Causes and symptoms of reactive arthritis in children, methods of treating the disease
Reactive arthritis (RA) is inflammation of the joints, which is secondary in nature and develops after a non-articular infection. Previously it was believed that with this disease microbes in the joint cavity are not detected. Modern science has proven that with RA, it is possible to identify pathogen antigens in the synovial membrane or fluid with the help of special research methods.
Among children under 18 years old, RA develops in about 30 out of 100,000 people for the first time. The prevalence of this disease is 87 cases per 100,000 children. Among all rheumatic diseases in childhood, the proportion of RA is 40–50%. Thus, reactive arthritis (not to be confused with rheumatoid!) Is a fairly common joint disease in children.
The tendency to develop RA is genetically determined and is associated with the presence in humans of the so-called histocompatibility antigen HLA B27.
Immediate causes of RA:
- urogenital infection (chlamydia, ureaplasma),
- intestinal infection (shigella, salmonella, campylobacter, yersinia),
- damage to the respiratory tract (mycoplasma and a special type of chlamydia - Clamidia pneumoniae).
Most cases of RA in children are caused by chlamydial infection. It can enter the child’s body through airborne droplets, through the household contact path or with dust particles, as well as passing through the birth canal. Sexual transmission can occur in adolescents.
Chlamydia in the body quickly get inside the cells, where they persist for a long time. Often in these patients the immune response is altered, which contributes to the chronization of the disease. In the presence of genetic predisposition in a child with chronic chlamydial infection develops RA.
The development of RA after intestinal infection is also associated with genetic changes, as well as with the body's cross-reaction to bacterial antigens and tissue of its own organism.
The classic manifestation of RA in children is Reiter's syndrome: urethritis, conjunctivitis, arthritis. It begins 14 to 28 days after the infection. First develops a lesion of the genitourinary system, then the eyes, and then the joints.
Urogenital symptoms are mild. Boys develop inflammation of the foreskin and phimosis appears. In girls, vulvitis, vulvovaginitis, cystitis develops, leukocytes are found in the urine. Such manifestations can occur several months before the development of arthritis, which makes diagnosis difficult.
Damage to the eyes is more often manifested by conjunctivitis, which quickly passes but is prone to recurrence. Yersiniosis causes severe suppurative inflammation. Approximately one third of all patients develop iridocyclitis, a complication of which may be loss of vision. Such signs may also develop long before the joints are damaged.
Arthritis affects one or more joints of the lower extremities: the knee, ankle, joints of the toes. It develops acutely, sometimes accompanied by fever, reddening of the skin over the joints, their swelling. In other cases, the manifestations of arthritis are not so pronounced, but constantly recur. Typical is the defeat of the first finger, "sausage" deformation of the toes due to swelling and redness of the skin.
In adolescent boys, pain in the places of attachment of tendons, pain in the heel, stiffness in the cervical spine and lower back, lesion of the ileosacral joints quite often join. Such patients have a high risk of developing juvenile ankylosing spondyloarthritis.
Additional signs of RA in children are changes in the skin of the palms and feet (keratoderma), psoriasis-like rash, and ulceration of the oral cavity (gingivitis, stomatitis), which often goes unnoticed.
In severe cases, lymph nodes, liver, spleen, heart, aorta are affected.
Sometimes, RA is manifested only by articular syndrome without damaging the eyes and urinary tract. In this case, its diagnosis is difficult.
With prolonged (from 6 months to a year) or chronic (more than a year) course in children, there is a lesion of the spine, joints of the upper limbs. Arthritis often becomes symmetrical. These children are likely to develop juvenile ankylosing spondylitis.
Diagnosis of RA is based on the identification of pathogens or antibodies to them, a characteristic clinical picture with extra-articular manifestations. It is necessary to differentiate RA with infectious arthritis (viral, tuberculosis, post-streptococcal, septic, Lyme disease), juvenile rheumatoid arthritis, juvenile ankylosing spondylitis, orthopedic diseases (Perthes disease, Osgud-Schlatter, Calve).
For the treatment of chlamydial infection in children, macrolide antibiotics (azithromycin, spiramycin, roxithromycin, josamycin, clarithromycin) are most often used for 7–10 days.
In children over 10 years old, fluoroquinolone or doxycycline is acceptable.
In intestinal infections aminoglycosides (amikacin, gentamicin) are used, and in children over 12 years old - fluoroquinolones.
In chronic chlamydial arthritis, there is insufficient immunity activity, therefore, immunomodulators (licopid, tactivin) are included in the treatment regimen.
To reduce the pain and swelling of the joints nonsteroidal anti-inflammatory drugs (diclofenac, ibuprofen, nimesulide) are prescribed. Indomethacin is not recommended for children.
In the period of exacerbation of arthritis, glucocorticosteroid hormones can be introduced into the cavity of the affected joint. This method helps to quickly suppress the clinical signs of inflammation.
In severe cases, pulse therapy with glucocorticosteroids or the appointment of immunosuppressants is used.
RA in children most often ends in recovery. In more severe cases, especially against the background of a genetic predisposition, chronic RA or juvenile ankylosing spondylitis develops. After arthritis caused by salmonella, sometimes psoriasis begins. In rare cases, RA is transformed into juvenile rheumatoid arthritis.
Causes of Reactive Arthritis in Children
According to the scientific data of specialists who study reactive arthritis in children, the causes of the disease are reduced mainly to the introduction of an infectious pathogen into the body. The disease is dangerous because of the difficulty of diagnosis, it is not possible to detect an infection in the synovial fluid even during an exacerbation. Diagnosis is complicated by the body’s specific response to its own tissues. Immune failure leads to the formation of new immune cell complexes that attack the joints. The cartilage and synovial membrane are recognized by the immune system as pathogenic bacteria, so inflammation develops.
The method of penetration of infection into the body does not make a fundamental difference, mainly bacteria use the airborne and dust paths. Often, the infection is transmitted from pets or other animals with which the child is in contact.
The incidence of reactive arthritis in children has risen sharply lately.
Reactive arthropathy in children is more likely to develop when a person lives in a dusty, dirty, and damp room. Parents are recommended from early childhood to teach the child to cleanliness, following the basics of personal hygiene and maintaining order in the apartment.
After the diagnosis of the disease is established, the ICD 10 code from M02.0 to M02.9 (reactive arthropathies) is awarded.
Dr. Komarovsky calls the main specific symptoms - joint changes:
- the disease is more often diagnosed on the hip, knee and ankle joints, much less frequently reactive arthropathy is found on other joints,
- pain manifests itself on the left or right side, in 80-90% of cases the illness has an asymmetrical course, bilateral lesion is rare,
- characteristic clinical signs of the inflammatory process: edema, aching nature (worries even in the absence of limb movements), acute pain syndrome during movement, hyperemia, local temperature rise,
- lameness, may be transient,
- up to 4 joints can be affected at the same time,
- deformation of the fingers, often affects the big toe,
- increase in phalanges of the foot.
Symptoms of reactive arthritis in children are largely derived from the inflammatory process, but there are other clinical consequences.
Relapse arthritis symptoms usually occur several weeks after an acute respiratory or intestinal infection.
It is important to understand that, as in adults with reactive arthritis, in children the causes, symptoms, treatment and effects are always individual, only a qualified and experienced doctor can determine them. Before therapy, it is important to undergo a diagnosis and provide the doctor with all the necessary data for drawing up a course of treatment.
Changes in the skin and mucous membranes
During diagnosis, the doctor pays the most attention to the skin and mucous membranes. Often, in the presence of arthritis, a child or even a baby develops: conjunctivitis, uveitis, erosion in the oral cavity, the urogenital system is affected, urethritis, cervicitis or balanitis is formed.
Recommendation for parents from a doctor - you should always pay attention to the appearance of a rash on the feet or palms, this is one of the barely noticeable manifestations of the disease. If untreated, keratoderma often develops (the skin is replaced by horny particles of the epidermis). If the nails change color, lose strength and are destroyed, you should immediately contact a doctor.
Damage to the connective tissue of muscles and articular syndrome
Predominantly reactive form involves damage to the legs: hips, knees, ankle and big toe on the foot. In the connective tissues, inflammation actively progresses, it can involve the hands, but is usually limited to the feet.
Arthritis and arthrosis indicate:
- pain in the joints of the lower limbs,
- discomfort in the sacrum or lumbar spine,
- finger deformation
The emergence of the Reiter triad is characteristic of the reactive form of pathology in childhood. The syndrome is often manifested after a postponed disease provoked by chlamydia, less often the condition is diagnosed due to an intestinal infection.
The triad includes 3 main symptoms:
- inflammation in joints 1-4 in the body,
- visual organ involvement: uveitis, conjunctivitis,
- inflammation of the urinary system: vulvitis, urethritis, etc.
The condition is characterized by an increase in the amount of intraarticular fluid. The disorder is developing rapidly, all new joints, usually located higher along the axis, can be involved in the pathological process. Often the joint is prone to collapse of the thumb, then for the baby there is a risk of complications in the ankles and knees.
The acute stage of the disease can have persistent symptoms for 2-3 months, and the disease will be incurable in the absence of a timely response. From the chronic form, pathology often recurs in an acute condition during adolescence.
It is important to correctly diagnose the disease, as it has extremely similar symptoms with juvenile rheumatoid arthritis.
The onset of the disease is acute, characterized by fever, weakness, refusal to play
Reactive arthritis in children Komarovsky E. O. describes the following symptoms:
- feverish state, temperature often reaches 38-39 ° С,
- nausea with bouts of vomiting, but gagging does not always appear,
- pain in any part of the head with dizziness,
- fatigue, weakness
- symptoms of the disease appear 2-3 weeks after an infectious disease,
- loss of appetite and weight loss
- aortic insufficiency
- increase in lymph nodes in the groin,
- pathology of the cardiovascular system.
The treatment of reactive arthritis in children is most effective when pathology is detected at the first stage, but during this period there are few characteristic symptoms. The disease is completely curable at the initial stage. If not treated or use the wrong course, develops a chronic form.
Who to contact?
To begin treatment of the disease, it is worth contacting a treatment center, preferably with a narrow specialization, aimed at eliminating arthritis. In such clinics there is an arthrologist. In normal clinics, a rheumatologist is more common, who also deals with the treatment of arthrosis and arthritis. Doctors will conduct a primary examination and send for diagnosis. In small towns it is worth contacting an orthopedist.
The child should be shown to the doctor without starting any treatment on his own.
If you conduct a course of treatment in a hospital, it will be easier to involve doctors from related specialties that are important for diagnosing, tracking the effectiveness of treatment and correcting the therapeutic scheme. Almost always, before rehabilitation, you will have to visit a pediatrician, a therapist, an ophthalmologist, an immunologist. Observation and treatment of reactive arthritis in children by one specialist is possible only in the case of primary pathology.
With early treatment, the prognosis for recovery is quite favorable.
What should be examined?
At the stage of diagnosis, it is important to distinguish rheumatoid arthritis from the reactive form, since the symptoms of both conditions are almost the same. The key factor for differential diagnosis is the absence of destruction in the cartilage of reactive arthritis, and rheumatoid leads to impaired cartilage and joint.
At the initial stage of the rheumatoid form (lasts from 2-3 months to a year), only manifestations of effusion in the intra-articular cavity, an increase in the density of periarticular tissues and osteoporosis appear. Reactive arthritis does not provoke a violation of the bone structure and joints.
Analyzes are the basis of diagnostic measures, they are carried out initially for the joints that are most susceptible to pathology. Diagnosis is made possible by general tests and targeted research of a specific joint, for example, punctate of synovial fluid.
Ultrasound of the joint, MRI - allows visualizing soft tissue structures that are not visible on X-rays, presence of articular effusion
What tests are needed?
During the consultation, the doctor examines the medical history and examines, then assigns the study.
Inspection and examination are carried out more often:
- temporomandibular joint.
Reactive arthritis of the hip joint in children occurs most often, by the number of cases it is a little around the knee joint.
Determine the type of phenomenon in the body, against the background of which pathology has developed, how long it takes in the body and determine the stage of the violation according to the generally accepted classification will help:
- X-ray examination helps to determine the presence of a narrowing of the inter-articular gap,
- clinical analysis of blood for ESR and leukocytes,
- microbiological analysis of feces, joint fluid, smears from the genitals and eye mucosa,
- blood biochemistry to detect: urea, CRP, fibrinogen, creatine,
- electrocardiogram, appointed when there is suspicion of heart disease.
Treatment of the disease in children
To combat the symptoms prescribed drugs of different groups:
- Antibiotics are prescribed in the presence of chlamydia pathology. The best results show the means that can accumulate inside the cells:
- the fluoroquinolone and tetracycline series is toxic, used in treatment only under the supervision of a physician,
- macrolides. Among the popular drugs: "Clarithromycin" (not appointed earlier than 6 years), "Roxithromycin", "Azithromycin".
- Aminoglycosides are prescribed in the presence of an intestinal infection: "Gentamicin", "Amikacin".
Antibiotics are the basis of therapy, but for complete recovery it is important to resort to a combination treatment. Often prescribed drugs from the group of immunomodulators, the greatest efficiency was observed for subquingual tablets "Licopid."
Standard therapeutic regimen:
- the course of reception "Likopida" - 24 days,
- after 1 week of admission to the complex include an antibiotic,
- antibacterial drugs continue to use for 10 days,
- after completing the course of antibiotics continue to drink "Licopid" until the completion of the course (another 1 week).
Often used and hormone therapy. This group includes drugs that affect the adrenal cortex and stimulate the synthesis of natural steroid hormones. In fact, these drugs can replace non-steroidal anti-inflammatory drugs (NSAIDs), as they have long suppressed the wrong reactions of the immune system.
The main goal of treatment is the fight against the infectious agent. Antibiotics are prescribed for this.
For relief of symptoms, use:
- NSAIDs help remove inflammation and pain: "Ibuprofen", "Diclofenac", "Nimesulid",
- glucocorticosteroid drugs are prescribed only for severe pain. For the quick effect of pain medication, intra-articular injections are prescribed,
- the use of "Methylprednisolone" in high doses for 3 days,
- immunosuppressants are used in the intensive development of pathology and the presence of spondylarthritis. Doctors recommend: "Methotrexate", "Sulfasalazin",
- Ofthymol, Normatin is often used to combat conjunctivitis.
To enhance the effectiveness of symptomatic and antibacterial drugs used traditional medicine:
- Shark fat is often used to treat joints in children who are severely allergic to medications,
- black radish and horseradish compress It has anti-inflammatory and warming effect. The ingredients are minced or grinded with a blender. The mixture is placed on the skin of the joint, then wound with a polyethylene film, cotton is put on top and the whole is wrapped with a bandage. It is better to do a compress in the evening and leave for the night,
- squeeze of foliage coltsfoot, burdock. Squeeze the juice from the plants, then they are soaked with cloth. A flap of tissue or cotton swab is pressed against the place with edema.
Forecasts and Prevention
With the correct diagnosis and accurate selection of drugs comes full recovery of the body. Fully cured can not only children with gene pathology - the presence of the gene HLA-B27 leads to the transition of the disease in a chronic condition.
Disease prevention comes down to:
- personal hygiene
- control over the freshness and quality of consumed products,
- regular antiparasitic cleaning of the room,
- completion of the course of treatment of all infectious diseases, elimination of symptoms is not a reason to stop therapy,
- Before conception, parents need to be examined and treated for all sexually transmitted diseases. Chlamydial infections are especially dangerous.
Responsibility for the health of the baby lies with the parents, they need to pay attention to the health of the child and treat disorders. If you give the baby proper attention and turn to a specialist in time if the first signs of arthritis are present, the disease will pass with minimal complications.
Originally posted 2018-07-02 11:50:29.
Causes of disease
Doctors believe that the causes of the development of joint disease in children are:
- Urinary tract infections,
- Gastrointestinal poisoning,
- Intestinal pathologies,
- Sprains or injuries
- Colds (untreated angina, acute respiratory viral infections, acute respiratory infections, etc.).
In addition to the main factors, the development of the disease can contribute to the following reasons:
- Poor living conditions.
- Stressful situations.
- Reduced immunity.
- Improper nutrition.
A malignant infection, the baby can also "pick up" through objects, dirty hands, pets and sick people.
The symptoms of knee and ankle arthritis should never be ignored. Even the slightest symptom for parents should be a kind of "bell" to visit a specialist.
To diagnose reactive arthritis in children will help not only the initial examination, but also a number of necessary examinations and tests:
- X-ray, allowing to identify changes in the intra-articular structure,
- Complete blood count to determine the level of leukocytes and ESR,
- Microbiological analysis, including: feces, synovial fluid, scraping from the genitals and conjunctiva,
- An electrocardiogram, in case of suspected heart problems,
- Biochemical blood test to determine the level of urea, CRP, creatinine, fibrinogen, uric acid.
Also, the doctor for accurate diagnosis must necessarily collect a family history in order to identify the hereditary susceptibility to diseases of the musculoskeletal system in a baby.
Only after collecting complete information, the doctor will be able to confirm or refute the diagnosis and prescribe a comprehensive treatment of reactive arthritis in children.
Your baby complains of pain and discomfort in the joints, no need to hesitate, consult a specialist. Remember that self-treatment leads to serious consequences. An experienced doctor will be able to prescribe complex therapy for a speedy recovery.
Today, modern medicine has in its arsenal enough techniques for the treatment of arthritis of the ankle and knee diseases in children, each of which has its own advantages.
Since the root cause of reactive joint disease is infection, the doctor will prescribe a course of antibiotic therapy to the patient. (Azithromycin, Vilprafen, Ofloxacin, etc.). However, taking antibiotics will have a positive effect if the disease is caused by a genitourinary infection. The course of treatment is not more than ten days. If necessary, the doctor may prescribe an additional course, after a week break.
In most cases, antibiotic therapy is prescribed along with immunomodulators, which increase the activity of cells of the immune system.
Anti-inflammatory nonsteroidal agents
The main method of treatment. The drugs will help not only reduce pain, but also significantly reduce the inflammatory process.
The drug is prescribed based on the age group of the child. Up to five years, Ibuprofen or Paracetamol is usually prescribed, older children - Meloxicam or Nimesulide.
For joint treatment, the doctor may prescribe special ointments and creams, which include nonsteroidal agents. This treatment is best suited for infants. In the case of severe, experts resort to injections of glucocorticosteroids. Possessing a powerful anti-inflammatory effect, injections quickly localize the inflammatory process, after which comes the long-awaited relief.
Summing up, we can say the following. Baby's health is completely dependent on the parents. Follow the rules of personal hygiene, eat right, and most importantly, promptly contact the experts.
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Causes of Reactive Arthritis
The causes of the development of reactive arthritis in a child are associated with impaired immune response. The term “reactive” itself means the absence of pathogenic microorganisms in the articular environment, therefore, the disease belongs to the group of seronegative spondyloarthritis. However, during illness, circulating bacterial antigens, fragments of microorganisms, and other signs of ongoing immunological reactions can be detected in the serum and joint fluid.
Great importance in the occurrence of reactive arthritis is attached to the hereditary factor, namely the presence of the HLA-B27 molecule. It has a similar structure with the cell wall of some microorganisms, so its own antibodies take it for an alien structure. This leads to damage to the tissues of the body, as well as disruption of the normal immune response (sluggish and chronic infections are formed).
Provocative factors for the occurrence of reactive arthritis in children are also:
- lack of hygiene (including living in unsanitary conditions),
- high humidity, poor ventilation in the room,
- the presence of acute and exacerbation of chronic diseases,
- allergic reactions
- immunodeficiency states, hypovitaminosis and avitaminosis.
Symptoms of the disease
The main symptoms of reactive arthritis in a child include:
- manifestations of an infectious disease 2-4 weeks before the onset of arthritis (fever, signs of intestinal infection, inflammation of the urinary tract or SARS),
- intoxication (fever, weakness, drowsiness, refusal to eat, muscle pain, headache and other symptoms),
- the predominant lesion of the large joints of the legs (knee, ankle), less often of the hands, hands and feet,
- joint pains, aggravated by movements, may be given to the heel region,
- joints increase in size.
The duration of the course of reactive arthritis is from several weeks to a year. In milder forms of the disease, improvement is noted already several days after the start of therapy.
Often during reactive arthritis, eye lesions may occur, which are manifested by tearing, redness, and photophobia. Possible involvement in the process of the urinary tract. Arthritis, conjunctivitis, and urethritis are classic symptoms of Reiter’s disease.
Reactive arthritis may be accompanied by keratoderma, which is a painless keratinization of the skin with rashes in the form of papules and plaques, most often on the plantar part of the feet and palms. It is possible to damage the nails (usually on the toes) in the form of yellow staining, peeling and destruction of the nail. Mouth mucous membranes (stomatitis), heart (pericarditis, myocarditis), peripheral nervous system (polyneuritis), kidneys (glomerulonephritis), lymph nodes (especially inguinal) can be inflamed.
In young children who still cannot complain of pain in the joint, it is necessary to pay attention to the following signs:
- gait disturbance, claudication, walking legs while walking,
- a small child may suddenly stop walking
- the child holds the handle with his other hand, strokes his fingers,
- "Spares" the joint, trying not to move the limb.
There are special criteria according to which reactive arthritis can be diagnosed:
- The presence of peripheral arthritis, which is characterized by:
- damage to one or more joints (no more than 4),
- primary damage to the joints of the legs.
- The presence of manifestations of infection (intestinal or urinary disorder) 2-4 weeks before the onset of arthritis.
- Laboratory confirmation of the infection is mandatory in the absence of clinical symptoms of an infectious disease, if it is, it is optional, but desirable.
The following methods are used to diagnose reactive arthritis in children:
- Laboratory research:
- in general, the blood test may show accelerated ESR, an increase in the number of leukocytes and an increase in the content of their stab forms, in the biochemical blood test - an increase in C-reactive protein, shifts in protein fractions,
- detecting the presence of antibodies to recent infections (chlamydia, salmonella, and others) in the blood or joint fluid,
- urine tests: elevated white blood cell levels, microorganisms and other signs of an infectious disease of the urinary tract can be detected,
- stool analysis: can be prescribed to identify bacteria that cause intestinal infection (Salmonella, Shigella, Yersinia and others),
- detection of chlamydia antigens in joint fluid, as well as scrapings obtained from the urethra or conjunctiva.
- Instrumental methods:
- X-ray of the affected joints does not reveal specific changes in the reactive process, but is used for differential diagnosis with other types of arthritis, ultrasound of large joints, CT, MRI and other studies can also be used,
- Examination of the genitourinary system: a consultation of a urologist, ultrasound of the kidneys and bladder is shown to rule out urinary system pathology (for example, nephritis or cystitis), as well as other methods,
- examination by an oculist.
Depending on the nature of the symptoms present, auxiliary diagnostic procedures may be prescribed.
Treatment of reactive arthritis in children includes the following methods:
- regime activities (bed rest to ensure the rest of the inflamed joint for at least 2 weeks),
- the use of drugs
- Spa treatment.
Drugs can be etiotropic (directed against the causative agent of infection), pathogenetic (their effect influences the mechanism of the development of the disease) and symptomatic (suppress the symptoms of the disease). The following drugs are prescribed:
- antibacterial therapy directed against the infection that caused the disease: when chlamydia is detected, drugs from the groups of macrolides, tetracyclines, fluoroquinolones, and in the case of an intestinal infection, usually aminoglycosides or fluoroquinolones,
- nonsteroidal anti-inflammatory drugs (diclofenac, ibuprofen, naproxen, nimesulide, meloxicam, and others),
- steroid hormonal drugs are prescribed in the period of exacerbation of the articular syndrome (methylprednisolone and others),
- immunomodulatory drugs (taktivin, licopid, polyoxidonium and others),
- immunosuppressive agents (in the severe course of the disease - sulfasalazin, methotrexate, azathioprine).
Medications can be administered intramuscularly, intravenously, through the mouth or injected into the joint. Doses of drugs, especially their introduction, the duration of therapy is determined by the doctor depending on the nature of the disease and the age of the child.
All medicines in children are used with caution, so therapy should be under the supervision of a specialist. Independently experimenting with treatment is prohibited.
When relieving the inflammatory process in the joint, physiotherapy exercises are prescribed, massage, possibly a spa treatment.
Prevention and prognosis of reactive arthritis
In most patients, the disease ends with full recovery. As a rule, reactive arthritis disappears without a trace, leaving no pathological changes in the joint. However, with repeated infectious disease, recurrence of arthritis is possible.
After the illness you should have follow-up care with a rheumatologist.
The likely outcome of chronically and often recurrent reactive arthritis is juvenile spondylitis. It occurs in patients carrying the HLA-B27 molecule, more often in adolescent boys. The joint syndrome in this disease is similar to reactive arthritis, but, according to X-ray diffraction, one- or bilateral sacroiliitis can be detected.
Adverse outcomes of the disease are possible in patients with concomitant heart disease (myocarditis, pericarditis, endocarditis, and combinations thereof).
The only possible preventive measures for reactive arthritis are the timely detection and treatment of infectious diseases, compliance with the recommendations of experts and the rejection of self-treatment, maintaining a healthy lifestyle. Especially it concerns persons with hereditary predisposition to rheumatic processes.