reactive arthritis

反应性关节炎
  • 文章类型: Journal Article
    背景。本系统评价和荟萃分析的目的是估计感染弯曲杆菌的个体的比例。埃希氏菌,沙门氏菌,志贺氏菌,或耶尔森氏菌会发展为反应性关节炎。方法。进行了系统的审查,包含2024年1月之前发表的英语文章,来自Embase,PubMed,Scopus,和WebofScience数据库。这篇综述包括观察性研究,这些研究报告了弯曲杆菌患者反应性关节炎(ReA)的发生,埃希氏菌,沙门氏菌,志贺氏菌,或耶尔森氏菌感染。数据提取由两名审阅者独立进行。随后,进行了随机效应荟萃分析,使用I2值评估异质性。此外,采用meta回归分析研究水平变量对观察到的异质性的潜在影响。结果。共确定了87项研究;23项报道了弯曲杆菌感染后的ReA发展,7例大肠杆菌感染后的ReA报告,30例报告沙门氏菌病后出现ReA,14在志贺氏菌病后报告了ReA,13例报告了耶尔森氏菌感染后的ReA。出现ReA的弯曲杆菌患者比例为0.03(95%CI[0.01,0.06],I2=97.62%);发生ReA的大肠埃希菌患者比例为0.01(95%CI[0.00,0.06],I2=92.78%);沙门氏菌患者比例为0.04(95%CI[0.02,0.08],I2=97.67%);志贺氏菌患者比例为0.01(95%CI[0.01,0.03],I2=90.64%);发生ReA的耶尔森氏菌患者比例为0.05(95%CI[0.02,0.13],I2=96%)。结论。沙门氏菌的比例很大,志贺氏菌,耶尔森氏菌病例导致了ReA。尽管如此,由于研究之间存在显著的异质性,因此谨慎解释研究结果非常重要.
    Background. The objective of this systematic review and meta-analysis was to estimate the proportions of individuals infected with Campylobacter, Escherichia, Salmonella, Shigella, or Yersinia who develop reactive arthritis. Methods. A systematic review was conducted, encompassing English-language articles published before January 2024, sourced from the Embase, PubMed, Scopus, and Web of Science databases. This review included observational studies that reported the occurrence of reactive arthritis (ReA) among patients with Campylobacter, Escherichia, Salmonella, Shigella, or Yersinia infections. Data extraction was carried out independently by two reviewers. Subsequently, a random-effects meta-analysis was performed, with heterogeneity assessed using the I2 value. Additionally, meta-regression was employed to investigate the potential influence of study-level variables on the observed heterogeneity. Results. A total of 87 studies were identified; 23 reported on ReA development after Campylobacter infection, 7 reported on ReA after Escherichia infection, 30 reported ReA onset after salmonellosis, 14 reported ReA after shigellosis, and 13 reported ReA after Yersinia infection. The proportion of Campylobacter patients who developed ReA was 0.03 (95% CI [0.01, 0.06], I2 = 97.62%); the proportion of Escherichia patients who developed ReA was 0.01 (95% CI [0.00, 0.06], I2 = 92.78%); the proportion of Salmonella patients was 0.04 (95% CI [0.02, 0.08], I2 = 97.67%); the proportion of Shigella patients was 0.01 (95% CI [0.01, 0.03], I2 = 90.64%); and the proportion of Yersinia patients who developed ReA was 0.05 (95% CI [0.02, 0.13], I2 = 96%). Conclusion. A significant proportion of Salmonella, Shigella, and Yersinia cases resulted in ReA. Nonetheless, it is important to interpret the findings cautiously due to the substantial heterogeneity observed between studies.
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  • 文章类型: Systematic Review
    目标:自2020年冠状病毒爆发成为全球卫生紧急情况以来,各种基于免疫的影响,如炎性关节炎(IA),已被记录下来。这项研究旨在确定COVID-19严重程度在COVID后关节炎中的作用。
    方法:我们通过检索数据库,系统回顾了95例严重和非严重COVID-19感染后出现关节炎的患者,包括PubMed,Scopus,和EMBASE。我们使用术语“COVID相关性关节炎”,因为没有明确的诊断方法来分类COVID-19感染后的关节炎,诊断的关节炎类型是基于作者的观点。
    结果:在评估了两个严重和非严重COVID-19感染患者组之间的数据后,结果表明,COVID-19的严重程度可能会影响IA的关节受累方式。在这两组中,联合治疗,包括口服非甾体抗炎药与不同类型的皮质类固醇,是最常见的治疗方法。此外,重症COVID-19组的平均年龄和合并症发生率较高.即使严重COVID-19组的患者出现了更严重的COVID-19症状,他们经历了较轻的关节炎,预后较好,延迟发作较多,需要较少的积极治疗.
    结论:我们得出结论,COVID-19严重程度与关节炎严重程度之间可能存在反比关系,可能是由于严重COVID-19患者接受免疫抑制剂治疗后免疫力较弱。
    Since the coronavirus outbreak became a global health emergency in 2020, various immune-based effects, such as inflammatory arthritis (IA), have been recorded. This study aimed to determine the role of COVID-19 severity on post-COVID arthritis.
    We systematically reviewed 95 patients who developed arthritis after severe and non-severe COVID-19 infection by searching the databases, including PubMed, SCOPUS, and EMBASE. We used the term \"COVID-associated arthritis\" because there was no definite diagnostic method for classifying arthritides after COVID-19 infection, and the diagnosed arthritis types were based on the authors\' viewpoints.
    After evaluating the data between the two severe and non-severe COVID-19-infected groups of patients, the results showed that the COVID-19 severity may affect the pattern of joint involvement in IA. In both groups, combination therapy, including oral nonsteroidal anti-inflammatory drugs with different types of corticosteroids, was the most common treatment. In addition, the mean age and comorbidities rate was higher in the severe COVID-19 group. Even though the patients in the severe COVID-19 group developed more serious COVID-19 symptoms, they experienced milder arthritis with better outcomes and more delayed onsets that required less aggressive therapy.
    We conclude that there may be an inverse relationship between COVID-19 severity and arthritis severity, possibly due to weaker immunity conditions following immunosuppressant treatments in patients with severe COVID-19.
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  • 文章类型: Case Reports
    反应性关节炎(ReA)是通常由关节外细菌感染引发的临床病症,并且通常与HLA-B27的存在相关。虽然ReA传统上与胃肠道和泌尿生殖系统感染有关,其发病机制涉及导致关节病变的免疫和炎症反应。由SARS-CoV-2引起的COVID-19的出现促使人们研究该病毒与ReA的可能关联。我们介绍了一名存活于COVID-19并伴有关节病变的患者的ReA病例。病人,一个31岁的男人,表现为下肢关节疼痛。SARS-CoV-2在COVID-19相关肺炎期间通过PCR检测得到证实。在彻底检查和排除所有ReA相关感染后,确诊为COVID-19后的ReA。此外,本文涵盖了一项全球报道的COVID-19后ReA的类似临床病例的研究。
    Reactive arthritis (ReA) is a clinical condition typically triggered by extra-articular bacterial infections and often associated with the presence of HLA-B27. While ReA has traditionally been associated with gastrointestinal and genitourinary infections, its pathogenesis involves immune and inflammatory responses that lead to joint affections. The emergence of COVID-19, caused by SARS-CoV-2, has prompted studies of plausible associations of the virus with ReA. We present a case of ReA in a patient who survived COVID-19 and presented with joint affections. The patient, a 31-year-old man, presented with lower limb joints pain. SARS-CoV-2 was confirmed by PCR testing during COVID-19-associated pneumonia. Following a thorough examination and exclusion of all ReA-associated infections, a diagnosis of ReA after COVID-19 was confirmed. In addition, this article encompasses a study of similar clinical cases of ReA following COVID-19 reported worldwide.
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  • 文章类型: Systematic Review
    膀胱内芽孢杆菌卡介苗(BCG)是一种常见且高效的非肌肉浸润性膀胱尿路上皮癌治疗方法。BCG可能在某些患者中引起自身免疫反应。分析了一百五十八篇论文,总共一百三十名反应性关节炎患者,60例眼部表现患者和18例其他风湿病患者。在130名反应性关节炎患者中,在5次膀胱内滴注BCG(IQR4-6)后出现自身免疫症状,在大多数情况下代表5周。51例患者并发眼部受累。症状的缓解在32.5天的中位数(IQR14-90)内实现。42名男性和20名女性有眼部表现,最常见的是结膜炎。HLA-B27分型患者较早出现与滴注次数相关的眼部症状(4.5vs6[p<0.05]。在128天的中位数(IQR21-150)达到症状的消退。在接受NSAIDs治疗的患者(含或不含类固醇)中,关节组和眼部组的疾病持续时间明显缩短(28vs.120[p<0.05]和30vs.105[p<0.05],分别)。其他自身免疫表现包括一般的自身免疫性疾病,比如血管炎,牛皮癣和重症肌无力。
    Intravesical bacillus Calmette-Guérin (BCG) is a common and highly effective treatment for non-muscle invasive urothelial carcinoma of the urinary bladder. BCG may cause an autoimmune reaction in some patients. One hundred and fifty-eight papers were analyzed, for a total of hundred and thirty patients with reactive arthritis, sixty patients with ocular manifestations and eighteen patients with other rheumatologic diseases. Among 130 subjects with reactive arthritis, an autoimmune symptom occurred after 5 instillations of intravesical BCG (IQR 4-6), which represents 5 weeks in most cases. Fifty-one patients had concurrent ocular involvement. The resolution of symptoms was achieved in a median of 32.5 days (IQR 14-90). Forty-two men and twenty women had ocular manifestations, most commonly conjunctivitis. Patients with HLA-B27 typing had earlier presentation of ocular symptoms related to the number of instillations (4.5 vs 6 [p < 0.05]. Resolution of symptoms was achieved at a median of 128 days (IQR 21-150). Among patients treated with NSAIDs (either with or without steroids), the duration of the disease was significantly shorter in both the articular and the ocular groups (28 vs. 120 [p < 0.05] and 30 vs.105 [p < 0.05], respectively). Other autoimmune manifestations included general autoimmune diseases, such as vasculitis, psoriasis and myasthenia gravis.
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  • 文章类型: Systematic Review
    背景:反应性关节炎(ReA)是一种在远处感染后的关节炎症,通常在胃肠道或泌尿生殖道。自2020年1月COVID-19出现以来,一些病例报告表明反应性关节炎与严重急性呼吸道综合征冠状病毒2(SARS-COV-2)之间存在关系,由于这种疾病的新颖性,大多数发现以病例报告或病例系列的形式报告,仍然缺乏全面的概述。
    方法:我们搜索了PubMed/Medline和Embase,以确定针对ReA和COVID-19之间关联的研究。使用了以下术语:(\“反应性关节炎\”或\“感染后关节炎\”或\“感染后关节炎\”)和(\“COVID-19\”或\“SARS-CoV-2\”或\“2019-nCoV\”)。
    结果:截至2月16日,共发布了35份报告,2022年被纳入本研究。受影响的年龄范围很广(平均41.0,最小4最大78),来自16个国家的男性患病率较高(61.0%)。纳入患者受影响关节的数量和位置不同,所有病例中41.5%的多关节炎患病率较高。发现皮肤表现和视觉障碍是最常见的相关症状。大多数患者(95.1%)康复,平均恢复时间为24天。此外,由COVID-19引起的关节炎似乎比ReA缓解得更快,其次是其他感染。
    结论:ReA可能是COVID-19感染的后遗症。由于肌肉骨骼疼痛是COVID-19的常见症状,起病迅速的ReA容易被误诊。因此,临床医生应将ReA视为COVID-19后关节肿胀患者的重要鉴别诊断。需要进一步的研究来进一步分析和证实这些发现。
    BACKGROUND: Reactive arthritis (ReA) is a joint inflammation that follows an infection at a distant site, often in the gastrointestinal or urogenital tract. Since the emergence of COVID-19 in January 2020, several case reports have suggested a relation between reactive arthritis and severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), due to the novelty of the disease, most findings were reported in the form of case reports or case series, and a comprehensive overview is still lacking.
    METHODS: We searched PubMed/Medline and Embase to identify studies addressing the association between ReA and COVID-19. The following terms were used: (\"Reactive Arthritis\" OR \"Post-Infectious Arthritis\" OR \"Post Infectious Arthritis\") AND (\"COVID-19\" OR \"SARS-CoV-2\" OR \"2019-nCoV\").
    RESULTS: A total number of 35 reports published up to February 16th, 2022, were included in this study. A wide range of ages was affected (mean 41.0, min 4 max 78), with a higher prevalence of males (61.0%) from 16 countries. The number and location of the affected joints were different in included patients, with a higher prevalence of polyarthritis in 41.5% of all cases. Cutaneous manifestations and visual impairments were found as the most common associated symptoms. Most patients (95.1%) recovered, with a mean recovery time of 24 days. Moreover, arthritis induced by COVID-19 seems to relieve faster than ReA, followed by other infections.
    CONCLUSIONS: ReA can be a possible sequel of COVID-19 infection. Since musculoskeletal pain is a frequent symptom of COVID-19, ReA with rapid onset can easily be misdiagnosed. Therefore, clinicians should consider ReA a vital differential diagnosis in patients with post-COVID-19 joint swelling. Additional studies are required for further analysis and to corroborate these findings.
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  • 文章类型: Case Reports
    COVID-19疫苗的快速发展对于应对全球大流行至关重要。疫苗接种后的反应性关节炎是一种罕见的现象。这里,我们提供了3例可能归因于COVID-19免疫(mRNA和活腺病毒载体疫苗)的关节炎症患者的病例系列.使用非甾体抗炎药和糖皮质激素可缓解症状。随访后,这些患者没有被诊断出患有任何其他风湿性疾病。COVID-19疫苗接种后的反应性关节炎是一种不寻常的不良反应,与免疫接种的益处相比,风险可以忽略不计,但是在鉴别诊断中,应该由执业的风湿病学家考虑,他在大流行时照顾没有明显原因的新发关节炎患者。
    The rapid development of COVID-19 vaccines became essential for addressing the global pandemic. Reactive arthritis after vaccination has been a rare phenomenon. Here, we present a case series of three patients with joint inflammation possibly attributed to COVID-19 immunization (mRNA and live adenovirus vectored vaccine). Symptoms were alleviated using non-steroid anti-inflammatory drugs and glucocorticoids. After follow-up, the patients have not been diagnosed with any other rheumatic disease. Reactive arthritis after the COVID-19 vaccine is an unusual adverse effect and poses a negligible risk in comparison to the benefits of immunization, but it should be considered in differential diagnostics by a practicing rheumatologist who cares for patients with new-onset arthritis without apparent cause at the time of pandemic.
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  • 文章类型: Journal Article
    关节痛和关节痛可能是COVID-19的表现,评估长期COVID症状的研究确定了这些疾病的持续存在。此外,一些病例报告强调了COVID-19患者出现新的炎性关节炎,提示可能存在相关性.病毒感染和风湿性疾病具有记录在案的关系;它们与遗传和环境风险因素有关,其中一些是原因。在几种风湿性疾病的发展过程中,病毒与免疫系统之间存在串扰。此外,感染可能参与自身免疫性风湿性疾病的发病机制,并导致患者死亡。因此,对病毒感染和风湿性疾病之间的相互作用提供更清晰的见解是至关重要的。这里,我们对目前的文献进行了简短的回顾,目的是阐明COVID-19与风湿性或肌肉骨骼疾病之间的关系,这还不清楚。具体来说,我们检查了几个方面:风湿性人群感染病毒或出现严重症状的风险,COVID-19和关节炎的相似性,COVID-19、风湿病药物和疫苗的可能的风湿病后果,和COVID-19通过疫苗接种预防风湿病患者。
    Joint pain and arthralgia can be manifestations of COVID-19, and studies evaluating long COVID symptoms identified the persistence of these disorders. Moreover, some case reports highlighted the development of new inflammatory arthritis in patients with COVID-19, suggesting a possible relation. Viral infections and rheumatic diseases share a documented relationship; they have been associated with genetic and environmental risk factors responsible for some of them. There is crosstalk between viruses and the immune system during the development of several rheumatic diseases. Moreover, infections may participate in the pathogenesis of autoimmune rheumatic diseases and contribute to patient mortality. Therefore, it is crucial to provide a clearer insight into the interaction between viral infections and rheumatic diseases. Here, we provide a mini-review of the current literature with the aim of shedding light on the relationship between COVID-19 and rheumatic or musculoskeletal diseases, which is still unclear. Specifically, we examined several aspects: risk for the rheumatic population of acquiring the virus or developing severe symptoms, similarities of COVID-19 and arthritis, the possible rheumatic consequence of COVID-19, of rheumatic drugs and vaccines, and COVID-19 prevention in rheumatic patients through vaccination.
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  • 文章类型: Systematic Review
    这项研究的目的是系统地回顾由贾第鞭毛虫病引起的反应性关节炎(ReA)患者的临床和临床发现。
    在这项研究中,在包括MEDLINE/PubMed在内的国际数据库中搜索后发现了描述贾第鞭毛虫病患者中ReA的论文,WebofScience,Scopus,和科学直接到2021年。还搜索了GoogleScholar以查找更多文章。
    最后,16项研究符合纳入标准,报告115例患者,年龄从19个月到49岁不等。这种疾病在儿童和青少年中的报道多于成人。关节炎最常见的关节是膝盖和脚踝,其次是髋关节,手腕,弯头,肩膀,轴向骨架,meta趾,和近端指间。最常见的关节外症状包括腹泻,过敏症状,和腹痛。
    贾第鞭毛虫病引起的ReA的体征和症状可能多种多样,从中度到重度表现。此外,它们可能与其他一些疾病相似,因此,建议医生和专家对这种疾病有更多的了解,以便正确诊断患者。
    The aim of this study was to systematically review the clinical and paraclinical findings in patients with reactive arthritis (ReA) caused by giardiasis.
    In this study, papers describing ReA in patients with giardiasis were found after searching in international databases including MEDLINE/PubMed, Web of Science, Scopus, and ScienceDirect up to 2021. Google Scholar was also searched to find more articles.
    Finally, 16 studies met the inclusion criteria with reporting 115 patients, ranging in age from 19 months to 49 years. This disease was more reported in children and adolescents than adults. The most frequently involved joints with arthritis were the knee and ankle followed by the hip, wrist, elbow, shoulder, axial skeleton, metatarsophalangeal, and proximal interphalangeal. The most common extra-articular symptoms included diarrhea, allergic symptoms, and abdominal pain.
    The signs and symptoms of ReA caused by giardiasis can be various, from moderate to severe manifestations. Also, they can be similar to some other diseases, so it is recommended that physicians and specialists have more knowledge about this disease to treat patients with a correct diagnosis.
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  • 文章类型: Journal Article
    吸附粒细胞和单核细胞分离术(GMA)是一种体外治疗方法,可选择性地从外周血中去除活化的髓系白细胞。该技术由带有醋酸纤维素珠作为吸收性白细胞提取载体的色谱柱组成,最初用于治疗溃疡性结肠炎。进行了文献检索,以提取最近发表的有关GMA在不同皮肤病患者中的临床疗效的研究,报告人口统计信息,临床症状,治疗和临床过程。皮肤病,GMA已经完成,包括全身性脓疱型银屑病,坏疽性脓皮病,掌足底脓疱型银屑病,Behcet病,甜蜜综合症,成人发作的斯蒂尔病,脓疱疮,反应性关节炎,痤疮和化脓性汗腺炎综合征,皮肤过敏性血管炎和系统性红斑狼疮。在大多数患者中,GMA是在常规治疗选择失败后开始的,在大多数情况下都有帮助。根据汇总的信息,对于患有多种皮肤病的患者,GMA可以被认为是一种有效的非药物治疗选择。用其他药物制剂很难治疗。
    Adsorptive granulocyte and monocyte apheresis (GMA) is an extracorporeal treatment that selectively removes activated myeloid lineage leukocytes from peripheral blood. This technique consists of a column with cellulose acetate beads as absorptive leukocytapheresis carriers, and was initially used to treat ulcerative colitis. A literature search was conducted to extract recently published studies about the clinical efficacy of GMA in patients with different skin disorders, reporting information on demographics, clinical symptoms, treatment and clinical course. Dermatological diseases, in which GMA has been performed, include generalized pustular psoriasis, pyoderma gangrenosum, palmoplantar pustular psoriasis, Behcet\'s disease, Sweet\'s syndrome, adult-onset Still\'s disease, impetigo herpetiformis, reactive arthritis, acne and hidradenitis suppurativa syndrome, cutaneous allergic vasculitis and systemic lupus erythematosus. In most patients, GMA was started after the failure of conventional therapeutic options and it was helpful in the majority of cases. Based on the information summarized, GMA could be considered a valid non-pharmacological treatment option for patients with several dermatological conditions, which are difficult to treat with other pharmacological preparations.
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  • 文章类型: Journal Article
    目的:反应性关节炎是指遗传易感个体在远处感染后1-4周发生的急性无菌性关节炎。它可能发生在COVID-19感染后。我们总结一下,在这篇文章中,COVID-19感染后反应性关节炎的最新发现。
    方法:从2019年12月至2021年12月进行了文献检索。我们纳入了COVID-19感染后发生反应性关节炎的病例报告。我们收集了人口统计,临床,和偏线性数据。
    结果:共22篇文献综述。有14名男性和11名女性,平均年龄为44.96+17.47岁。下肢少关节受累是最常见的临床表现。关节炎和COVID感染之间的时间为6至48天。诊断基于临床和实验室检查结果。20例以非甾体抗炎药为基础的药物治疗。13例患者需要全身或局部类固醇治疗。有2例患者使用柳氮磺吡啶。22例患者症状缓解和恢复。临床消退的平均持续时间为16+57天。
    结论:对于COVID-19感染后新发作的关节炎患者,应考虑诊断为反应性关节炎。其机制尚不清楚。
    OBJECTIVE: Reactive arthritis is acute aseptic arthritis occurring 1 to 4 weeks after a distant infection in a genetically predisposed individual. It may occur after COVID-19 infection. We summarize, in this article, the current findings of reactive arthritis following COVID-19 infection.
    METHODS: A literature search has been performed from December 2019 to December 2021. We included case reports of reactive arthritis occurring after COVID-19 infection. We collected demographic, clinical, and paraclinical data.
    RESULTS: A total of 22 articles were reviewed. There were 14 men and 11 women with a mean age of 44.96 + 17.47 years. Oligoarticular involvement of the lower limbs was the most frequent clinical presentation. The time between arthritis and COVID infection ranged from 6 to 48 days. The diagnosis was based on clinical and laboratory findings. The pharmacological management was based on non-steroidal anti-inflammatory drugs in 20 cases. Systemic or local steroid therapy was indicated in 13 patients. Sulfasalazine was indicated in two cases. Alleviation of symptoms and recovery were noted in 22 cases. The mean duration of the clinical resolution was 16 + 57 days.
    CONCLUSIONS: The diagnosis of reactive arthritis should be considered in patients with a new onset of arthritis following COVID-19 infection. Its mechanism is still unclear.
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