Overview
Post-dysentery syndrome, also known as Reiter’s syndrome, post enteropathy rheumatoid, and oculourethral arthritis syndrome, whose etiology and pathogenesis are still poorly understood, is clinically characterized by conjunctivitis, urethritis, and arthritis. It occurs more often in children and is more common in males.
Etiology
The etiology of the disease is unknown and can be related to infections, including bacterial viral mycoplasma infections. It is partly a systemic complication of dysentery, and is thought to be related to allergic reactions, endocrine disorders, and drug allergies, such as penicillin, sulfonamide, and salicylic acid preparations.
Symptoms
Typical clinical manifestations are the triad of conjunctivitis, urethritis, and arthritis, often accompanied by skin damage. Conjunctivitis, the earliest appearance, short duration, often bilateral, can be the bulbar conjunctiva or lid conjunctiva involvement, severe cases affecting the whole conjunctiva, accompanied by conjunctival edema, periorbital swelling, occasionally keratitis and iritis. Iritis may be present in 5% to 10% of patients with first-ever disease; it occurs in 20% to 50% of patients with disease progression or recurrence. A few cases of uveitis, outer scleral laminitis, and corneal ulcers; optic neuritis, uveitis, and speckled retinal edema have also been reported, but are rare. About 3% can lead to permanent visual impairment. ② urethritis urinary urgency, urinary frequency, urinary pain, there may be mucus-like discharge, in severe cases, hematuria, pus urine, urinary pain, there may be mucus-like discharge, in severe cases, hematuria, pus urine, accompanied by cystitis, prostatitis, but the urine bacterial culture has no bacterial growth. Arthritis is the main symptom of the disease, which is found in large weight-bearing joints such as knee, ankle and wrist joints, but the small joints of fingers and toes are also often involved, but the ankle and knee joints are the most common ones, which manifests as redness, swelling and pain in the joints and often occurs symmetrically, similar to rheumatoid arthritis and ankylosing spondylitis, and in severe cases, there is effusion in the joint cavities and limitation of limb movement. Skin and mucous membrane damage can involve the whole body skin and mucous membrane, palm and metatarsal and glans are common, typical lesions of herpetic erythema multiform of varying sizes, blisters rupture after vesicles and scabs, healing and pigmentation, and gradually fading, a small number of lesions in the basis of epidermolysis bullosa and erythema fusion into a piece. In addition to the above main damage, it can be accompanied by systemic toxic symptoms, fever, body temperature up to 39 ℃, infants and young children with high fever convulsions, mostly without chills, accompanied by loss of appetite, nausea and vomiting, diarrhea, restlessness, headache and dizziness, etc., which can last for 2-3 weeks, and in severe cases, it can be complicated by pleurisy and endocarditis.
Examination
1. Blood picture
The white blood cell count is often elevated, the blood sedimentation rate increases, white blood cells and red blood cells can be seen in the urine, but the bacterial culture is negative.
2. X-ray examination
Soft tissue swelling, periarticular hypertrophy, limited osteoporosis can be seen, while chronic cases show extensive new bone formation and joint cavity narrowing.
3. Examination of synovial fluid in the joint cavity
Synovial fluid is turbid, some cases are obviously purulent, the white blood cell count is often (2~5)×109/L (2000~5000/mm3), and occasionally it can be as high as 10~×109/L. In the early stage, most of them are multinucleated leukocytes, but the proportion decreases when inflammatory reaction subsides, and lymphocytes become predominant; the sugar content of the synovial fluid is normal, but the sugar content can be lowered when the number of leukocytes is especially high; the synovial complement level is usually dominated by barocytes; the synovial complement level is usually high; the sugar content of the synovial fluid is normal. Usually predominantly barocytes; normal sugar content in synovial fluid, but sugar content may decrease with particularly high leukocyte counts; synovial complement level usually higher than other exudates; increased protein content; protein-complement binding similar to that of arthrodysplasia, rheumatoid and rheumatoid arthritis.
Diagnosis
Diagnosis is based on the triad of conjunctivitis, urethritis, and arthritis, as well as typical skin changes.
Treatment
In the acute stage, bed rest should be provided, oral care should be strengthened, skin lesions should be protected, weight bearing should be limited, cleanliness and hygiene should be paid attention to, vitamin C should be supplemented, and water electrolyte acid-base balance should be corrected. Adrenocorticotropic hormone as the first choice of drugs, the beginning of the intravenous drug, symptoms improve after the change to oral maintenance. Antipyretic and analgesic drugs such as aspirin and anti-inflammatory pain can also be used. Application of broad-spectrum antibiotics to prevent infection. Chronic synovitis can be synovectomy, joint fusion can be considered when there is destruction of the joint.