What is Yersinia Arthritis?
Yersinia arthritis is a disease of the joints caused by the pathogen Yersinia enterocolitica.
Causes of Yersinia Arthritis
Yersinia enterocolitica is a microorganism that has attracted the attention of rheumatologists relatively recently. It is on a par with the causative agents of plague and pseudotuberculosis, but the diseases caused by it are not among the most dangerous infections,
Infection caused by Yersinia is found in animals and humans, and of the 30 known microbial serotypes for humans, only a few are pathogenic.
In most cases, yersinia arthritis is considered as “reactive,” but it is also known about septic variants of joint inflammation.
Symptoms of Yersinia Arthritis
In humans, the main symptoms of yersiniosis are associated with intestinal damage, which is usually manifested by acute enterocolitis. There may be diarrhea, sometimes mixed with blood and mucus. In such cases, dysentery is usually suspected, which, however, does not find bacteriological confirmation. Sometimes there may be an indefinite abdominal pain syndrome or appendicitis clinic, or rather, pseudoapppendicular syndrome caused by terminal ileitis, inflammation of the mesenteric lymph nodes (mesadenitis), or a combination of these processes. Gastrointestinal manifestations can be mild, erased, short-term, but sometimes extremely pronounced, accompanied by septicemia, dehydration of the body and leading patients to death.
Arthritis usually occurs 1-3 weeks after enterocolitis or abdominal syndrome, sometimes develops simultaneously with enterocolitis or even 1-2 days precedes it. Large and medium joints of the lower limbs are affected, occasionally the joints of the hands. Usually there is fever (38-39 ° C), leukocytosis (12 10 / l and more), increased ESR. Arthritis is in most cases similar to rheumatic, but it does not show streptococcal antibodies, but antibodies to Yersinia are detected in high titer. The synovial fluid is inflammatory, does not contain microbes, but specific antibodies can be detected in it.
Arthritis lasts 1-5 months and ends in complete recovery, but may recur or even acquire a chronic course. In Yersinia arthritis, the development of Reiter’s triad is described: conjunctivitis, urethritis, arthritis.
When yersiniosis infection often develops allergic myocarditis, which is observed in about 1/3 of patients. Endocardial and valvular lesions usually do not occur. In 18-20% of patients state erythema nodosum, characterized by a benign course with a complete reverse development in 2-3 weeks. Relatively frequent eye damage (episcleritis, conjunctivitis, uveitis, etc.).
Diagnosis of Yersinia Arthritis
The diagnosis of Yersinia arthritis is based on anamnestic data, bacteriological examination of feces, detection of antibodies to Yersinia in the blood serum (in diagnostic titer of 1: 200 or more) or synovial fluid.
The main diagnostic features of Yersinia reactive arthritis are the following manifestations.
- Yersinia reactive arthritis is more common in women, although yersinia enterocolitis occurs equally often in men and women.
- Arthritis is preceded by enterocolitis, which is often manifested by short-term diarrhea, pain in the right iliac region (due to terminal ileitis or mesodenitis).
- Arthritis develops 1-3 weeks after enterocolitis, sometimes at the same time as it, and is accompanied by urticular, maculopapular eruptions on the trunk, limbs, often in the area of large joints, erythema nodosum appears in the region of the legs.
- The onset of arthritis is usually acute, localizing it mainly in the region of the joints of the lower extremities, which is typical of reactive arthritis in general, but the involvement of the wrists, elbows, fingers is possible.
- There are tendovaginitis, including Achilles tendon, bursitis.
- Perhaps the development of extra-articular manifestations – episcleritis, conjunctivitis, iritis, myocarditis, pericarditis.
- In the acute period, body temperature rises to 38–39 ° C, leukocytosis is observed with a shift to the left, an increase in the ESR.
- The duration of arthritis is about 4 months, 70% of patients complete cure, 30% of patients develop chronic seronegative (in the Russian Federation) non-erosive arthritis of large and medium-sized joints and / or slowly progressive sacroiliitis.
- If arthritis has developed within the period of 7-14 days from the onset of the disease, then antibodies to Yersinia are determined in the blood, titers of at least 1: 160 are diagnostically significant.
- Complete blood count: increased ESR, possible signs of anemia, leukocytosis.
- Biochemical analysis of blood: increased levels of alpha-2- and y-globulins, fibrin: seromucoid, sialic acids, the appearance of PSA.
- Bacteriological and serological confirmation of infection. Diagnostic criteria for Yersinia infection – excretion of coproculture and increasing titer of antibodies to Yersinia, determined by the RPHA method (diagnostic titer 1: 160 and higher), dysentery – excretion of shigella coproculture, reaction of indirect hemagglutination with standard erythrocyte diagnostics in titer 1: 200 and above (set that the Flexner strain has arthritogenic properties), salmonella and campylobacterial reactive arthritis – the determination of antibody titers in the blood, less often – the study of co-culture (by the time Itijah reactive arthritis, it can be negative).
- Synovial fluid examination: inflammatory – turbid liquid, yellowish, low viscosity, leukocyte count (2-100) × 109 / l, neutrophils more than 50%, flaky-shaped mucin clot, detection of specific antibodies.
Treatment for Yersinia Arthritis
Yersinia is tetracycline sensitive. It is recommended to prescribe this antibiotic in the acute period of the process (1-2 g / day), adding non-hormonal anti-inflammatory drugs. Corticosteroid preparations should be resorted to only with extreme severity of the inflammatory activity of the articular process, significant eye damage, or with the progress of infectious-allergic myocarditis.
This section lists far from all arthritis that can be combined with a variety of infections, but already. The foregoing indicates a wide range of such joint diseases. Some of these arthritis are quite common (for example, yersiniosis, brucellosis, gonococcal, acute infectious, tuberculosis), others are rare (Lyme disease, Whipple disease). The selection of a group of arthritis associated with infection, dictates the need to search for specific etiological factors of joint diseases and further clarify the mechanisms of their pathogenesis.