reactive arthritis

反应性关节炎
  • 文章类型: Case Reports
    横纹肌溶解症的特征是骨骼肌组织的降解,将细胞内容物释放到循环中。这种情况通常源于各种因素,包括外伤,过度劳累,肌肉缺氧,感染,代谢和电解质失衡,某些药物,毒素,和遗传异常。尽管如此,由感染性心内膜炎菌血症引起的横纹肌溶解仍然极为罕见。本报告描述了一个不寻常的病例,其中感染性心内膜炎表现为横纹肌溶解,伴有肌肉脓肿和急性肾功能衰竭。通过水合和靶向抗生素治疗,患者的病情得到了成功控制。导致有利的复苏。该病例强调了对感染性心内膜炎的心外症状和体征保持警惕的重要性。如横纹肌溶解和肌肉脓肿。在这种情况下,特别值得注意的是发现了一种非典型致病细菌,乳酸链球菌,在感染性心内膜炎的背景下。该病例突出了与这种严重心脏病相关的广泛的潜在表现和因果因素。
    Rhabdomyolysis is characterized by the degradation of skeletal muscle tissue, which releases cellular contents into circulation. This condition commonly stems from various factors, including trauma, overexertion, muscular hypoxia, infections, metabolic and electrolyte imbalances, certain medications, toxins, and genetic abnormalities. Despite this, instances of rhabdomyolysis precipitated by bacteremia of infective endocarditis remain exceedingly rare. This report describes an unusual case wherein infective endocarditis manifested as rhabdomyolysis, accompanied by a muscular abscess and acute renal failure. The patient\'s condition was successfully managed through hydration and targeted antibiotic therapy, leading to a favorable recovery. The case underscores the importance of vigilance for extracardiac symptoms and signs of infective endocarditis, such as rhabdomyolysis and muscular abscesses. Of particular note in this case was the discovery of an atypical causal bacterium, Streptococcus dysgalactiae, in the setting of infective endocarditis. This case highlights the broad range of potential manifestations and causal factors associated with this serious cardiac condition.
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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: Case Reports
    2019年冠状病毒(COVID-19)感染后的反应性关节炎(ReA)主要在成人中被描述,仅报告了两例儿科病例。我们报告了第三例ReA被发现是COVID-19感染后的后遗症。一名15岁的右撇子白人女孩表现出严重的左手腕疼痛。她发烧了,皮疹,和迁徙性寡关节炎,实验室检查显示炎症标志物升高和COVID-19IgG抗体检测阳性。影像学显示炎性关节病伴腕关节滑膜炎。该患者在COVID-19感染后被诊断为ReA,并在保守治疗失败后通过腕关节镜滑膜切除术进行手术治疗。她手术后已经一年了,她做得很好。新出现的病例报告将ReA视为对COVID-19感染的延迟反应;因此,ReA应纳入COVID-19感染后所有关节痛患者的鉴别诊断清单。
    Reactive arthritis (ReA) following Coronavirus 2019 (COVID-19) infection has been described mainly in adults, and only two pediatric cases have been reported. We report a third case where ReA was found to be a sequela following COVID-19 infection. A 15-year-old right-handed Caucasian girl presented with severe left-wrist pain. She was experiencing fever, rash, and migratory oligoarthritis, and laboratory work-up showed elevated inflammatory markers and a positive COVID-19 IgG antibody test. Imaging revealed inflammatory arthropathy with wrist synovitis. The patient was diagnosed with ReA following COVID-19 infection and was treated surgically by wrist arthroscopic synovectomy after the failure of conservative management. It has been 1 year after her surgery, and she is doing well. Emerging case reports are linking ReA as a delayed response to COVID-19 infection; therefore, ReA should be included in the list of differential diagnoses in all patients with joint pain following COVID-19 infection.
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  • 文章类型: Case Reports
    反应性关节炎是由遗传易感宿主中的泌尿生殖道或肠道引起的免疫介导的无菌性关节炎。反应性关节炎并不少见,最常见的感染因子是沙眼衣原体,沙门氏菌,耶尔森氏菌,和志贺氏菌,一些新的传染因子包括卢氏葡萄球菌,粘胶红花,和脐带衍生的沃顿果冻,以及SARS-CoV-2病毒,这在近年来得到了更多的研究。我们发现由肛周脓肿感染引起的反应性关节炎非常罕见,医学文献中很少描述病例。我们报道了一个21岁的男性多关节肿胀和疼痛,右踝关节皮下血肿被认为是反应性关节炎.用非甾体抗炎药治疗后,柳氮磺胺吡啶,手术,和抗生素,随访1个月,患者关节痛逐渐好转,症状基本消失。
    Reactive arthritis is an immune-mediated aseptic arthritis resulting from either genitourinary or intestinal tract in a genetically susceptible host. Reactive arthritis is not uncommon, and the most common infectious agents are Chlamydia trachomatis, Salmonella, Yersinia, and Shigella, some new infectious agents include Staphylococcus lugdunensis, Rothia mucilaginosa, and umbilical cord-derived Wharton\'s jelly, as well as the SARS-CoV-2 virus, which has been more studied in recent years. We found that reactive arthritis caused by infection of perianal abscesses is very rare and few cases have been described in the medical literature. We report a 21-year-old man with polyarticular swelling and pain, and subcutaneous hematoma at his right ankle joint; he was considered reactive arthritis. After treating with non-steroidal anti-inflammatory drugs, sulfasalazine, surgery, and antibiotics, the patient\'s arthralgia gradually improved and the symptoms largely disappeared at the 1-month follow-up.
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  • 文章类型: Case Reports
    2021年初,在全球范围内成功向人类接种了多种免疫制剂的2019年冠状病毒病(COVID-19)疫苗。尽管预期会有许多副作用,有一些意想不到的效果。我们报告了一例患者,该患者在右膝关节中很少发生反应性关节炎,表现为疼痛,热,在接种牛津-阿斯利康COVID-19疫苗后第二天肿胀。病人接受了一系列的调查,确认可疑诊断并排除其他可能的疾病。该病例难以口服非甾体抗炎药。因此,治疗转向关节内类固醇治疗.尽管治疗计划明显改善了患者的症状,它没有解决他们。COVID-19疫苗接种后一种罕见的可能副作用是反应性关节炎,这种情况通常发生在年轻健康的个体中,没有明显的合并症。
    In early 2021, multiple vaccinations for the coronavirus disease 2019 (COVID-19) in various immunological formulations were administered successfully to humans worldwide. Although numerous encountered side effects were expected, there were some effects that were unexpected. We report a case of a patient who experienced a rare occurrence of reactive arthritis in the right knee joint that manifested insidiously as pain, heat, and swelling on the second day following vaccination with the Oxford-AstraZeneca COVID-19 vaccine. The patient underwent a series of investigations, confirming the suspected diagnosis and ruling out other possible diseases. The case was refractory to oral non-steroidal anti-inflammatory drugs. Thus, the treatment was shifted to intra-articular steroids. Although the treatment plan improved the symptoms of the patient noticeably, it did not resolve them. A rare possible side effect following COVID-19 vaccination is reactive arthritis, which often occurs in young and healthy individuals with no significant comorbidities.
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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: Case Reports
    尽管接种疫苗的安全性和有效性已经通过临床试验进行了评估,医学专家和当局对公众对SARS-CoV-2免疫接种后不良事件的报告和调查非常感兴趣。这篇文章报道了一名41岁的男子,没有基础疾病史,抱怨他的左肘关节持续晨僵和急性不适,服用第一剂SputnikV后20天,对该病例进行了广泛研究,并做出了反应性关节炎的可能诊断。
    Although the safety and efficacy of vaccinations have been evaluated through clinical trials, medical experts and authorities are very interested in the reporting and investigation of adverse events following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunisation in the general public. This article reports about a 41-year-old man without a history of underlying diseases, complaining of continuous morning stiffness and acute discomfort in his left elbow joint, 20 days after taking the first dosage of Sputnik V. The case was extensively studied, and a possible diagnosis of reactive arthritis was made.
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  • 文章类型: Case Reports
    Reactive arthritis is a rare form of spondyloarthropathies occurring after genital or enteric infection. It is most often self-limited but can progress to chronic spondylarthritis. We report the case of a 30-year-old man who presented with acute arthritis occurring 2 months after an episode of urethral discharge. Physical examination revealed polyarthritis, dactylitis, sacroiliac joint involvement, and plantar papulosquamous plaques. The human leukocyte antigen B27 was positive. Detection of Chlamydia trachomatis and Gonococcus in the first catch urine specimen was negative. Hepatitis B and C, Chlamydia trachomatis, human immunodeficiency virus, and syphilis serologic test results were negative. Pelvic magnetic resonance imaging revealed left sacroiliitis. The patient was treated with antibiotics, diclofenac, and sulfasalazine. After 6 months of follow-up, a significant clinical improvement was obtained without remission, suggesting an evolution to chronic spondylarthritis. Diagnosis of Reactive arthritis is difficult since microbiologic examinations are commonly negative. This disease should be considered in patients with rheumatologic manifestations occurring after a urogenital or enteric infection, mainly when associated with skin manifestations and human leukocyte antigen B27.
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  • 文章类型: Case Reports
    格氏链球菌(S.gordonii)属于α-溶血性链球菌群。它是在人类口腔粘膜中发现的共生细菌,大量存在于牙齿表面。它通常被认为是非致病性或弱致病性的,并且已知会引起亚急性心内膜炎;然而,关于由S.gordonii引起的反应性关节炎(ReA)的报道很少。在这里,我们报道了1例由gordonii引起的亚急性感染性心内膜炎合并ReA的病例,并探讨了由gordonii引起的ReA的可能致病机制。
    Streptococcus gordonii (S. gordonii) belongs to the alpha-hemolytic Streptococcus group. It is a symbiotic bacterium found in the human oral mucosa which is present in large quantities on the surface of the teeth. It is generally considered nonpathogenic or weakly pathogenic and is known to cause subacute endocarditis; however, there are few reports of reactive arthritis (ReA) caused by S. gordonii. Herein, we report a case of ReA complicated by subacute infective endocarditis caused by S. gordonii and explore the possible pathogenic mechanism of ReA caused by S. gordonii.
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