopy aspiration lavages for mucosal metataxonomic profiling of spondylarthritis-associated gastrointestinal tract alterations. Sci Rep 2023; 13:7015. [PMID: 37117227 PMCID: PMC10147911 DOI: 10.1038/s41598-023-33597-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 04/15/2023] [Indexed: 04/30/2023] Open
Abstract
The study of the GI-tract microbiota of spondylarthritis (SpA) patients has focused on the analysis of feces samples, that picture mostly the luminal microbiota. The aim of this study was to determine the contribution of mucosal and luminal microbiome to the gut dysbiosis in SpA, using colonoscopy aspiration lavages (CAL), a recent alternative for regional studies of the GI-tract. We analyzed 59 CAL (from sigmoid colon and distal ileum), and 41 feces samples, from 32 SpA patients and 7 healthy individuals, using 16S rRNA gene-targeted metataxonomic profiling. It was found high prevalence of GI-tract manifestations among SpA patients (65.3%). Metataxonomic profiling, confirmed CAL samples from the lower GI tract (colon or ileum) presented a distinctive and undifferentiated bacteriome and separate from that found in feces' samples or in the beginning of the GI tract (oral cavity (OC)). Lower GI-tract samples and feces of SpA patients exhibited similar behavior to the microbiota of IBD group with reduced microbial richness and diversity, comparing to the healthy controls. Interestingly, it was found increase in proinflammatory taxa in SpA patients, such as Enterobacteriaceae family (mostly in the ileum), Succinivibrio spp. and Prevotella stercorea. Conversely, SpA patients presented significant decrease in the SCFA producers Coprococcus catus and Eubacterium biforme. Our data support the value of CAL samples for the regional study of GI-tract and contribute with information of potential "disruptor taxa" involved in the GI-tract associated disorders observed in SpA patients.
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Affiliation(s)
- Ricaurte A Marquez-Ortiz
- Bacterial Molecular Genetics Laboratory/LGMB, Vicerrectoría de Investigaciones, Universidad El Bosque, Av. Cra 9 No. 131 A-02, Bogotá, Colombia.
| | - Moises Leon
- Master's Program in Basic Biomedical Sciences, Faculty of Science, Universidad El Bosque, Bogotá, Colombia
| | - Deisy Abril
- Bacterial Molecular Genetics Laboratory/LGMB, Vicerrectoría de Investigaciones, Universidad El Bosque, Av. Cra 9 No. 131 A-02, Bogotá, Colombia
| | - Javier Escobar-Perez
- Bacterial Molecular Genetics Laboratory/LGMB, Vicerrectoría de Investigaciones, Universidad El Bosque, Av. Cra 9 No. 131 A-02, Bogotá, Colombia
| | - Cristian Florez-Sarmiento
- Cellular and Molecular Immunology Group/INMUBO, School of Dentistry, Universidad El Bosque, Av. Cra 9 No. 131 A-02, Bogotá, Colombia
- Gastroadvanced, Bogotá, Colombia
| | - Viviana Parra-Izquierdo
- Cellular and Molecular Immunology Group/INMUBO, School of Dentistry, Universidad El Bosque, Av. Cra 9 No. 131 A-02, Bogotá, Colombia
- Gastroadvanced, Bogotá, Colombia
| | - Philippe Chalem
- Fundación Instituto de Reumatología Fernando Chalem, Bogotá, Colombia
| | - Consuelo Romero-Sanchez
- Cellular and Molecular Immunology Group/INMUBO, School of Dentistry, Universidad El Bosque, Av. Cra 9 No. 131 A-02, Bogotá, Colombia.
- Hospital Militar Central, Rheumatology and Immunology Department, Bogotá, Colombia.
- Clinical Immunology Group, School of Medicine, Universidad Militar Nueva Granada, Bogotá, Colombia.
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3
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Migliorini F, Bell A, Vaishya R, Eschweiler J, Hildebrand F, Maffulli N. Reactive arthritis following COVID-19 current evidence, diagnosis, and management strategies. J Orthop Surg Res 2023; 18:205. [PMID: 36922870 PMCID: PMC10017067 DOI: 10.1186/s13018-023-03651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/25/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Immune-mediated conditions associated to Corona Virus Disease-19 (COVID-19) have been reported, including vasculitis, antiphospholipid antibody syndrome, myositis, and lupus. Emerging studies have reported the potential occurrence of reactive arthritis in patients previously infected with COVID-19. This systematic review summarised the current evidence on the occurrence of reactive arthritis in patients previously infected by COVID-19. METHODS This study was conducted according to the 2020 PRISMA guidelines. All the clinical investigations describing the occurrence of reactive arthritis following COVID-19 were accessed. In September 2022, the following databases were accessed: PubMed, Web of Science, Google Scholar, Embase. The generalities of the study were extracted: author, year and journal of publication, country of the main author, study design, sample size, mean age, number of women, main results of the study. The following data on COVID-19 severity and management were retrieved: type of treatment, hospitalization regimes (inpatient or outpatient), admission to the intensive care unit, need of mechanical ventilation, pharmacological management. The following data on reactive arthritis were collected: time elapsed between COVID-19 infection to the onset of reactive arthritis symptoms (days), pharmacological management, type of arthritis (mono- or bilateral, mono- or polyarticular), extra-articular manifestations, presence of tenosynovitis or enthesitis, synovial examination at microscopic polarised light, imaging (radiography, magnetic resonance, sonography), clinical examination, laboratory findings. RESULTS Data from 27 case reports (54 patients) were retrieved, with a mean age of 49.8 ± 14.5 years. 54% (29 of 54 patients) were women. The mean time span between COVID-19 infection and the occurrence of reactive arthritis symptoms was 22.3 ± 10.7 days. Between studies diagnosis and management of reactive arthritis were heterogeneous. Symptoms resolved within few days in all studies considered. At last follow-up, all patients were minimally symptomatic or asymptomatic, and no additional therapy or attentions were required by any patient. CONCLUSION Poor evidence suggests that COVID-19 could target the musculoskeletal system causing reactive arthritis at its post infectious stage. COVID-19 can act as a causative agent or as a trigger for development of reactive arthritis even without presence of antibodies of rheumatological disorders. Treating physicians should have a high index of suspicion while treating post infectious COVID-19 patient with arthralgia. LEVEL OF EVIDENCE Level IV, systematic review.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany. .,Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany.
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals Institutes of Orthopaedics, New Delhi, India
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, ST4 7QB, England.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, E1 4DG, England
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Migliorini F, Karlsson J, Maffulli N. Reactive arthritis following COVID-19: cause for concern. Knee Surg Sports Traumatol Arthrosc 2023; 31:2068-2070. [PMID: 36809513 PMCID: PMC9942056 DOI: 10.1007/s00167-023-07332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
Low-quality evidence suggests that COVID-19 may trigger reactive arthritis one to four weeks after the infection. Post COVID-19 reactive arthritis resolves within a few days, and no additional treatment is required. Established diagnostic or classification criteria for reactive arthritis are missing, and a deeper understanding of the immune mechanism related to COVID-19 prompt us to further investigate the immunopathogenic mechanisms capable of promoting or contrasting the development of specific rheumatic diseases. Caution should be exerted when managing post-infectious COVID-19 patient with arthralgia.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany. .,Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany.
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy ,School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, ST4 7QB Stoke On Trent, England ,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, E1 4DG London, England
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5
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Yan LF, Zhang J, Zhang Z. Reactive arthritis and subacute infective endocarditis caused by Streptococcus gordonii infection: A case report. Int J Rheum Dis 2023; 26:376-378. [PMID: 36314763 DOI: 10.1111/1756-185x.14481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/08/2022] [Accepted: 10/14/2022] [Indexed: 01/28/2023]
Abstract
Streptococcus gordonii (S. gordonii) belongs to the alpha-hemolytic Streptococcus group. It is a symbiotic bacterium found in the human oral mucosa which is present in large quantities on the surface of the teeth. It is generally considered nonpathogenic or weakly pathogenic and is known to cause subacute endocarditis; however, there are few reports of reactive arthritis (ReA) caused by S. gordonii. Herein, we report a case of ReA complicated by subacute infective endocarditis caused by S. gordonii and explore the possible pathogenic mechanism of ReA caused by S. gordonii.
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Affiliation(s)
- Li-Fang Yan
- Department of Rheumatism and Immunology, Qinghai Red Cross Hospital, Xining, China
| | - Jie Zhang
- Department of Rheumatism and Immunology, Qinghai Red Cross Hospital, Xining, China
| | - Zhen Zhang
- Department of Rheumatism and Immunology, Qinghai Red Cross Hospital, Xining, China
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6
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Wang CR, Tsai HW. Seronegative spondyloarthropathy-associated inflammatory bowel disease. World J Gastroenterol 2023; 29:450-468. [PMID: 36688014 PMCID: PMC9850936 DOI: 10.3748/wjg.v29.i3.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/18/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Seronegative spondyloarthropathy (SpA) usually starts in the third decade of life with negative rheumatoid factor, human leukocyte antigen-B27 genetic marker and clinical features of spinal and peripheral arthritis, dactylitis, enthesitis and extra-articular manifestations (EAMs). Cases can be classified as ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis, or juvenile-onset spondyloarthritis. Joint and gut inflammation is intricately linked in SpA and inflammatory bowel disease (IBD), with shared genetic and immunopathogenic mechanisms. IBD is a common EAM in SpA patients, while extraintestinal manifestations in IBD patients mostly affect the joints. Although individual protocols are available for the management of each disease, the standard therapeutic guidelines of SpA-associated IBD patients remain to be established. Nonsteroidal anti-inflammatory drugs are recommended as initial therapy of peripheral and axial SpA, whereas their use is controversial in IBD due to associated disease flares. Conventional disease-modifying anti-rheumatic drugs are beneficial for peripheral arthritis but ineffective for axial SpA or IBD therapy. Anti-tumor necrosis factor monoclonal antibodies are effective medications with indicated use in SpA and IBD, and a drug of choice for treating SpA-associated IBD. Janus kinase inhibitors, approved for treating SpA and ulcerative colitis, are promising therapeutics in SpA coexistent with ulcerative colitis. A tight collaboration between gastroenterologists and rheumatologists with mutual referral from early accurate diagnosis to appropriately prompt therapy is required in this complex clinical scenario.
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Affiliation(s)
- Chrong-Reen Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 70403, Taiwan
| | - Hung-Wen Tsai
- Department of Pathology, National Cheng Kung University Hospital, Tainan 70403, Taiwan
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7
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Slouma M, Abbes M, Mehmli T, Dhahri R, Metoui L, Gharsallah I, Louzir B. Reactive arthritis occurring after COVID-19 infection: a narrative review. Infection 2023; 51:37-45. [PMID: 35655110 PMCID: PMC9162104 DOI: 10.1007/s15010-022-01858-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/15/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Reactive arthritis is acute aseptic arthritis occurring 1 to 4 weeks after a distant infection in a genetically predisposed individual. It may occur after COVID-19 infection. We summarize, in this article, the current findings of reactive arthritis following COVID-19 infection. METHODS A literature search has been performed from December 2019 to December 2021. We included case reports of reactive arthritis occurring after COVID-19 infection. We collected demographic, clinical, and paraclinical data. RESULTS A total of 22 articles were reviewed. There were 14 men and 11 women with a mean age of 44.96 + 17.47 years. Oligoarticular involvement of the lower limbs was the most frequent clinical presentation. The time between arthritis and COVID infection ranged from 6 to 48 days. The diagnosis was based on clinical and laboratory findings. The pharmacological management was based on non-steroidal anti-inflammatory drugs in 20 cases. Systemic or local steroid therapy was indicated in 13 patients. Sulfasalazine was indicated in two cases. Alleviation of symptoms and recovery were noted in 22 cases. The mean duration of the clinical resolution was 16 + 57 days. CONCLUSION The diagnosis of reactive arthritis should be considered in patients with a new onset of arthritis following COVID-19 infection. Its mechanism is still unclear.
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Affiliation(s)
- Maroua Slouma
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Maissa Abbes
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Takoua Mehmli
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Rim Dhahri
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Leila Metoui
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Imen Gharsallah
- grid.415617.0Department of Rheumatology, Military Hospital, 1007 Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
| | - Bassem Louzir
- grid.415617.0Department of Internal Medicine, Military Hospital, Tunis, Tunisia ,grid.12574.350000000122959819Tunis El Manar University, Tunis, Tunisia
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8
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Reveille JD, Ridley LK. Spondyloarthritis. Clin Immunol 2023. [DOI: 10.1016/b978-0-7020-8165-1.00058-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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9
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Liu Y, He J, Jiang J, Wang Y, Liu T. Reactive Arthritis Triggered by Adalimumab and Leflunomide in a Patient with Ankylosing Spondylitis. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:2601-2605. [DOI: 10.2147/ccid.s390918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022]
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10
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Higashiguchi M, Matsumoto T, Kitamura T, Nakajima T, Nishioka K, Kimura H, Yamamoto T, Komuta K. Poncet's Disease (Reactive Arthritis Associated with Tuberculosis). Intern Med 2022; 61:3245-3249. [PMID: 35342140 PMCID: PMC9683800 DOI: 10.2169/internalmedicine.9241-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 82-year-old man with miliary tuberculosis was admitted to our hospital. Approximately six weeks after starting anti-tuberculosis treatment, he complained of pain in the fingers, wrists, and ankles. A histopathological examination of the synovial biopsy revealed nonspecific chronic inflammation with no granulomas. Culture of the biopsy specimen yielded no acid-fast bacilli. Poncet's disease was diagnosed based on the clinical presentation, with no findings suggestive of other diseases. His joint pain rapidly improved with steroid therapy. Tuberculosis can cause arthritis through immune-mediated mechanisms without direct invasion in an entity known as Poncet's disease.
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Affiliation(s)
- Masayoshi Higashiguchi
- Department of Internal Medicine, Osaka Anti-Tuberculosis Association Osaka Fukujuji Hospital, Japan
| | - Tomoshige Matsumoto
- Department of Internal Medicine, Osaka Anti-Tuberculosis Association Osaka Fukujuji Hospital, Japan
| | - Takashi Kitamura
- Department of Orthopedic Surgery, Osaka Anti-Tuberculosis Association Osaka Fukujuji Hospital, Japan
| | - Takako Nakajima
- Department of Orthopedic Surgery, Osaka Anti-Tuberculosis Association Osaka Fukujuji Hospital, Japan
| | - Koji Nishioka
- Department of Internal Medicine, Osaka Anti-Tuberculosis Association Osaka Fukujuji Hospital, Japan
| | - Hiromi Kimura
- Department of Internal Medicine, Osaka Anti-Tuberculosis Association Osaka Fukujuji Hospital, Japan
| | - Takafumi Yamamoto
- Department of Orthopedic Surgery, Osaka Anti-Tuberculosis Association Osaka Fukujuji Hospital, Japan
| | - Kiyoshi Komuta
- Department of Internal Medicine, Osaka Anti-Tuberculosis Association Osaka Fukujuji Hospital, Japan
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Ding Y, Xue L. The potential value of fibrinogen to albumin ratio (FAR) in the assessment of inflammation in spondyloarthritis. BMC Musculoskelet Disord 2022; 23:864. [PMID: 36109740 PMCID: PMC9479360 DOI: 10.1186/s12891-022-05797-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
Background Fibrinogen to albumin ratio (FAR) is a newly investigated indicator for inflammation. The study aimed to explore the potential ability of FAR in assessing the severity of inflammation in spondyloarthritis. Methods The clinical data of 196 spondyloarthritis (SpA) patients, 66 osteoarthritis (OA) patients, and 81 healthy controls (HC) were collected in this retrospective study. The SpA group included 69 psoriatic arthritis patients, 47 reactive arthritis patients and 80 ankylosing spondylitis patients. Chi-square test and Mann–Whitney U test, Spearman’s correlation test, regression analysis, and ROC analyses were used for the analysis of FAR. Results FAR level in group SpA was higher than in OA or HC. In the SpA group, the reactive arthritis group was characterized by the highest FAR level. After matching the erythrocyte sedimentation rate, a significant difference occurred between groups SpA and OA, but not in SpA subgroups. The FAR level was significantly related to erythrocyte sedimentation rate and C-reactive protein. After regression and receiver operating characteristics analysis, FAR was considered the most potential pointer to evaluate inflammation in SpA with the area under curve of 0.95. The recommended cut-off value of FAR was 9.44 for serious inflammation and 8.34 for mild conditions. Conclusion FAR is closely related to inflammatory biomarkers and can be a potential indicator in the assessment of inflammation in spondyloarthritis. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05797-6.
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Ding Y, Xue L. HLA-B27 negative reactive arthritis versus HLA-B27 positive reactive arthritis: A retrospective study. Medicine (Baltimore) 2022; 101:e30383. [PMID: 36107557 PMCID: PMC9439772 DOI: 10.1097/md.0000000000030383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Reactive arthritis (ReA) is defined as inflammatory arthritis secondary to an extra-articular infection with a key genetic background, HLA-B27. However, to date, the diagnosis and classification remain incomplete. The study focused on the similarities and differences in clinical manifestation, imaging features, and laboratory inspection between HLA-B27 negative patients and HLA-B27 positive patients in order to provide a reference for future development of diagnostic and classification criteria. Twenty-five ReA (19 HLA-B27 negative patients and 6 HLA-B27 positive patients) were included in this retrospective study. Clinical data, including demographics, clinical symptoms, imaging features, and laboratory inspection, were collected. The chi-square test and Mann-Whitney U test were used in the analysis. HLA-B27 negative group showed more involvement of upper extremities and small joints, while HLA-B27 positive group performed more axial symptoms. No significant difference was found in imaging features (ultrasound and magnetic resonance imaging) or laboratory inspection (microbes culture and infection-related indicators) between the 2 groups. ReA patients with different genetic backgrounds show various manifestations, although they encounter similar infections.
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Affiliation(s)
- Yimei Ding
- Department of Rheumatology and Immunology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Luan Xue
- Department of Rheumatology and Immunology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Luan Xue, Department of Rheumatology and Immunology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China (e-mail: )
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Dombret S, Skapenko A, Schulze-Koops H. Reactive arthritis after SARS-CoV-2 infection. RMD Open 2022; 8:rmdopen-2022-002519. [PMID: 36096524 PMCID: PMC9471204 DOI: 10.1136/rmdopen-2022-002519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/08/2022] [Indexed: 12/02/2022] Open
Abstract
SARS-CoV-2 has been recognised as a potential trigger of inflammatory arthritis in individuals with inflammatory rheumatic diseases as well as in previously unaffected individuals. However, new-onset arthritis after COVID-19 is a heterogeneous phenomenon that complicates differential diagnosis. For example, acute arthritis with features of viral arthritis has been reported after COVID-19, as has crystal-induced arthritis. Arthritides mimicking reactive arthritis (ReA) have also been described, but these patients often do not fulfil the typical features of ReA: several reports describe cases of patients older than 45 years at the onset of arthritis, and the characteristic genetic feature of ReA, HLA-B27, is rarely found. Because viral infections are much less likely to cause ReA than bacterial infections, and respiratory infections are rarely the cause of ReA, it is currently unknown whether SARS-CoV-2 can cause true ReA. Here, we report the case of a 30-year-old patient who presented with acute pain, swelling and redness in the left metatarsophalangeal (MTP) joint and ankle 7 days after resolution of a SARS-CoV-2 infection. Diagnostics revealed arthritis of the MTP2, synovitis of the upper ankle with significant joint effusion and peritendinitis of the flexor tendons. Based on the clinical manifestations and diagnostic test results, ReA appeared to be the most likely cause. A screening for typical ReA-associated infections was negative. The patient was treated with NSAIDs and intra-articular and systemic glucocorticoids. At a follow-up visit after discontinuation of glucocorticoids, the patient was symptom-free. Overall, we observed a ReA with typical clinical, genetic and patient characteristics after SARS-CoV-2 infection, and we conclude that a direct association with COVID-19 is highly plausible.
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Affiliation(s)
- Sophia Dombret
- Division of Rheumatology and Clinical Immunology, Ludwig Maximilians University Munich, Department of Medicine IV, Munich, Germany
| | - Alla Skapenko
- Division of Rheumatology and Clinical Immunology, Ludwig Maximilians University Munich, Department of Medicine IV, Munich, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Ludwig Maximilians University Munich, Department of Medicine IV, Munich, Germany
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14
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Farisogullari B, Pinto AS, Machado PM. COVID-19-associated arthritis: an emerging new entity? RMD Open 2022; 8:rmdopen-2021-002026. [PMID: 36100294 PMCID: PMC9471208 DOI: 10.1136/rmdopen-2021-002026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/20/2022] [Indexed: 11/03/2022] Open
Abstract
The current COVID-19 pandemic raises several clinical challenges. Cases of COVID-19-associated arthritis have been reported, and inconsistently described as either COVID-19 viral arthritis or COVID-19 reactive arthritis. We aimed to review all the reported cases of 'COVID-19-associated arthritis', which we propose, is a better term to define the entire spectrum of new-onset arthritis believed to be associated with SARS-CoV-2 infection. We performed a systematic literature review using MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews to search for articles published up to 13 December 2021. We included cohort studies, case series and case reports describing patients diagnosed with COVID-19 reactive or viral arthritis by a physician, irrespective of fulfilment of classification criteria. To identify relevant studies, medical subject headings and keywords related to 'COVID-19/SARS-CoV-2 infection' and 'reactive arthritis' were used. Our search retrieved 419 articles, of which 31 were included in the review. A total of 33 cases were reported in these 31 articles, the majority being adults (28/33=85%) with peripheral joint involvement (26/33=79%). Most of the patients responded well to treatment and the disease was self-limiting. These 33 case reports describe a possible causal relationship between exposure to SARS-CoV-2 and the onset of arthritis. However, since these cases were reported during a pandemic, other aetiologies cannot be fully excluded. The exact mechanism through which SARS-CoV-2 might trigger arthritis is not fully understood and robust epidemiological data to support a causal relationship are still lacking.
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Affiliation(s)
- Bayram Farisogullari
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Ana S Pinto
- Department of Rheumatology, Unidade Local de Saúde da Guarda EPE, Guarda, Portugal
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK .,National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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15
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Wang J, Zeng J, Liu Z, Zhou Q, Wang X, Zhao F, Zhang Y, Wang J, Liu M, Du R. Promising Strategies for Transdermal Delivery of Arthritis Drugs: Microneedle Systems. Pharmaceutics 2022; 14:pharmaceutics14081736. [PMID: 36015362 PMCID: PMC9416616 DOI: 10.3390/pharmaceutics14081736] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/12/2022] [Accepted: 08/14/2022] [Indexed: 11/16/2022] Open
Abstract
Arthritis is a general term for various types of inflammatory joint diseases. The most common clinical conditions are mainly represented by rheumatoid arthritis and osteoarthritis, which affect more than 4% of people worldwide and seriously limit their mobility. Arthritis medication generally requires long-term application, while conventional administrations by oral delivery or injections may cause gastrointestinal side effects and are inconvenient for patients during long-term application. Emerging microneedle (MN) technology in recent years has created new avenues of transdermal delivery for arthritis drugs due to its advantages of painless skin perforation and efficient local delivery. This review summarizes various types of arthritis and current therapeutic agents. The current development of MNs in the delivery of arthritis drugs is highlighted, demonstrating their capabilities in achieving different drug release profiles through different self-enhancement methods or the incorporation of nanocarriers. Furthermore, the challenges of translating MNs from laboratory studies to the clinical practice and the marketplace are discussed. This promising technology provides a new approach to the current drug delivery paradigm in treating arthritis in transdermal delivery.
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Affiliation(s)
- Jitong Wang
- Engineering Research Center of Modern Preparation Technology of TCM of Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Jia Zeng
- NHC Key Lab of Reproduction Regulation, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai Engineering Research Center of Reproductive Health Drug and Devices, Shanghai 200032, China
| | - Zhidan Liu
- Department of Rehabilitation, Baoshan Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai 201999, China
| | - Qin Zhou
- Engineering Research Center of Modern Preparation Technology of TCM of Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Xin Wang
- Engineering Research Center of Modern Preparation Technology of TCM of Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Fan Zhao
- Engineering Research Center of Modern Preparation Technology of TCM of Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yu Zhang
- Engineering Research Center of Modern Preparation Technology of TCM of Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Jiamiao Wang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Minchen Liu
- Engineering Research Center of Modern Preparation Technology of TCM of Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Correspondence: (M.L.); (R.D.)
| | - Ruofei Du
- Engineering Research Center of Modern Preparation Technology of TCM of Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Correspondence: (M.L.); (R.D.)
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16
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Zeidler H, Hudson AP. Quo vadis reactive arthritis? Curr Opin Rheumatol 2022; 34:218-224. [PMID: 35699331 DOI: 10.1097/bor.0000000000000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW We provide an overview of recent articles which describe new thinking regarding HLA-B27-associated reactive arthritis (ReA), including those additional infection-related arthritides triggered by microbes that often are grouped under the term ReA. RECENT FINDINGS With the advent and continuation of the pandemic, an increasing number of cases and case series of post-COVID-19 arthritis have been reported and classified as ReA. Further, arthritis after COVID-19 vaccination is a new entity included within the spectrum of ReA. New causative microorganisms identified in case reports include Clostridium difficile, Mycoplasma pneumoniae, Giardia lamblia, Leptospira , and babesiosis. SARS-CoV-2 is emerging as a significant etiologic agent for apparent ReA. SUMMARY It is now clear that comprehensive clinical and laboratory investigations, synovial fluid analyses, and close follow-up of patients all are essential to differentiate ReA from diseases that may present with similar clinical attributes. Further, and importantly, additional research is required to define the wide diversity in causative agents, epidemiology, and rare case presentations of these arthritides. Finally, new classification and diagnostic criteria, and updated treatment recommendations, are essential to the advancement of our understanding of ReA.
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Affiliation(s)
- Henning Zeidler
- Clinic of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Alan P Hudson
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
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17
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Ardakani MV, Parviz S, Ghadimi E, Zamani Z, Salehi M, Firoozabadi MA, Mortazavi SMJ. Concomitant septic arthritis of the hip joint and femoral head avascular necrosis in patients with recent COVID-19 infection: a cautionary report. J Orthop Surg Res 2022; 17:302. [PMID: 35668523 PMCID: PMC9168355 DOI: 10.1186/s13018-022-03192-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/25/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose At present, concomitant avascular necrosis (AVN) of femoral head and septic arthritis (SA) as a sequel of COVID-19 infection has yet not been documented. By large-scale use of life-saving corticosteroids (CS) in COVID-19 cases, our aim is to warn of the occurrence of hip joint infection in these patients.
Methods We report a series of five cases in which patients developed septic arthritis concomitant with AVN after being treated for COVID-19 infection. The mean dose of prednisolone used in these cases was 1695.2 mg. The time period of onset of hip symptoms in our cases from the beginning of the COVID-19 infection was 56 days in the first case, 43 days in the second case, 30 days in the third case, 29 days in the fourth case and 50 days in the last case, with an average time of 41.6 days. All patients underwent surgery depending on the extent of articular cartilage damage by direct anterior approach. Results Clinical and laboratory symptoms improved significantly in all patients. The mean visual analogue pain score of the patients decreased from 9.4 (9–10) before surgery to 2.8 (1–4) after 1 week of operation. Conclusion In any patient with the history of COVID-19 infection specially those who have been treated with corticosteroid as one of the medications prescribed during the disease, any joint symptom specially in the hips should draw our attention to the joint infection, and with timely diagnosis and surgery, their hip joint can be saved.
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Affiliation(s)
- Mohammad Vahedian Ardakani
- Joint Reconstruction Research Centre, Tehran University of Medical Sciences, End of Keshavarz Blvd, Tehran, 1419733141, Iran
| | - Sara Parviz
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Department of Radiology, Medical Imaging Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Ghadimi
- Joint Reconstruction Research Centre, Tehran University of Medical Sciences, End of Keshavarz Blvd, Tehran, 1419733141, Iran
| | - Zahra Zamani
- Community Medicine Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Imam Khomeini Hospital Complex, Infectious Diseases Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ayati Firoozabadi
- Joint Reconstruction Research Centre, Tehran University of Medical Sciences, End of Keshavarz Blvd, Tehran, 1419733141, Iran
| | - S M Javad Mortazavi
- Joint Reconstruction Research Centre, Tehran University of Medical Sciences, End of Keshavarz Blvd, Tehran, 1419733141, Iran.
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18
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Jensen AK, Chatzidionysiou K, Torp CK, Sørensen AS, Tenstad HB, Schäfer VS, Kostine M, Jacobsen S, Leipe J, Kragstrup TW. Comparison of immune checkpoint inhibitor-induced arthritis and reactive arthritis to inform therapeutic strategy. Biomed Pharmacother 2022; 148:112687. [PMID: 35228067 DOI: 10.1016/j.biopha.2022.112687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Immune checkpoint inhibitor-induced inflammatory arthritis (ICI-IA) is a relatively new disease entity caused by ICI agents during cancer therapy. Reactive arthritis (ReA) is a well-known disease entity caused by urogenital or gastrointestinal bacterial infection or pneumonia. In this sense, ICI-IA and ReA are both defined by a reaction to a well-specified causal event. As a result, comparing these diseases may help to determine therapeutic strategies. METHODS We compared ICI-IA and ReA with special focus on pharmacological management. Specifically regarding treatment, we conducted a literature search of studies published in the PubMed database. Inclusion criteria were studies on treatment with non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GC), or disease modifying antirheumatic drugs (DMARDs) in ICI-IA or ReA. During systematic selection, 21 studies evaluating ICI-IA and 14 studies evaluating ReA were included. RESULTS In ICI-IA, prospective and retrospective studies have shown effects of non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoid (GC), sulfasalazine (SSZ), methotrexate (MTX), hydroxychloroquine (HCQ) and TNFi. In ReA, retrospective studies evaluated NSAIDs and GC. A randomized controlled trial reported the effect of SSZ, and a retrospective study reported the effect of MTX and SSZ in combination with tumor necrosis factor alpha inhibition (TNFi). For both entities, small case reports show treatment effects of interleukin 6 receptor inhibition (IL-6Ri). DISCUSSION This literature review identified both similarities and differences regarding the pathogenesis and clinical features of ReA and ICI-IA. Studies on treatment reported effectiveness of NSAIDs, GC, MTX, SSZ and TNFi in both diseases. Further, small case reports showed effects of IL-6Ri.
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Affiliation(s)
- Anders Kirkegaard Jensen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Sygehus Lillebælt, Kolding, Denmark
| | - Katerina Chatzidionysiou
- Department of Medicine Solna, Karolinska Institutet, Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Valentin S Schäfer
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Marie Kostine
- Department of Rheumatology, Bordeaux, University, Hospital, France
| | - Søren Jacobsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen, Denmark; Department of Rheumatology, Rigshospitalet, Copenhagen, Denmark
| | - Jan Leipe
- Division of Rheumatology, Department of Medicine V, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Germany.
| | - Tue Wenzel Kragstrup
- Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
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19
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Shrestha S, Rottmann E, Kharel P, Lim F, Bulbin DH. Bilateral sacroiliitis following group C streptococcal sepsis. Proc AMIA Symp 2022; 35:344-345. [DOI: 10.1080/08998280.2022.2043678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Sanjeev Shrestha
- Department of Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | - Eva Rottmann
- Department of Rheumatology, Geisinger Medical Center, Danville, Pennsylvania
| | - Prakash Kharel
- Department of Hospital Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | - Francis Lim
- Department of Hospital Medicine, Geisinger Medical Center, Danville, Pennsylvania
| | - David Henry Bulbin
- Department of Rheumatology, Geisinger Medical Center, Danville, Pennsylvania
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20
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Quaytman J, Gollamudi U, Bass N, Suresh S. Reactive arthritis and silent thyroiditis following SARS-CoV-2 infection: Case report and review of the literature. Clin Case Rep 2022; 10:e05430. [PMID: 35154733 PMCID: PMC8819636 DOI: 10.1002/ccr3.5430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 11/17/2022] Open
Abstract
SARS-CoV-2 has been implicated in the development of reactive arthritis (ReA) days to weeks following exposure or infection. We present a case of ReA with enthesitis and subsequent silent thyroiditis in a patient following infection with SARS-CoV-2, along with a review of the published cases of SARS-CoV-2-related ReA.
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Affiliation(s)
- Jacob Quaytman
- Division of General Internal MedicineDepartment of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Usha Gollamudi
- Internal MedicineUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Noah Bass
- Division of Rheumatology and Clinical ImmunologyDepartment of MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Shashank Suresh
- Community MedicineUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
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21
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Jørgensen SL, Mechlenburg I. Effects of Low-Load Blood-Flow Restricted Resistance Training on Functional Capacity and Patient-Reported Outcome in a Young Male Suffering From Reactive Arthritis. Front Sports Act Living 2022; 3:798902. [PMID: 34988436 PMCID: PMC8720780 DOI: 10.3389/fspor.2021.798902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/02/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction: Reactive arthritis (ReA) is a chronic inflammatory disease usually caused by a preceding gastrointestinal or genitourinary bacterial infection. ReA usually occurs in the lower limbs causing joint pain and joint swelling. Physiotherapy-led exercise is recommended to prevent muscle atrophy. The purpose of this case report is to describe the outcome after 12 weeks of low-load blood flow restricted resistance training (BFR-RT) as a rehabilitation method for a young male suffering from ReA. Methods and materials: A 17-year-old male suffered from ReA in the both knee joints and the left hip joint. 36 months after the incident, he suffered from another ReA incident in his right knee. Non-steroid anti-inflammatory drugs and a new arthrocentesis added with corticosteroid injection was unsuccessful in treating the ReA. The patient performed 12 weeks of BFR-RT on the right lower limb with a low amount of supervision after the first week of training. Assessment of unilateral 30-sec chair stand test (u30-sec CST), low-thigh circumference above apex patella, The Knee Injury and Osteoarthritis Outcome Score (KOOS), The Forgotten Knee Joint Score (FJS), and Numeric Ranking Scale for pain (NRS) was performed at baseline and after 3,6,9, and 12 weeks of BFR-RT. Results: The patient completed all planned exercise sessions. u30-sec CST improved with 7 repetitions (reps) on the right limb and 5 reps on the left leg. Low-thigh circumference decreased 1.1 cm on the right leg and 1.0 on the left leg. KOOS symptoms, ADL, quality of life and FJS demonstrated a clinically relevant change on 10, 14 and 23 points. Conclusion: The present case study indicates that even with low amounts of supervision BFR-RT could increase functional performance, reduce knee joint swelling and improve key patient-reported outcome.
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Affiliation(s)
- Stian Langgård Jørgensen
- Department of Occupational and Physical Therapy, Horsens Regional Hospital, Aarhus, Denmark.,H-HIP, Horsens Regional Hospital, Horsens, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Inger Mechlenburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
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22
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Tonsillitis-Related Arthritis: Advanced Understandings of Tonsillitis and Sterile Inflammatory Arthritis. Case Rep Rheumatol 2022; 2021:2983267. [PMID: 34976425 PMCID: PMC8718286 DOI: 10.1155/2021/2983267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
A 49-year-old man developed acute aseptic arthritis of the nonmigratory and asymmetrical type in his knee, ankle, and bilateral metatarsal joints 13 days after treatment with antibiotics for acute tonsillitis. He was diagnosed with tonsillitis-related arthritis after other rheumatic diseases were ruled out. Treatment with salazosulfapyridine, methotrexate, and methylprednisolone for 3 months did not completely improve. Then, tonsillectomy was undertaken and arthritis rapidly improved. Finegoldia magna (previously Peptostreptococcus magnus) was cultured from the microabscesses of the resected tonsils. After outpatient follow-up, the patient did not experience a relapse of arthritis for more than 2.7 years without any treatment. Poststreptococcal reactive arthritis (PSRA) is well described. However, up to 40% of patients with tonsillitis-related arthritis did not demonstrate evidence of streptococcal infection. It is noted that tonsillectomy is necessary to remove the tonsillar microabscesses and eradicate bacterial infection of the tonsils, especially for patients with a prolonged and/or recurrent course of PSRA and/or tonsillitis-related arthritis.
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23
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Ananthanathorn P, Sukharomana M, Charuvanij S. Clinical profiles of post-infectious arthritis and transient synovitis of the hip in children. Pediatr Int 2022; 64:e15237. [PMID: 35938590 DOI: 10.1111/ped.15237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/09/2021] [Accepted: 05/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute inflammatory arthritides can present as a result of immune reaction following infections. Post-infectious arthritis and transient synovitis of the hip in children are included in this disease entity. The aim of this study was to describe the clinical profiles of post-infectious arthritis and transient synovitis of the hip in Thai children. METHODS A retrospective review was performed at a tertiary care hospital in Bangkok, Thailand from January 2005 to July 2017. RESULTS Eighty-six patients (56 boys and 30 girls) were included in this study. Mean age was 8.4 ± 4.8 years. Reactive arthritis was diagnosed in two patients (2.3%) following Salmonella spp. and Chlamydia trachomatis infections. Post-streptococcal reactive arthritis was present in 10 patients (11.6%). Transient synovitis of the hip was found in 30 patients (34.9%). Forty-four patients (51.2%) were clinically diagnosed with post-infectious arthritis. Mono/oligoarthritis was the most common clinical profile (84.9%). The distribution of lower-extremity involvement was as follows: hip, 47.6%; knee, 46.5%; and ankle joints, 30.2%. The documented preceding illness consisted mostly of upper respiratory tract symptoms (30.2%). Non-steroidal anti-inflammatory drugs were prescribed for 70 patients (81.4%). CONCLUSION Mono/oligoarthritis of the lower extremity was the main clinical profile. Preceding viral illness was documented in one-third of children. Reactive arthritis was rarely seen.
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Affiliation(s)
- Paween Ananthanathorn
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Maynart Sukharomana
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirirat Charuvanij
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Abstract
Reactive arthritis (ReA) following bacterial infection from the urogenital and gastrointestinal tract is widely described but is not typical post-viral infections. This report presents the second case of ReA after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the United States. A 45-year-old black male with chronic low back pain was hospitalized for 45 days with coronavirus disease 2019 (COVID-19), complicated due to the development of multiorgan failure managed with intubation, extracorporeal membrane oxygenation, and hemodialysis. He was subsequently discharged to an acute rehabilitation facility where he complained of new-onset pain in his shoulders, left elbow, and left knee three weeks after a negative SARS-CoV-2 test. He was readmitted from his acute rehabilitation facility due to recurrent fever and the development of a swollen, warm left knee. Laboratory studies at readmission showed elevated inflammatory markers, negative extensive infectious disease workup, and aseptic inflammatory left knee synovial fluid without crystals. Testing returned negative for most common antibodies seen in immune-mediated arthritides (e.g., rheumatoid arthritis, systemic lupus erythematosus), as well as for common respiratory and gastrointestinal tract pathogens responsible for viral arthritis. The multidisciplinary inpatient medical team deemed the clinical presentation and laboratory findings most consistent with ReA. The patient received a course of oral corticosteroids, followed by a second course due to the recurrence of symptoms weeks after initial treatment and recovery. The current body of medical literature on SARS-CoV-2 pathophysiology supports plausible mechanisms on how this infection may induce ReA. Such a scenario should be considered in the differential of COVID-19-recovered patients presenting with polyarthritis as prompt steroid treatment may help patient recovery.
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Affiliation(s)
- Faizal Ouedraogo
- Department of Medicine, University of Maryland Capital Region Health, Largo, USA
| | - Rachita Navara
- Division of Cardiology, Washington University School of Medicine, St. Louis, USA
| | - Rusha Thapa
- Medicine, Nepal Medical School, Kathmandu City, NPL
| | - Kunj G Patel
- Department of Physical Medicine and Rehabilitation, Barnes-Jewish West County Hospital, St. Louis, USA
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25
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Abstract
Reactive arthritis (ReA) is a form of inflammatory arthritis triggered by a remote antecedent infection, usually in the genitourinary or gastrointestinal tract. It is part of the spondyloarthropathy (SpA) spectrum, an umbrella term for a group of distinct conditions with shared clinical features. Typically, it presents with an asymmetric oligoarthritis of the lower limb joints, and patients may also have sacroiliitis, enthesitis and dactylitis. Other features often seen include anterior uveitis, urethritis and skin manifestations such as pustular lesions on the plantar areas. Although ReA was characterised initially as a sterile arthritis, the detection of metabolically active Chlamydia species in the joint fluid of some affected patients has generated further questions on the pathophysiology of this condition. There are no formal diagnostic criteria, and the diagnosis is mainly clinical. HLA-B27 can support the diagnosis in the correct clinical context, and serves as a prognostic indicator. The majority of patients have a self-limiting course, but some develop chronic SpA and require immunomodulatory therapy.
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Affiliation(s)
- Ameen Jubber
- Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK,
| | - Arumugam Moorthy
- Department of Rheumatology, University Hospitals of Leicester NHS Trust, Leicester; College of Life Sciences, University of Leicester, Leicester
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26
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Parida JR, Kumar S, Ahmed S, Chaurasia S, Mukherjee R, Singh R, Ravindran B, Aggarwal A, Misra R. Reactive arthritis and undifferentiated peripheral spondyloarthritis share human leucocyte antigen B27 subtypes and serum and synovial fluid cytokine profiles. Rheumatology (Oxford) 2021; 60:3004-3011. [PMID: 34144605 DOI: 10.1093/rheumatology/keaa746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/07/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Peripheral SpA (pSpA) is comprised of ReA, PsA, enteritis-associated arthritis and undifferentiated pSpA (upSpA). ReA and upSpA share T cell oligotypes and metabolomics in serum and SF. We investigated HLA-B27 subtypes and cytokines in serum and SF that were compared between ReA and upSpA. METHODS ReA and upSpA were compared in two cohorts. In cohort I (44 ReA and 56 upSpA), HLA-B27 subtyping was carried out. In cohort II (17 ReA and 21 upSpA), serum and SF cytokines were compared using a multiplex cytokine bead assay (27 cytokines). A total of 28 healthy controls with similar age and sex to cohort II were included for comparison of serum cytokine levels. RESULTS In cohort I, HLA-B27 was positive in 81.8% (36/44) of ReA and 85.71% (48/56) of upSpA patients. HLA-B27 typing was successful in 70 patients (30 ReA and 40 uSpA). HLA-B*2705 was the most common, followed by HLA-B*2704 and HLA-B*2707. Frequencies were the same between ReA and upSpA. In cohort II, 14 cytokines were detectable in the serum of patients. The levels of eight cytokines were higher than in the controls. The cytokine levels of ReA and upSpA were similar. Sixteen cytokines were detectable in the SF of patients. There was no statistical difference in the levels between ReA and upSpA. The cytokine profiles in sera and SF were also similar among HLA-B27-positive and negative patients. CONCLUSION ReA and upSpA have similar HLA-B27 subtype associations and similar cytokine profiles. They should be considered as a single entity during studies as well as clinical management.
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Affiliation(s)
- Jyoti Ranjan Parida
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.,Department of Clinical Immunology & Rheumatology IMS and SUM Hospital and Medical College, Bhubaneswar, India
| | - Sandeep Kumar
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.,Department of Medicine, Section Pulmonary Disease, Tulane University, New Orleans, LA, USA
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.,Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Smriti Chaurasia
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.,Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ratnadeep Mukherjee
- Infectious Disease Biology Group, Institute of Life Sciences, Bhubaneswar, India.,Immunodynamics Section, Laboratory of Integrative Cancer Immunology, Centre for Cancer Research -National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rajeev Singh
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.,ICMR-Regional Medical Research Centre, Ministry of Health and Family Welfare, Government of India, BRD Medical College Campus, Gorakhpur, India
| | - Balachandran Ravindran
- Institute of Life Sciences, Bhubaneswar, India.,Institute of Life Sciences, Bhubaneswar, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ramnath Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.,Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
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Post-COVID-19 Arthritis and Sacroiliitis: Natural History with Longitudinal Magnetic Resonance Imaging Study in Two Cases and Review of the Literature. Viruses 2021; 13:v13081558. [PMID: 34452422 PMCID: PMC8402767 DOI: 10.3390/v13081558] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 12/24/2022] Open
Abstract
Severe acute respiratory coronavirus-2 syndrome (SARS-CoV-2) is a well-known pandemic infectious disease caused by an RNA virus belonging to the coronaviridae family. The most important involvement during the acute phase of infection concerns the respiratory tract and may be fatal. However, COVID-19 may become a systemic disease with a wide spectrum of manifestations. Herein, we report the natural history of sacroiliac inflammatory involvement in two females who developed COVID-19 infection with mild flu-like symptoms. After the infection they reported inflammatory back pain, with magnetic resonance imaging (MRI) studies showing typical aspects of sacroiliitis. Symptoms improved with NSAIDs therapy over the following months while MRI remained positive. A literature review was performed on this emerging topic. To our knowledge, this is the first MRI longitudinal study of post-COVID-19 sacroiliitis with almost one year of follow-up. Predisposing factors for the development of articular involvement are unclear but a long-lasting persistence of the virus, demonstrated by nasopharyngeal swab, may enhance the probability of altering the immune system in a favourable background.
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Turner RA, Duke JN, Foran JRH. Giardia lamblia Reactive Arthritis Mimicking Acute Periprosthetic Knee Infection: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00040. [PMID: 34297707 DOI: 10.2106/jbjs.cc.21.00165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
CASE A healthy 49-year-old man with a well-functioning total knee replacement developed a painful swollen knee. The erythrocyte sedimentation rate was 12 mm/hour, and C-reactive protein was 20.3 mg/L. Aspiration revealed 24,440 white blood cells and 5% neutrophils. His 2018 International Consensus Meeting (ICM) definition score of 5 met criteria for "possibly infected." He was diagnosed with reactive arthritis (ReA) secondary to Giardia lamblia, mimicking acute periprosthetic infection. He was successfully treated with a 10-week course of multiple oral antiparasitic medications. CONCLUSION Systemic parasitic infectious ReA can mimic acute infection in the presence of total knee arthroplasty. Careful application of the 2018 ICM criteria can be critical for workup and the treatment of suspected periprosthetic infection.
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Affiliation(s)
- Rachael A Turner
- University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas
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Kobayashi S, Taniguchi Y, Kida I, Tamura N. SARS-CoV2-triggered acute arthritis: Viral arthritis rather than reactive arthritis. J Med Virol 2021; 93:6458-6459. [PMID: 34297354 PMCID: PMC8426820 DOI: 10.1002/jmv.27229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 01/07/2023]
Affiliation(s)
- Shigeto Kobayashi
- Department of Rheumatology and Internal MedicineJuntendo University Koshigaya HospitalSaitamaJapan
| | - Yoshinori Taniguchi
- Department of Endocrinology, Metabolism, and Nephrology, School of MedicineKochi UniversityNankokuJapan
| | - Issei Kida
- Department of Rheumatology and Internal MedicineJuntendo University Koshigaya HospitalSaitamaJapan
| | - Naoto Tamura
- Department of Internal Medicine and RheumatologyJuntendo UniversityTokyoJapan
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Pogreba-Brown K, Austhof E, Tang X, Trejo MJ, Owusu-Dommey A, Boyd K, Armstrong A, Schaefer K, Bazaco MC, Batz M, Riddle M, Porter C. Enteric Pathogens and Reactive Arthritis: Systematic Review and Meta-Analyses of Pathogen-Associated Reactive Arthritis. Foodborne Pathog Dis 2021; 18:627-639. [PMID: 34255548 DOI: 10.1089/fpd.2020.2910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The objective of this systematic review and meta-analysis was to estimate the proportion of postinfectious reactive arthritis (ReA) after bacterial enteric infection from one of four selected pathogens. We collected studies from PubMed, Web of Science, and Embase, which assessed the proportion of postinfectious ReA published from January 1, 2000 to April 1, 2018. Papers were screened independently by title, abstract, and full text; papers in English, Spanish, and Portuguese utilizing a case-control (CC) or cohort study design, with a laboratory confirmed or probable acute bacterial enteric infection and subsequent ReA, were included. The proportion of ReA cases was pooled between and across pathogens. Factors that can induce study heterogeneity were explored using univariate meta-regression, including region, sample size, study design, and ReA case ascertainment. Twenty-four articles were included in the final review. The estimated percentage of cases across studies describing Campylobacter-associated ReA (n = 11) was 1.71 (95% confidence interval [CI] 0.49-5.84%); Salmonella (n = 17) was 3.9 (95% CI 1.6-9.1%); Shigella (n = 6) was 1.0 (95% CI 0.2-4.9%); and Yersinia (n = 7) was 3.4 (95% CI 0.8-13.7%). Combining all four pathogens, the estimated percentage of cases that developed ReA was 2.6 (95% CI 1.5-4.7%). Due to high heterogeneity reflected by high I2 values, results should be interpreted with caution. However, the pooled proportion developing ReA from studies with sample sizes (N) <1000 were higher compared with N > 1000 (6% vs. 0.3%), retrospective cohort studies were lower (1.1%) compared with CC or prospective cohorts (6.8% and 5.9%, respectively), and those where ReA cases are identified through medical record review were lower (0.3%) than those identified by a specialist (3.9%) or self-report (12%). The estimated percentage of people who developed ReA after infection with Campylobacter, Salmonella, Shigella, or Yersinia is relatively low (2.6). In the United States, this estimate would result in 84,480 new cases of ReA annually.
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Affiliation(s)
- Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Erika Austhof
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Xin Tang
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Mario J Trejo
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Ama Owusu-Dommey
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Kylie Boyd
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Alexandra Armstrong
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Kenzie Schaefer
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | | | - Michael Batz
- U.S. Food and Drug Administration, College Park, Maryland, USA
| | - Mark Riddle
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Chad Porter
- Naval Medical Research Center, Silver Spring, Maryland, USA
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Zeidler H, Hudson AP. Reactive Arthritis Update: Spotlight on New and Rare Infectious Agents Implicated as Pathogens. Curr Rheumatol Rep 2021; 23:53. [PMID: 34196842 PMCID: PMC8247622 DOI: 10.1007/s11926-021-01018-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/11/2022]
Abstract
Purpose of Review This article presents a comprehensive narrative review of reactive arthritis (ReA) with focus on articles published between 2018 and 2020. We discuss the entire spectrum of microbial agents known to be the main causative agents of ReA, those reported to be rare infective agents, and those reported to be new candidates causing the disease. The discussion is set within the context of changing disease terminology, definition, and classification over time. Further, we include reports that present at least a hint of effective antimicrobial therapy for ReA as documented in case reports or in double-blind controlled studies. Additional information is included on microbial products detected in the joint, as well as on the positivity of HLA-B27. Recent Findings Recent reports of ReA cover several rare causative microorganism such as Neisseria meningitides, Clostridium difficile, Escherichia coli, Hafnia alvei, Blastocytosis, Giardia lamblia, Cryptosporidium, Cyclospora cayetanensis, Entamoeba histolytica/dispar, Strongyloides stercoralis, β-haemolytic Streptococci, Mycobacterium tuberculosis, Mycoplasma pneumoniae, Mycobacterium bovis bacillus Calmette-Guerin, and Rickettsia rickettsii. The most prominent new infectious agents implicated as causative in ReA are Staphylococcus lugdunensis, placenta- and umbilical cord–derived Wharton’s jelly, Rothia mucilaginosa, and most importantly the SARS-CoV-2 virus. Summary In view of the increasingly large spectrum of causative agents, diagnostic consideration for the disease must include the entire panel of post-infectious arthritides termed ReA. Diagnostic procedures cannot be restricted to the well-known HLA-B27-associated group of ReA, but must also cover the large number of rare forms of arthritis following infections and vaccinations, as well as those elicited by the newly identified members of the ReA group summarized herein. Inclusion of these newly identified etiologic agents must necessitate increased research into the pathogenic mechanisms variously involved, which will engender important insights for treatment and management of ReA. Supplementary Information The online version contains supplementary material available at 10.1007/s11926-021-01018-6.
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Affiliation(s)
- Henning Zeidler
- Division of Clinical Immunology and Rheumatology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Alan P Hudson
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MI, USA
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Mahran MA, Khalifa AA, Elsherif ME, Refai O. Neglected reactive arthritis complicated by bilateral hip and temporomandibular joints ankylosis after a suspected tetanus infection: a case report. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.1186/s43162-021-00044-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background
Reactive arthritis had been reported to occur after various vaccinations, including the tetanus toxoid vaccine; here, we report a case of ankylosing arthropathy suggested to be a complication of missed neglected reactive arthritis after tetanus infection.
Case presentation
A healthy 20-year-old woman presented with subtrochanteric right femoral fracture; imaging studies showed bilateral ankylosed hip, kyphoscoliosis, bilateral fused temporomandibular joints, and normal sacroiliac joints bilaterally. Laboratory investigations for a rheumatic or autoimmune disease were all within normal ranges. Detailed history revealed admission of the patient to an ICU unit (1 year before the trauma) for a month as she was diagnosed as having tetanus infection, after which she was unable to walk or feed herself. At the final follow-up, the patient started walking with a moderate limb after having a series of surgeries including femoral fracture fixation, temporomandibular joint excision arthroplasty, and bilateral total hip arthroplasty.
Conclusion
Unusual complications after tetanus infection can occur in the form of joint ankylosis, which could be presented after prolonged immobilization possibly due to improper management of reactive arthritis.
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Inflammatory Arthritis following Hepatitis B Vaccination in an Infant. Case Rep Rheumatol 2021; 2021:5598217. [PMID: 33880198 PMCID: PMC8046550 DOI: 10.1155/2021/5598217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/12/2021] [Accepted: 03/27/2021] [Indexed: 11/25/2022] Open
Abstract
Inflammatory arthritis in children may be idiopathic in nature or may be due to or follow infections. Rare reports identify inflammatory arthritis temporally related to vaccination in children. Herein, we describe the first reported case of an infant who developed inflammatory arthritis following hepatitis B vaccination. A 10-day-old female presented for evaluation of decreased movement of the right lower extremity and right knee swelling. Of note, the patient received a hepatitis B vaccine in her right thigh at birth. A workup found the patient to have a negative ANA but the presence of HLA B27. Findings resolved using ibuprofen. A literature review identified reports of what has been termed “reactive arthritis” in adult patients following the hepatitis B vaccine, frequently in association with HLA B27. No prior pediatric cases have been published. Healthcare providers must be aware of the rare development of postvaccination inflammatory arthritis.
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Treatment of reactive arthritis with biological agents: a review. Biosci Rep 2021; 40:222065. [PMID: 32039436 PMCID: PMC7033307 DOI: 10.1042/bsr20191927] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 02/02/2020] [Accepted: 02/05/2020] [Indexed: 12/31/2022] Open
Abstract
The pathogenesis of reactive arthritis (ReA) has not been fully elucidated. In recent years, many researchers have confirmed that multiple cytokines are involved in the occurrence and development of ReA. Although ReA is self-limiting, it is still incurable for some patients who have no or a weak response to traditional drugs, such as non-steroidal anti-inflammatory agents, glucocorticoids and immunosuppressive agents. This is called refractory reactive arthritis. Currently, there is insufficient evidences for the treatment of refractory ReA with biological agents, though biological agents against cytokines have been developed over the past few years. This review summarizes the current development of clinical treatments of ReA with biological agents, which provides future investigations on refractory ReA with more evidence and references.
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Kavadichanda CG, Geng J, Bulusu SN, Negi VS, Raghavan M. Spondyloarthritis and the Human Leukocyte Antigen (HLA)-B *27 Connection. Front Immunol 2021; 12:601518. [PMID: 33763060 PMCID: PMC7982681 DOI: 10.3389/fimmu.2021.601518] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/08/2021] [Indexed: 01/12/2023] Open
Abstract
Heritability of Spondyloarthritis (SpA) is highlighted by several familial studies and a high association with the presence of human leukocyte antigen (HLA)-B*27. Though it has been over four decades since the association of HLA-B*27 with SpA was first determined, the pathophysiological roles played by specific HLA-B*27 allotypes are not fully understood. Popular hypotheses include the presentation of arthritogenic peptides, triggering of endoplasmic reticulum (ER) stress by misfolded HLA-B*27, and the interaction between free heavy chains or heavy chain homodimers of HLA-B*27 and immune receptors to drive IL-17 responses. Several non-HLA susceptibility loci have also been identified for SpA, including endoplasmic reticulum aminopeptidases (ERAP) and those related to the IL-23/IL-17 axes. In this review, we summarize clinical aspects of SpA including known characteristics of gut inflammation, enthesitis and new bone formation and the existing models for understanding the association of HLA-B*27 with disease pathogenesis. We also examine newer insights into the biology of HLA class I (HLA-I) proteins and their implications for expanding our understanding of HLA-B*27 contributions to SpA pathogenesis.
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Affiliation(s)
- Chengappa G Kavadichanda
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Jie Geng
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Sree Nethra Bulusu
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vir Singh Negi
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Malini Raghavan
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, United States
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Handa R. Reactive Arthritis. Clin Rheumatol 2021. [DOI: 10.1007/978-981-33-4885-1_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is a novel virus that results in a variety of clinical manifestations. In this report, I describe an uncommon presentation of reactive arthritis (ReA) following COVID-19. I report the case of a 39-year-old woman who presented with arthritis in the small joints of the hands after recovery from COVID-19 infection. To my knowledge, only four cases involving such a presentation have been reported in the literature so far.
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Affiliation(s)
- Ibtisam Jali
- Medicine, King Abdulaziz University, Jeddah, SAU
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Abstract
Purpose of Review The aim of this paper is to provide an overview about reactive arthritis, with an update regarding pathophysiology and therapeutic approach of the disease, outlining the clinical features and diagnostic approach, based on recent literature review. Recent Findings Reactive arthritis is considered to be part of the spectrum of the spondyloarthritis. Its epidemiology is changing worldwide due to several reasons, among them are as follows: different diagnosis approach and clinical presentations, different grades of infection, microbiome changes, etc. The understanding of pathophysiological models is challenging, but recent studies contribute to elucidate the major factors involved in the development of the disease. The management of ReA depends on the triggering agent and the phase of disease, whether it is acute or chronic. Summary The association between the microbiome changes and spondyloarthropathies (ReA) is becoming increasingly evident. The results regarding the biologic treatment on refectory ReA are promising.
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Di Bartolomeo S, Carubbi F, Cipriani P. Hepatitis E Virus and rheumatic diseases: what do rheumatologists need to know? BMC Rheumatol 2020; 4:51. [PMID: 32974609 PMCID: PMC7504648 DOI: 10.1186/s41927-020-00149-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/26/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hepatitis E virus (HEV) represents the most common cause of acute hepatitis and jaundice in the world. About 2 million of infection cases occur each year in Europe, mainly as autochthonous anthropozoonosis, and HEV can be transmitted through undercooked pork meat. This infection has been linked to various extra-hepatic manifestations, while chronic infections with a rapid development of liver failure have been described in heavily immunosuppressed patients undergoing solid organ transplantations (SOTs), in patients with hematological diseases or with immunodeficiency virus infection. MAIN BODY OF ABSTRACT The purpose of this review article is to describe rheumatic manifestations related to HEV infection and their implications for rheumatologists in the daily clinical practice. Despite recent accumulating literature in this field, little is known about the course of the infection in patients with rheumatic diseases (RDs) and about the impact of immunosuppressive drugs. Moreover, HEV infection can mimic RDs' manifestations or drugs toxicity. Specific guidelines on management are lacking and the majority of data are referred to SOTs receivers. CONCLUSIONS More studies are needed to better understand the real impact of HEV infection in patients with RDs, regarding both clinical outcomes and their management.
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Affiliation(s)
- Salvatore Di Bartolomeo
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L’Aquila, L’Aquila, Italy
- Department of Medicine, ASL1 Avezzano-Sulmona-L’Aquila, L’Aquila and Sulmona, Italy
| | - Francesco Carubbi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L’Aquila, L’Aquila, Italy
- Department of Medicine, ASL1 Avezzano-Sulmona-L’Aquila, L’Aquila and Sulmona, Italy
| | - Paola Cipriani
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L’Aquila, L’Aquila, Italy
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Castro Rocha FA, Duarte-Monteiro AM, Henrique da Mota LM, Matias Dinelly Pinto AC, Fonseca JE. Microbes, helminths, and rheumatic diseases. Best Pract Res Clin Rheumatol 2020; 34:101528. [PMID: 32448639 PMCID: PMC7203059 DOI: 10.1016/j.berh.2020.101528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There has been a progressive interest on modifications of the human defense system following insults occurring in the interface between our body and the external environment, as they may provoke or worsen disease states. Studies suggest that billions of germs, which compose the gut microbiota influence one's innate and adaptive immune responses at the intestinal level, but these microorganisms may also impact rheumatic diseases. The microbiota of the skin, respiratory, and urinary tracts may also be relevant in rheumatology. Evidence indicates that changes in the gut microbiome alter the pathogenesis of immune-mediated diseases such as rheumatoid arthritis and ankylosing spondylitis but also of other disorders like atherosclerosis and osteoarthritis. Therapeutic strategies to modify the microbiota, including probiotics and fecal microbiota transplantation, have been received with skepticism, which, in turn, has drawn attention back to previously developed interventions such as antibiotics. Helminths adapted to humans over the evolution process, but their role in disease modulation, particularly immune-mediated diseases, remains to be understood. The present review focuses on data concerning modifications of the immune system induced by interactions with microbes and pluricellular organisms, namely helminths, and their impact on rheumatic diseases. Practical aspects, including specific microbiota-targeted therapies, are also discussed.
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Affiliation(s)
- Francisco Airton Castro Rocha
- Departamento de Medicina Clínica, Liga de Reumatologia e Doenças Autoimunes, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil.
| | - Ana Margarida Duarte-Monteiro
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHULN and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Licia Maria Henrique da Mota
- Hospital Universitário de Brasília, Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brazil
| | - Ana Carolina Matias Dinelly Pinto
- Departamento de Medicina Clínica, Liga de Reumatologia e Doenças Autoimunes, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - João Eurico Fonseca
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHULN and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
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Cozzi F, Galozzi P, Ciprian L, Zanatta E, Polito P, Oliviero F, Carrara M, Punzi L. Mud-bath treatment of seronegative spondyloarthritis: experience at the Euganean Thermal Area. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2020; 64:937-941. [PMID: 31342241 DOI: 10.1007/s00484-019-01761-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 05/19/2023]
Abstract
Mud-bath therapy (MBT) has been used as a treatment for rheumatic diseases and musculoskeletal complaints in the Euganean Thermal Area (near Padova, Italy) since ancient time. There is no consensus about the use of MBT in patients with inflammatory rheumatic diseases, although experimental studies have suggested a beneficial effect of MBT on chronic articular inflammation. To evaluate the effects of MBT in patients affected by seronegative spondyloarthritis, very common chronic inflammatory rheumatic diseases, randomized controlled trials (RCT) performed in the Euganean Thermal Area have been reviewed. A significant improvement of spondylitis parameters was observed in enteropathic spondylitis, without bowel symptom exacerbation. A long-term amelioration of clinical evaluation indices was found in ankylosing spondylitis. A significant improvement of cutaneous lesions, arthritis activity, and patient's functional ability was observed in psoriatic arthritis. MBT was usually well tolerated and adverse side effects were rarely reported. The review of the RCT suggests that MBT may exert additional beneficial effects in patients with seronegative spondyloarthritis treated with pharmacological therapy.
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Affiliation(s)
- Franco Cozzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy.
| | - Paola Galozzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Luca Ciprian
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Pamela Polito
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Francesca Oliviero
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Maria Carrara
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padua, Italy
| | - Leonardo Punzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padua, Italy
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Induction of HLA-B27–Associated Reactive Arthritis After a Wharton’s Jelly “Stem Cell” Injection. Am J Phys Med Rehabil 2020; 99:e142-e145. [DOI: 10.1097/phm.0000000000001418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Tuompo R, Lääveri T, Hannu T, Pakkanen SH, Kirveskari J, Leirisalo-Repo M, Kantele A. Reactive arthritis and other musculoskeletal symptoms associated with acquisition of diarrhoeagenic Escherichia coli (DEC). Ann Rheum Dis 2020; 79:605-611. [PMID: 32179576 PMCID: PMC7213310 DOI: 10.1136/annrheumdis-2019-216736] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 01/15/2023]
Abstract
Objectives Using a prospective research design, we evaluated the association between acquisition of diarrhoeagenic Escherichia coli (DEC) and development of reactive arthritis (ReA) and other reactive musculoskeletal (MSK) symptoms among international travellers. Methods A total of 526 study participants were asked to provide pretravel and post-travel stool samples and fill in questionnaires (pretravel, post-travel and 3-week follow-up). A multiplex quantitative PCR assay was deployed to detect five DEC comprising enteroaggregative E. coli, enteropathogenic E. coli, enterotoxigenic E. coli, enterohaemorrhagic E. coli and enteroinvasive E. coli and Salmonella, Shigella, Campylobacter, Yersinia, and Vibrio cholerae. Multivariate analysis was employed to identify factors predisposing to MSK symptoms. New post-travel MSK symptoms reported by participants with DEC were assessed by phone interviews and, if needed, clinically confirmed. Results From among the total of 224 volunteers who returned all questionnaires and stool specimens, 38 (17.0%) reported MSK symptoms. Multivariate analysis revealed that acquisition of DEC was associated with MSK symptoms (OR 3.9; 95% CI 1.2 to 13.3). Of the 151 with only-DEC, four (2.6%) had ReA, two (1.3%) reactive tendinitis and three (2.0%) reactive arthralgia. ReA was mostly mild, and all patients with ReA were negative for human leucocyte antigen B27. Antibiotic treatment of travellers’ diarrhoea did not prevent development of MSK symptoms. Conclusion A total of 17% of volunteers reported post-travel MSK symptoms. DEC acquisition was associated with an increased risk of developing them, yet the ReA incidence remained low and the clinical picture mild. Antibiotic treatment did not protect against development of MSK symptoms.
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Affiliation(s)
- Riitta Tuompo
- Inflammation Center, Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tinja Lääveri
- Inflammation Center, Department of Infectious diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Timo Hannu
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Sari H Pakkanen
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Juha Kirveskari
- Department of Bacteriology, Helsinki University Hospital Laboratory, Helsinki, Finland.,Mobidiag Ltd, Espoo, Finland
| | - Marjatta Leirisalo-Repo
- Inflammation Center, Department of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Kantele
- Inflammation Center, Department of Infectious diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
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Fairhead CE, Hampson A, Dwyer-Hemmings L, Vasdev N. Is Non-Chlamydial Non-Gonococcal Urethritis Associated with Significant Clinical Complications in Men? A Systematic Review. Curr Urol 2020; 14:1-13. [PMID: 32398991 PMCID: PMC7206600 DOI: 10.1159/000499266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND It is estimated that between 50 and 89% of non-gonococcal urethritis is not caused by Chlamydia trachomatis. Associations between non-chlamydial non-gonococcal urethritis (NCNGU) with balanoposthitis, epididymo-orchitis and reactive arthritis have been suggested, but evidence to support these often-theoretical relationships is sparse and further investigation is called for. Concerns over increasing antimicrobial resistance has rendered the need for clarity over this question ever more pressing in recent years. A review of the current evidence on the complications of NCNGU in men is therefore urgently warranted. OBJECTIVE This systematic review summarizes and evaluates the available evidence that NCNGU, whether symptomatic or asymptomatic, causes the significant complications that are already well-recognized to be associated with non-gonococcal urethritis. These significant complications are epididymo-orchitis, balanoposthitis, and sexually-acquired reactive arthritis (Reiter's syndrome) including arthritis or conjunctivitis. SUMMARY We conducted a systematic review and qualitative synthesis using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. Five databases (PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and British Nursing Index) were searched. We included studies that measured clinical outcome after diagnosis of NCNGU in men. Bias was assessed using variations of the Newcastle-Ottawa scale. Data were extracted and entered into a pre-written data abstraction proforma. Seven peer-review studies were included. This included 2 retrospective cohort studies, 1 case series, 2 case reports and 2 cross-sectional studies. The studies described and analyzed 3 types of complication: balanitis, posthitis and/or meatitis; reactive arthritis and/or conjunctivitis; and epididymitis. All studies reported one or more complications. KEY MESSAGES This review identifies an important avenue for future research: while the available evidence suggests that NCNGU has the potential to cause significant complications in men, with the strongest evidence existing for balanitis, posthitis and/or meatitis, the nature and significance of these relationships is far from clear. The findings of this review suggest that prospective, adequately powered research into whether there is a causal link between NCNGU and significant clinical complications in men would be highly worthwhile. The findings of this review raise important questions about the utility of the term NCNGU in research and clinical practice.
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Affiliation(s)
- Cassandra E.L. Fairhead
- University College London Medical School, London
- East and North Hertfordshire NHS Trust, Department of Urology, Lister Hospital, Stevenage
| | - Alexander Hampson
- East and North Hertfordshire NHS Trust, Department of Urology, Lister Hospital, Stevenage
| | - Louis Dwyer-Hemmings
- University College London Medical School, London
- East and North Hertfordshire NHS Trust, Department of Urology, Lister Hospital, Stevenage
| | - Nikhil Vasdev
- East and North Hertfordshire NHS Trust, Department of Urology, Lister Hospital, Stevenage
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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Sharma M, Sharma S, Sharma A, Sharma K. Chlamydia Trachomatis Associated Reactive Arthritis: A Urinary PCR Based Study. Indian Dermatol Online J 2020; 11:21-24. [PMID: 32055503 PMCID: PMC7001391 DOI: 10.4103/idoj.idoj_410_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and Objective: Chlamydia trachomatis is increasingly being associated with reactive arthritis (ReA). The present study was undertaken to assess the role of C. trachomatis in patients with ReA since such data is lacking from the Indian population. Materials and Methods: PCR using specific primers for C. trachomatis was carried out from urine samples of 65 patients with ReA, 20 of other inflammatory arthritis, and 20 healthy controls. Results: C. trachomatis DNA was detected from urinary samples with PCR in 24 (36%) of 65 ReA patients. PCR was negative in the patients of other inflammatory arthritis as well as in normal healthy control group. Out of the 24 patients with urinary PCR positivity, 14 (58.33%) were males and 10 (41.66%) were females. Conclusion: Urinary PCR plays an important role in rapid diagnosis of ReA associated with C. trachomatis.
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Affiliation(s)
- Megha Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Susmita Sharma
- Department of Obstetrics and Gynaecology, Adesh Medical College and Hospital, Mohri, Haryana, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kusum Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Klonowski A, Schwarting A. [Infection-triggered arthralgia and arthritis]. MMW Fortschr Med 2020; 162:39-42. [PMID: 32016764 DOI: 10.1007/s15006-020-0104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Anna Klonowski
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin Mainz, Langenbeckstr. 1, D-55131, Mainz, Deutschland
| | - Andreas Schwarting
- Schwerpunkt Rheumatologie und klinische Immunologie, Universitätsmedizin Mainz, Langenbeckstr. 1, D-55131, Mainz, Deutschland.
- ACURA Rheumakliniken Rheinland-Pfalz, Bad Kreuznach, Deutschland.
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PECULIARITIES OF TLR9 EXPRESSION ON IMMUNE COMPETENT CELLS IN REACTIVE ARTHRITIS PATIENTS WITH CHRONIC EPSTEIN-BARR VIRUS INFECTION. WORLD OF MEDICINE AND BIOLOGY 2020. [DOI: 10.26724/2079-8334-2020-1-71-83-88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
PURPOSE OF REVIEW Recent studies regarding the frequency of Chlamydia-induced reactive arthritis (ReA) are reviewed, with a focus on the question of whether the entity is in fact disappearing or whether it is simply being underdiagnosed/underreported. Epidemiological reports indicate diversity in the frequency of Chlamydia-associated ReA in various parts of the world, with evidence of declining incidence in some regions. RECENT FINDINGS The hypothesis that early effective treatment with antibiotics prevents the manifestation of Chlamydia-associated ReA requires further investigation. For clinicians, it is important to remember that ReA secondary to Lymphogranuloma venereum (LGV) serovars L1-L3 of C. trachomatis is probably underestimated due to a limited awareness of this condition, the re-emergence in Western countries of LGV overall, and the present increasingly rare classical inguinal presentation.
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Alpay-Kanıtez N, Çelik S, Bes C. Polyarthritis and its differential diagnosis. Eur J Rheumatol 2019; 6:167-173. [PMID: 31657698 DOI: 10.5152/eurjrheum.2019.19145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/13/2019] [Indexed: 01/31/2023] Open
Abstract
Polyarthritis is a term used when at least five joints are affected with arthritis. Several different diseases ranging from rheumatoid arthritis to infection diseases can lead to polyarthritis. Anamnesis, physical examination, laboratory findings and imaging methods are important tools to differential diagnosis.
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Affiliation(s)
- Nilüfer Alpay-Kanıtez
- Division of Rheumatology, Department of Internal Medicine, Koç University School of Medicine, İstanbul, Turkey
| | - Selda Çelik
- Division of Rheumatology, Department of Internal Medicine, University of Health Sciences Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Cemal Bes
- Division of Rheumatology, Department of Internal Medicine, University of Health Sciences Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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