Background Timely diagnostics of inflammatory rheumatic diseases, particularly of Reactive Arthritis (ReA), and the development of reasonable management methods for their course are of a high importance in practice rheumatology, which are needed for early ethiotropic and pathogenetic treatment.
Objectives Study course features of the urogenital ReA and causes of its misdiagnosis.
Methods We have conducted 86 patients being admitted to the rheumatologic department of the 1st Clinic of Tashkent Medical Academy with directional diagnosis of ReA. 86 patients were divided into 48 men and 38 women aged 19 to 49 years old, with the disease duration of 1 month to 5 years. Acute course was observed in 17 patients, subacute course in 44, and chronic course of the disease in 25 patients. Disease progression after urogenital infection of the urinary tract was established in 58 cases, enterocolitic form in 18 cases, mixed form of ReA in 10 cases. To detect the urogenital chlamydial infection, we used a method of the indirect immunofluorescence of urethral or endocervical smear, and method of DNA diagnostics, when necessary. Patients with enterocolitic form of ReA were conducted with bacteriological stool test.
Results The classic disease presentation, including arthritis, eyes and genital tract impairment was established in 47 of 58 cases. Among them, all 14 patients suffered from acute, 30 of 33 from subacute, 11 of 14 from chronic form of ReA. As to the misdiagnoses at onset of the disease, 1 patient was diagnosed with gout, 3 with rheumatoid arthritis, and 1 patient over 35 years old was diagnosed with osteoarthritis. All patients had involvement of the lower limbs joints in the pathological process. The oligoarthritis prevailed in acute and sub-acute ReA (80% and 92.8% of cases respectively). Monoarthritis was observed only in 20% cases with acute form of the disease. In the chronic disease course, polyarthritis prevailed with symmetric and asymmetric forms, which were observed in 62.8%; and the oligoarthritis in 37.2% cases. All patients during hospitalization or in history mentioned eyes impairment, which, according to our observations, was course independent.
Conclusions Thus, timely diagnosis and adequate management requires distinctive knowledge of ReA clinical presentation and taking into account the course of the disease, and use of existing diagnostic criteria. Difficult diagnostic situations should be extended with case follow-up.
Disclosure of Interest None declared
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