What is chlamydia arthritis: causes and signs, complications, methods of diagnosis and treatment. Reiter's syndrome in chlamydia: clinical picture, diagnosis and treatment Chlamydia complications on the joints

Today, chlamydia has become so widespread that you probably won’t find anyone who hasn’t heard of it. But few people know that this disease can develop into chlamydial arthritis and affect the joints. There is no point in talking further about the other consequences of this disease, and its symptoms are known to almost everyone, which cannot be said about the cause-and-effect relationship with joint diseases.

It would seem, well, what can connect joints and chlamydia? However, there is such a connection, and its consequences are quite unpleasant. Therefore, it is better to have information in advance about a very unpleasant joint pathology in order to take the necessary measures in a timely manner and cure the disease.

How are joints and chlamydia related?

Medical research has long established that almost any disease can cause complications if left untreated. Complications that arise in the joints due to chlamydia develop precisely because of late diagnosis and lack of treatment. This becomes possible due to the frequent asymptomatic course of the disease, and in some cases the symptoms suggest the presence of completely different problems. Discharge from the genitals, as well as minor pain during urination, occurs extremely rarely.

Most people are of the opinion that any sexually transmitted infection poses a danger only to the genitourinary organs and human reproduction. Of course, this is correct, but partly, because with chlamydia, the joints hurt only as a consequence of a very advanced disease, and are in no way a symptom of it. That is why the doctor always tries to convey to the patient the idea that serious complications can be avoided, but for this it is necessary to periodically undergo preventive examinations. Only such examinations make it possible to detect diseases in the early stages.

After contacting a specialist with a complaint about sore joints, chlamydia may be detected. Because of this, there are situations when a patient, without seeing a doctor, suffers joint pain for quite a long time, without even realizing that chlamydia is the cause. If this disease is detected, it is impossible to say which joints will be affected by the complication first. However, medical practice shows that according to the frequency of damage to joints, they are arranged in the following order:

• knee;
• ankle;
• finger joints;
• elbows;
• hip

Simultaneous damage to several departments occurs extremely rarely, and very specific symptoms indicate where exactly the pathology occurred: a small tumor and soreness of the affected area.

Diagnosis of the disease

Chlamydia and joint pain are not always linked, but in most cases there is a link. Therefore, correct and timely diagnosis is important to begin treatment and maintain the functionality of the joints. To make a final diagnosis, joint pain alone is not enough as an indisputable symptom; you will have to undergo a whole range of studies.

When conducting diagnostics, it is extremely important to differentiate arthritis from other similar diseases. Sometimes it can be quite difficult to distinguish the pathology caused by chlamydia from psoriatic arthritis or some urological diseases. Therefore, to obtain an unambiguous conclusion, it is sometimes necessary to resort to puncture of the affected joint and examination of the contents.

Using modern diagnostic tools and methods, it is possible to both identify chlamydia and determine the most effective antibiotic for a particular case.

Therapy for chlamydial arthritis

Chlamydial arthritis is a secondary disease, so it is quite natural that, regardless of which specific joint is affected, it is necessary to first treat the primary disease, that is, chlamydia. Of course, there is no reason to refuse to use painkillers, but the effect of their use will only be eliminated symptoms. But the disease will have to be fought with completely different methods.

As a rule, this disease is treated with courses of antibacterial therapy. It should be borne in mind that therapy for chlamydial arthritis is much longer than fighting infection in the urogenital tract. The minimum duration of the course is twenty-one days, and at the very beginning, treatment still involves the use of painkillers to relieve pain. In the most severe cases, the use of hormones is allowed.

Usually, obvious symptoms of the disease can be stopped fairly quickly, but complete disappearance of arthritis is observed approximately six months after treatment is completed. Alas, in approximately twenty percent of patients the disease becomes chronic or transforms into another disease. For such people, treatment can take years. The possibility of re-infection cannot be ruled out; in this situation, treatment usually becomes much more difficult.

The earlier treatment begins, the simpler and more effective it is. As soon as the slightest symptoms of the disease are detected, you should immediately seek medical help.

Development of Reiter's disease

Even during the First World War, doctors learned about this disease, which received its name after its discoverer, the German doctor Reiter. In its classic form, Reiter's disease is characterized by the simultaneous presence of conjunctivitis, polyarthritis and urethritis. There are patients who have no symptoms of one of the diseases.

Most often, the disease is caused by chlamydia entering the body. Reiter's disease mainly affects men; among women and children, symptoms are detected much less frequently. Recent medical research has made it possible to establish with sufficient accuracy that Reiter's disease mainly affects people who are genetically predisposed to this particular development of chlamydia.

If Reiter's syndrome develops classically, and its symptoms appear quite clearly, then diagnosis does not present any difficulties. However, doctors are often faced with a situation where Reiter's syndrome manifests itself exclusively as inflammation of the joints, and it is quite easy to confuse it with rheumatoid arthritis.

The development of Reiter's disease occurs as follows. Approximately fifteen days after infection, the patient begins to experience pain in the spine and joints, with the lesion primarily affecting the legs (from the knee and below). The skin over the inflamed joints turns red and becomes hot. At night and in the morning there is an increase in pain. The hallmark of Reiter's disease is pain at the base of the heel while walking. If treatment is not started in a timely manner, skin damage (on the palms and soles) and atrophy of the muscles located next to the affected joints may begin.

It is, of course, possible to cure Reiter's syndrome, but this process is quite lengthy and requires considerable perseverance. With an adequate approach, cure can occur in about six months. The main goal of drug therapy is the complete removal of chlamydia from the patient's body. The main treatment is led by a rheumatologist, involving a urologist or gynecologist to combat local inflammation.

After complete recovery, it is necessary to remember that there is no immunity to this disease, so prudence should be exercised in sexual intercourse, which is the main factor in prevention.

When you feel unwell, have a headache, a runny nose, or a fever, does anyone go to a gynecologist or urologist? If you have pain in the heart, shortness of breath, inflammation of the joints, do you think of making an appointment with a venereologist? Absurd, isn't it? Only discomfort in the genital area causes suspicion, and not always.

The insidiousness of chlamydial infections is their diversity, their ability to affect different organs, causing various symptoms.

Chlamydial infections in humans

Scientists know of 30 types of chlamydia, differing in DNA structure. What unites them is their position between viruses and bacteria, that is, the ability to exhibit the properties of both.

• genitourinary infection - “classic” venereal chlamydia;
• the pulmonary form affects the respiratory system;
• Zoonotic infections are transmitted to humans from birds and mammals.

The listed types of infection, getting on the epithelium of various organs, cause diseases. Symptoms will also vary. Chlamydia is often accompanied by another infection (gonorrhea, trichomoniasis, ureaplasmosis). This also changes symptoms.

Genitourinary system

Genital chlamydia is known as one of the most common sexually transmitted diseases, along with trichomoniasis, ureaplasmosis, and gonorrhea. The incubation period lasts from one week to a month. At this time, the disease does not manifest itself in any way. Infection occurs through unprotected sexual intercourse with a sick partner.

• Discharge . They may appear within 7 days. In men - in the morning from the urethra, in the form of a cloudy or glassy drop. In women, slight clear or white odorless vaginal discharge.
• Inflammation, redness mucous membranes of the genital organs. Discomfort, burning during urination and sexual intercourse.
• General intoxication. Weakness, malaise, fever.

Since the symptoms are mild or absent altogether, the main sign of the disease is a subjective feeling of discomfort, heaviness in the lower abdomen. With such “strange” complaints, you should visit a gynecologist (urologist). Only examination and laboratory tests will answer whether there is cause for concern.

If the first signs are left unattended, the disease becomes chronic. By attacking the tissues of neighboring organs, the infection causes serious complications.

For women, this risks inflammation of the pelvic organs, scarring, adhesions, and, as a result, infertility. Men are characterized by inflammation of the testicles and prostate, which results in impotence and infertility. The symptoms are already more severe: bloody discharge, severe pain, menstrual irregularities, erosion. A person comes to the doctor with these serious problems as if they were symptoms, but in fact these are the consequences of chronic chlamydia that was previously missed.

Rectum

Infection of the rectum occurs during unprotected anal-genital intercourse with a patient. More often a passive partner (male or female) is infected. Symptoms: itching, burning, slight discharge from the anus. Possibly, infection of the mucous membranes of the rectum due to the venereal disease lymphogranulomatosis.

Lymph nodes

Inflammation and enlargement of the lymph nodes occurs when infected with the sexual form of chlamydia and indicates the development of lymphogranulomatosis venereum. The disease is rare, but dangerous. It begins with infection of the genitourinary tract by chlamydia, with a distinctive feature - ulcers and erosions of the external genitalia. The infection then spreads to the inguinal lymph nodes (femoral and pelvic nodes may be affected). They become inflamed and buboes appear in the tissues. After opening such an abscess, long-term non-healing ulcers remain.

The symptoms are obvious and formidable; they are difficult to ignore. A general feeling of “being overwhelmed,” lethargy, and fever complete the clinical picture. As a result of the destructive action of bacteria, adhesions and scar tissue remain. Finding them in the rectum is an important symptom of the disease. Papillomas and scarring provoke obstruction of the intestines and genitourinary tract, obstruct the outflow of lymph, and infertility occurs.

Oral mucosa

Infection occurs:

• In adults during oral-genital sexual contact. The pathogen enters the mucous membranes with infected sperm or secretions of a partner.
• In children and adults through everyday use. Bacteria are transferred by hands or household items from the patient’s genitals to the mouth.
• In newborns during childbirth. From a mother suffering from the sexual form of chlamydia, the infection is transmitted to the baby from the mucous membrane of the birth canal, entering the oral cavity.

Clinical signs of infection with the sexual form of chlamydia are congestion and mucus in the nasopharynx. The discharge gradually spreads in the mouth and tongue in the form of a white coating. The smell of rotten fish appears from the mouth, the larynx swells, swallowing and chewing causes pain.

With further progression of the disease along the respiratory tract, tracheitis, bronchitis, and pneumonia may appear with a corresponding symptom - cough.

Eye infection

Infection occurs in the same way as with oral infection. Eye diseases caused by sexual chlamydia:

• Ophthalmochlamydia. The disease manifests itself as ordinary conjunctivitis: inflammation of the eyelids, photophobia, pain when blinking. The lymph nodes become enlarged, and purulent discharge from the eyes may appear. With unjustified treatment, the symptoms smooth out or disappear, but the disease continues to progress.
• Conjunctivitis of newborns. It is transmitted by mother to child in utero through the placenta or during natural childbirth. A distinctive sign is inflammation and redness of the lower eyelid.
• Trachoma is a serious eye disease, rare for our latitudes (single cases are observed in Russia). Its development is also provoked by chlamydia. The outer shell of the eye becomes inflamed and thickens, “nodules” appear on it, and foci of infection arise inside the cornea. The result is scarring, which can lead to vision loss.
• "Basin" conjunctivitis appears as a result of contact with water in public places, sometimes causing epidemic outbreaks. Infection with any type of chlamydia leads to eye disease. The symptoms will be similar, the difference in treatment. It is determined only by a doctor in each case individually.

Airways, lungs

Damage to the lungs and bronchi causes symptoms typical of pneumonia. The causative agents are different strains of chlamydia.

Pneumochlamydia occurs when infected with a strain of bacteria that primarily affects the lungs. Causes bacterial inflammation of the respiratory tract. In the sexual form of the disease, such infection occurs extremely rarely. Characteristic signs of pneumochlamydia:

• The cough is strong, hacking, dry, later with sputum. Appears earlier than other symptoms;
• shortness of breath, increasing every day, even with minimal physical exertion and in a lying position;
• low-grade fever (up to 38°), weakness, headache, pharyngitis - the signs are the same for all pneumonia. This makes diagnosis quite difficult;
• the main symptom is the return of the disease (chronic bronchitis, habitual pneumonia, asthmatic syndrome).

Psittacosis is transmitted from domestic and wild birds to humans through airborne dust and household contact. From infected excretions and excrement of birds, pathogens enter the air and onto objects. Symptoms are similar to other types of pneumonia. It differs from pneumochlamydia in that respiratory signs appear first, and then diseases of the bronchi and lungs.

Joints

With urogenital chlamydia, an autoimmune disease sometimes occurs - Reiter's syndrome, sequential damage to the genitals, eyes and some joints. Chlamydia does not penetrate directly into them. Inflammation of one or more joints is a signal that the immune system is confused and has begun to attack the cells of its own body.

The disease proceeds hidden. It begins with sexual infection, later symptoms of conjunctivitis appear, but disappear within a few days. Characteristic signs are asymmetrical damage to the joints of the legs, swelling of the fingers, painless enlargement of the lymph nodes (observed 1 - 2 months after genitourinary infection). The joints swell, hurt (worst at night and in the morning), the skin around them turns red.

If you are concerned about these symptoms, do not hesitate to tell your doctor. He will be able to connect all the complaints into one picture and make a correct diagnosis. This syndrome also causes salmonellosis, ureaplasmosis and other infections if the patient is genetically predisposed. In men, Reiter's syndrome occurs tens of times more often than in women.

The cardiovascular system

Specific signs of infective endocarditis include: shortness of breath, chest pain, heart murmurs, changes in the shape of the fingers (clubs), sometimes a skin rash, and fragility of blood vessels.

The disease occurs in a latent form and when the main symptoms appear, it is already difficult to determine the cause.

Asymptomatic

We can generalize: chlamydia occurs in a latent (latent), chronic and extremely rarely acute form.

Chlamydia can hide its symptoms, live in the body for years, and manifest itself at different times in different ways. It is difficult to associate all these signs with one infection. Only an experienced doctor, based on “strange” complaints and vague signs, is able to suspect an infection and prescribe an examination. If the disease is not treated in time, it will lead to irreparable complications over the years, such as heart disease, bronchial asthma, and infertility.

Scientists say that 6 - 15% of people in the world have chlamydia. In women, it occurs without symptoms in 70% of cases. Even without knowing about their illness, they are all sources of infection for others.

Chlamydia and immunity

Any infection can invade the body only if its defenses are weakened. A strong immune system can independently cope with the attack of harmful microorganisms. Weakened immunity leads to infection. Infection weakens the immune system even further and another infection occurs. This is the vicious circle of infections.

During laboratory tests, pathogens of only one disease of the reproductive system are rarely detected. Mycoplasmosis, ureaplasmosis, gonorrhea, and syphilis can accompany chlamydia. Symptoms overlap each other. Based on such a clinical picture, it is impossible to make an accurate diagnosis.

By destroying the healthy microflora of the genitourinary system, chlamydia creates conditions in which opportunistic microorganisms develop. Thus, ureaplasmosis, mycoplasmosis, and candidiasis occur. By creating “communities,” microorganisms jointly protect themselves from the effects of drugs. It is mixed infections that are most difficult to cure.

Compliance with basic hygiene standards, the use of condoms during sexual intercourse, and awareness of the ways of transmission of the disease are simple ways to protect yourself from a difficult disease.

Doctors have to deal with Reiter's disease quite often. The reason for this is the high percentage of urogenital infections. With untimely diagnosis and lack of adequate treatment for chlamydia, various systemic lesions develop, which bring a lot of suffering to the patient.

What is Reiter's disease?

Reiter's syndrome is classified as reactive arthritis. It is a complication of chlamydial infection, which results in a triad of clinical symptoms: arthritis, urethritis, conjunctivitis. Reiter's “tetrad” is considered to be a combination of these complications with damage to the skin and mucous membranes. Doctors also call it urethro-oculosynovial syndrome.

There are 6 main reasons that make you think about promptly seeing a doctor if you have a combination of urogenital and joint complaints:

The main factors contributing to the development of urethro-oculosynovial syndrome are:

These properties ensure the development of autoimmune processes.

1. A marked decrease in the protective properties and resistance of the patient’s body, or an ineffective immune response.
2. Presence of microtrauma of joints.

Bacteria spread throughout the body hematogenously, penetrating the synovial membrane and multiplying in it by simple division.

The greater survival rate of chlamydia is due to the ability to transform into intermediate forms that are very small in size. They are immune to aggressive environmental factors. Later they return to their original state.

The division of Reiter's syndrome (disease) is multifactorial, which makes it possible to select more effective therapy for each individual option. According to the duration of development of the disease, the following forms are distinguished:

According to the degree of activity they are divided into:

• I (low);
• II (average);
• III (high);
• remission.

The diagnosis of Reiter's disease necessarily includes functional insufficiency of the affected joints (FNS):

• I – maintaining professional ability;
• II – only daily activity is preserved;
• III – impossibility of self-service.

When formulating the final diagnosis, all of the above classifications are included.

Clinical picture

Complaints of patients with the development of Reiter's syndrome against the background of chlamydial infection are:

Joint pain occurs a month after infection with chlamydia (rarely after a few days). A “staircase” version of the flow (from bottom to top) with a spiral transition from one side to the other is typical.

Reiter's disease affects the joints of the following groups:

• small joints of the feet;
• ankle;
• knee;
• iliosacral joints;
• spine.

The most common localization of the process is on the metatarsophalangeal joints of the big toe. Patients note the asymmetric nature of joint damage. The pain is constant. For example, in the knee joint on the right leg and ankle on the other.

Inflammation of the periarticular capsule often develops, which is manifested by redness and swelling of the skin over the affected area. Due to damage to the ligamentous apparatus, patients often develop flat feet - “gonorrheal foot”. In severe cases of Reiter's disease, the spine and sacroiliac joints are affected. This is expressed in a pronounced limitation of movements and intense pain, affecting the patient’s quality of life and his social activity.

Women with Reiter's syndrome are diagnosed with the following urogenital diseases:

• cervicitis;
• endometritis;
• vaginitis;
• salpingitis;
• salpingo-oophoritis.

Diagnosis and treatment

If Reiter's disease is suspected, the patient should visit:

• gynecologist or urologist;
• rheumatologist;
• ophthalmologist.

This disease is a combined pathology, and the final diagnosis is made by a rheumatologist based on all the data obtained.

Disease detection includes:

• questioning the patient's complaints;
• studying the history of the disease;
• laboratory research;
• additional methods;
• objective examination by various specialists.

General laboratory methods are nonspecific. Their results indicate an active inflammatory process. Their dynamic implementation to assess the effectiveness of the therapy is of clinical importance. The gold standard for diagnosis for Reiter's disease is the detection of the causative agent of the disease from various materials: scrapings from the urethra or cervical canal, synovial fluid, blood.

The presence of chlamydia in the body is detected using:

Additional methods are prescribed:

• radiographs of the affected joints;
• if necessary, arthroscopy;
• Ultrasound of the pelvic organs;
• MRI of the spine and sacroiliac joints.

Detection of chlamydia and damage to joints and eyes form the basis of a comprehensive diagnosis of Reiter's syndrome.

Treatment is complex and includes the following groups of drugs:

The course of antibiotic therapy should be at least 2 weeks (at best - 28 days). This is due to the high survival rate of the pathogen. It is necessary to treat the sexual partner with antibiotics. The drug, dose and duration of use are prescribed by a gynecologist or urologist.

Control is carried out by repeating methods that identify the pathogen after completing a course of antibiotic therapy. Treatment for articular syndrome can take years. The rheumatologist will select a course of basic therapy to prevent the development of complications and reduce pain.

Reiter's syndrome with identified chlamydia is a related pathology. Despite the active development of medicine, the percentage of such patients is not decreasing. This is due to the common chlamydial infection in young people and the frequent recurrence of the disease. Timely consultation with a doctor will help prevent the development of severe disease.

Chlamydia trachomatis are the main causative agents of chlamydial arthritis, but the appearance of joint pain with chlamydia is not a symptom, but a consequence of an untreated urogenital infection. Without timely diagnosis, such a disease takes a chronic course and leads to damage to internal organs and bone structures.

How does chlamydia affect joints?

Chlamydial arthritis is an acute articular disease that develops after infection of the genitourinary organs with Chlamydia trachomatis.

• The appearance of pain, swelling and swelling in the joints. The ankle and knee joints are primarily affected.
• Asymmetry of joint damage.
• Prolonged disease leads to a change in the characteristically expressed articular syndrome. The number of affected joints increases - the wrist, elbow and spine are involved.
• Lack of treatment can cause the development of severe arthrosis.

Etiology and pathogenesis of chlamydial arthritis

In some patients, chlamydia is mild, while others experience complications with joints and other organs. The main version of joint damage is considered to be the immunological theory, according to which the development of the disease is influenced by the individual characteristics of the immune defense, which responds to a specific reaction to the pathogen. But why the host’s immune system does not protect the body is unknown.

Symptoms of the disease

Joint pain appears suddenly, and the interval between the onset of arthritis and the previous infection varies from 1 to 12 weeks.

The clinical picture of chlamydial arthritis is quite diverse, which makes it possible to suspect the development of the disease even in cases with asymptomatic urogenital inflammation, to which patients often do not pay attention, for example:

• The attack of the disease begins acutely.
• Exudative manifestations are pronounced - joints swell and hurt, hyperemia is observed, and the temperature rises.
• Almost half of the patients experience damage to the skin and mucous tissues, for example, balanoposthitis, balanitis.
• Painless erosions on the oral mucosa are possible, which often go unnoticed.
• The appearance of extra-articular signs characteristic of joint damage is accompanied by conjunctivitis and urethritis.
• Possible enlarged lymph nodes in the groin.
• Palpitations, heart pain, changes in the electrocardiogram, shortness of breath.

The best way to diagnose

To make a correct diagnosis, the doctor prescribes the following examinations:

• General and biochemical blood test to determine the level of platelets, leukocytes, erythrocytes, ESR, and to detect proteins characteristic of the acute phase of inflammation.
• Radiography. Assess the condition of the affected joint.
• MRI. Allows you to identify and evaluate the degree of erosive-destructive lesions.
• Genetic research. Rarely performed, it is used to identify the connection between the patient’s genetic characteristics and the development of reactive arthritis.