How to treat chlamydial arthritis: symptoms and signs of the disease, diagnosis, treatment methods

Joints affected by chlamydial arthritis.
Chlamydial arthritis is a rheumatic pathology, which is characterized by combined damage to the urogenital tract, joints, and mucous membranes of the eyes. Simultaneous damage to these structures is rarely diagnosed. The disease clinically manifests itself gradually, causing dysuric disorders, conjunctivitis, arthralgia, and joint stiffness. Chlamydial arthritis occurs as a result of an autoimmune process that develops against the background of a urogenital infection.

To detect pathology, laboratory methods are used - PCR, examination of synovial fluid, serological reactions. X-rays, MRI, and CT help to identify damage that has occurred in the synovial membrane, joint capsule, and ligamentous-tendon apparatus. The therapy uses drugs of various clinical and pharmacological groups - antibiotics, NSAIDs, immunomodulators, glucocorticosteroids. If you seek medical help in a timely manner, the prognosis for full recovery is favorable.

Joints affected by chlamydial arthritis.

Causes

The leading etiological agent of chlamydial arthritis is chlamydia. These causative agents of urogenital chlamydia - Chlamydia trachomatis - are small bacteria that parasitize human cells. After entering the body, they remain in it for a long time without manifesting themselves. But with a sharp decrease in immunity, pathogenic microorganisms begin to actively multiply, releasing toxic products of their vital activity into the surrounding space. Chlamydia is most often transmitted sexually, and the arthritis of the same name is diagnosed in 80% of men and 15-20% of women. Pathology is detected extremely rarely in children.

The role of infectious agents in the etiopathogenesis of reactive aseptic arthritis lies in the molecular similarity of their antigens to human autoantigens. Having penetrated the joints, microorganisms begin to multiply rapidly, but this is not the cause of the development of the inflammatory process. After their detection, the immune system produces specific proteins - antibodies, necessary to destroy pathogenic bacteria. But the similarity of the protein structures of microorganisms with the tissues of cartilage, synovial membranes, ligaments, and tendons leads to an attack by antibodies on the body’s own cells. This becomes the impetus for the development of chlamydial arthritis, which has an autoimmune etiology. Thus, the inflammatory process in the joints is caused not by the infectious agents themselves, but by the reaction of the immune system to their invasion.

Not every infected person develops chlamydial arthritis. The penetration and persistence of microbes is facilitated by the anatomical and histological uniqueness of articular tissues. Migration of antigen-presenting cells from the systemic circulation is facilitated by:

• fenestrated (with thin endothelium and pores in endothelial cells) synovial capillaries;
• presence of cell adhesion molecules.

Antigens are fixed by chondrocytes and synoviocytes, which leads to various immunological reactions - cell growth factors, cytokines, inflammatory mediators are produced, and the concentration of toxic oxygen radicals and nitric oxide increases. Chlamydial arthritis is diagnosed in patients who are hereditarily predisposed to it and have a special structure of joint tissue.

Clinical picture

Chlamydial infection is asymptomatic for a long time. In the future, it can clinically manifest itself in women as cervicitis, salpingitis, adnexitis, cystitis, proctitis, sluggish endometritis, and adhesions in the pelvic organs. Pharyngitis, conjunctivitis, and uveitis are also detected. Women often experience dull, nagging pain in the lower abdomen, especially during sexual intercourse. The symptoms of chlamydia differ in men. They often suffer from conjunctivitis, uveitis, urethritis, balanitis or balanoposthitis, prostatitis, proctitis and epididymitis during sexual activity.

Chlamydial arthritis is often accompanied by intra-articular symptoms. These are specific signs of myocarditis, pericarditis, rhythm disturbances, conduction disturbances, relative aortic valve insufficiency, bronchiolitis. Pathogenic microorganisms provoke the development of pyelonephritis, erythema nodosum, and renal amyloidosis. Characteristic symptoms of joint pathology:

• pain in one or more joints that gets worse during movement or when lifting heavy objects;
• painful sensations of varying variability at rest as the pathology progresses;
• swelling, redness of the skin in the area of ​​the affected joints;
• the skin is constantly hot to the touch due to the involvement of soft tissues in the inflammatory process;
• pain on palpation;
• development of protective contractures - restrictions on passive movements in the joint, inadequate flexion or extension;
• spasm of skeletal muscles in the affected area;
• accumulation of pathological exudate in the joint;
• morning swelling and stiffness of movement.

Swelling and morning stiffness of the joints are one of the signs of pathology.
Symptoms of chlamydial arthritis are mild during the remission stage. During relapses, their intensity increases significantly. Often there are signs of general intoxication of the body - body temperature rises, sweating increases, chills and cold sweat appear. A person suffers from gastrointestinal disorders - excessive gas formation, nausea, lack of appetite. Headaches, dizziness, weakness, fatigue, and sleep disorders may occur.

Chlamydial arthritis is characterized by asymmetric joint damage. First, one joint is damaged, usually the ankle or knee. If the patient does not seek medical help, he will soon be diagnosed with polyarthritis - multiple combined joint injuries. The skin of the palms and soles is often affected, similar to keratoderma. The dermis becomes keratinized with the formation of dense plaques. With chlamydial arthritis, the structure and color of the nail plates also change, and the lymph nodes become enlarged, especially in the groin area.

The condition of nails with chlamydial arthritis worsens.

A blow to the joints - Chlamydia!

There may be cases where one of the symptoms is absent. Usually the disease is caused by chlamydia, which entered the body through sexual contact. As a rule, victims of Reiter's disease are men (women and children get sick less often). In the case of the traditional version of Reiter's syndrome, there are usually no difficulties in diagnosis. If the process manifests itself only as inflammation of the joints, it happens that it is sometimes confused with rheumatoid arthritis, a disease that needs to be treated differently.

Pain in the joints and spine begins approximately two weeks after infection. The first joints to suffer are the knees and small joints located below. Moreover, each leg has its own set of inflamed joints. The skin over them turns red, sometimes acquiring a bluish tint, and becomes hot to the touch. The pain is worse at night and in the morning. If the toes are affected, they take on a characteristic “sausage” appearance. But the “trademark” of Reiter's disease is pain under the heel when walking. At the same time, pain begins in the lower part of the spine, similar to that which occurs with radiculitis.

If treatment is not started or is carried out incorrectly, arthritis may be accompanied by skin lesions on the palms and feet and atrophy of the muscles adjacent to the affected joints. Malaise, fever, slightly elevated temperature and weakness last for months, then for one or two years the disease may seem to disappear, but then returns again.

Treatment of Reiter's syndrome is a long process that requires persistence. With the right approach, recovery occurs within four to six months. The main goal of therapy is to eliminate chlamydia from the body with the help of appropriate antibiotics.

At the same time, it is necessary to normalize the immune system and suppress inflammatory and allergic reactions. The main treatment is carried out by a rheumatologist specializing in this infection; local inflammatory foci are treated by a urologist or gynecologist and, if necessary, an ophthalmologist.

To avoid relapses, you need to make sure that the infection is over. To do this, wait 3-4 weeks after taking antibiotics and do tests.

The so-called immunofluorescence analysis is inexpensive and quite reliable. Sometimes they resort to diagnostic isolation of chlamydia in cell culture or turn to the new, most accurate (but also the most expensive) polymerase chain reaction (PCR) method.

To be completely confident in the results of treatment, tests should be repeated over the next three months. If they turn out to be negative, then in the future you can limit yourself to annual visits to your doctor. Since immunity against re-infection is not developed, prudence and discrimination in sexual intercourse are an important (if not the main) factor in preventing relapse of the disease.

The genital tract is not the only portal for infection. Unwashed hands and household items (such as a towel) contaminated with the patient's secretions can cause conjunctivitis. In newborns, damage to the eyes and nasopharynx by chlamydia occurs as a result of infection during the passage of the fetus through the affected cervix.

Advanced chlamydia in women often leads to infertility caused by obstruction of the fallopian tubes and causes miscarriages, as well as undeveloped pregnancies.
To avoid severe complications of chlamydia, you should consult a doctor at the first signs of inflammation of the genitourinary tract (even if they are slightly disturbing).

Diagnostics

A rheumatologist, venereologist, urologist, ophthalmologist, and gynecologist are often involved in diagnosing joint pathology. Suspicion of the development of chlamydial arthritis arises when examining the patient based on characteristic external signs - redness of the eyes, swelling of the affected joints and lymph nodes. Detailed general clinical examinations of blood and urine are prescribed. After carrying out a three-glass test, Addis-Kakovsky, Nechiporenko tests, pus is detected in the urine, which indicates the presence of pathogenic microorganisms (leukocyturia). When examining prostatic secretions, an increased concentration of leukocytes is revealed against the background of a decrease in the number of lecithin bodies. In the blood of a patient with chlamydia, the number of alpha and beta globulins, fibrin, seroglycoids, and C-reactive protein is always increased. However, the test for the presence of rheumatoid factor is negative. Cytological studies of the following biological samples are required:

• scrapings of the urethra, cervix;
• part of the lacrimal secretion of the conjunctiva;
• synovial exudate;
• sperm;
• prostate secret.

The samples contain chlamydial intracellular cytoplasmic inclusions. The polymerase chain reaction method detects the DNA of an infectious agent in biological material. The presence of microorganisms in the blood can be determined by performing one of the serological reactions.

After taking synovial fluid from joints affected by pathology using puncture, changes in its qualitative and quantitative composition are detected. The mucin residue is loose, the concentration of leukocytes and the proportion of neutrophilic granulocytes are increased. Cytophagocytic macrophages, chlamydial antigens and antibodies, and increased complement activity are detected in the blood.

Paraarticular asymmetrical osteoporosis, narrowing of joint spaces, erosive bone destruction are established by radiographic photographs. Most often, the feet and vertebral bodies undergo degenerative changes. A third of patients are diagnosed with inflammation of the sacroiliac joints.

Asymmetrical osteoporosis.

Chlamydia (chlamydial infection) - symptoms and treatment

In 50% of men and 80% of women, chlamydial infection is asymptomatic [3]. In other cases, clinical symptoms depend on the location of the primary infection [4].

Symptoms of chlamydia in men

In men, a manifestation of chlamydial infection is urethritis - inflammation of the urethra, manifested by slight mucopurulent discharge from the urethra, which, as a rule, is detected only after prolonged urinary retention. The “sponges” of the external opening of the urethra are moderately hyperemic and edematous. Pain and itching in the urethra are often absent.

Annular balanitis is an inflammation of the glans penis. It appears in the form of ring-shaped rashes of round or irregular shape, often with microerosions and scales on the surface. Most often it is a symptom of reactive arthritis, but, as observations show, it can be an independent manifestation of chlamydia.

Symptoms of chlamydia in women

A symptom of chlamydia in women is endocervicitis - inflammation of the cervical canal. Endocervicitis occurs with purulent mucous discharge from the vagina, abnormal bloody discharge not associated with menstruation (for example, during or after sexual intercourse). Other symptoms of chlamydia in women include dyspareunia (pain during sexual intercourse), rarely dysuria (frequent and painful urination) and pain in the pubic area and lower abdomen. When examining the cervix in the speculum, its swelling and hyperemia (redness), scanty mucous or purulent discharge from the cervical canal, and rarely erosion are revealed.

Proctitis is inflammation of the rectal mucosa. Occurs in both sexes due to infection during anal intercourse. It manifests itself as pain, burning or itching in the anus, bloody or mucopurulent discharge from the rectum, and less commonly, tenesmus (painful urge to defecate).

Pharyngitis is an inflammation of the back wall of the pharynx. It occurs in both sexes as a result of infection through oral sexual contact and is manifested by dryness and pain in the throat that worsens when swallowing. Upon examination, redness and swelling of the mucous membrane of the posterior wall of the pharynx and tonsils are revealed. In most cases it is asymptomatic.

Conjunctivitis is an inflammation of the mucous membrane of the conjunctiva of the eye. In newborns it occurs in the first two weeks after birth due to passage through the birth canal of a sick mother. In adults - when carrying infected discharge from the genitals by hand and with Reiter's syndrome due to autoimmune processes. Transmission of chlamydia from an infected mother to a newborn occurs in 50-60% of cases. The main symptoms are burning, pain, photophobia, conjunctival hyperemia, periorbital edema, and the presence of mucopurulent discharge from the eyes.

Chlamydia in children

Children become infected perinatally and through sexual contact; in exceptional cases, young girls can become infected due to violation of personal hygiene rules [22].

Chlamydia can affect the mucous membranes of the vulva and vagina. Symptoms of infection in children and adults are similar, but in girls they are more pronounced. This is due to the fact that the mucous membranes of the vulva and vagina are more affected.

Pneumonia is an inflammation of the lungs that occurs exclusively in newborns. Develops in the first 3 months after birth due to aspiration of infected material when passing through the birth canal of a sick mother. The infection is transmitted in 10-20% of cases. Symptoms are similar to pneumonia caused by other bacterial agents.

Basic treatment methods

To avoid re-infection, simultaneous therapy of the sexual partner is carried out. The main goals of treatment for chlamydial arthritis are:

• destruction of pathogenic microorganisms - chlamydia, activated bacteria and (or) fungi of opportunistic biocenosis;
• reduction and then complete elimination of the severity of articular and extra-articular clinical manifestations;
• treatment of negative consequences that have arisen.

To eliminate infectious agents, patients are prescribed antibiotic therapy with Doxycycline. Treatment regimens include antibacterial agents from other groups. These are fluoroquinolones (Lomefloxacin, Ofloxacin, Ciprofloxacin), macrolides (Erythromycin, Clarithromycin, Azithromycin), semisynthetic penicillins with clavulanic acid (Panclave, Augmentin, Amoxiclav).

After antibiotic therapy, eubiotics are used to stimulate the growth of beneficial lacto- and bifidobacteria - Hilak Forte, Bifidumbacterin, Lactobacterin, Linex, Acipol. Since chlamydia affects internal organs along with joints, patients are recommended to take hepatoprotectors (Essentiale Forte, Karsil, Essliver Forte), proteolytic enzymes (Pancreatin, Trypsin, Chymotrypsin).

The activity of pathogenic fungi often increases against the background of a changed composition of the intestinal and vaginal microflora. To correct this condition, antimycotic agents are used, usually Fluconazole, Nystatin, Clotrimazole.

To normalize the immune response to the introduction of infectious agents, immunocorrective therapy is carried out. Drugs with interferon or those that stimulate its production are used. Patients are prescribed adaptogens (ginseng, eleutherococcus), which increase the body's resistance to external and internal negative factors. For the same purpose, a course of balanced complexes of vitamins and microelements (Centrum, Vitrum, Selmevit, Complivit, Multitabs) is recommended.

Severe attacks of chlamydial arthritis are stopped by detoxification and antihistamine therapy. In particularly difficult cases, extracorporeal hemocorrection (plasmapheresis, cascade plasma filtration, cryoapheresis) is used. To eliminate the articular symptoms of chlamydial arthritis, drugs of various clinical and pharmacological groups are used:

• non-steroidal anti-inflammatory drugs - Diclofenac, Nimesulide, Celecoxib, Meloxicam, Ketoprofen, Ibuprofen;

• glucocorticosteroids - Triamcinolone, Dexamethasone, Diprospan, Flosteron, Kenalog in the form of drug blockades in combination with the anesthetics Lidocaine or Novocaine;

• muscle relaxants - Baklosan, Sirdalud, Mydocalm for muscle spasms, contractures;

• basic agents - Sulfosalazine, Methotrexate to eliminate rheumatoid clinical manifestations;
• Dimexide in the form of compresses for inflammatory edema;

• ointments with analgesic and anti-inflammatory effects (Finalgel, Nise, Fastum, Voltaren, Nurofen);

• chondroprotectors - Teraflex, Structum, Artra for the regeneration of cartilage, ligaments, tendons.

The therapy is complemented by physiotherapeutic procedures - phonophoresis with one of the proteolytic enzymes, electrophoresis with analgesics, magnetic therapy, laser therapy, UHF therapy. At the rehabilitation stage, patients are shown massage, daily exercise therapy or gymnastics.

Physical therapy for arthritis patients.

Chlamydial arthritis responds well to treatment, especially if you seek medical help in a timely manner. If all medical recommendations are followed, it is completely cured within a few weeks.