Reaktywne zapalenie stawów (zespół Reitera, ReA) to choroba reumatyczna występująca najczęściej po przebyciu infekcji bakteryjnej układu pokarmowego lub moczowo-płciowego. Schorzenie może manifestować się na wiele różnych sposobów – najczęściej obejmuje stawy obwodowe, kręgosłup, skórę, narząd wzroku, układ pokarmowy.
Reaktywne zapalenie stawów rozwija się wskutek odpowiedzi układu odpornościowego na bakterie lub ich fragmenty obecne w stawach, co prowadzi do wystąpienia stanu zapalnego. Patogeny, których obecność wiąże się zwykle z reaktywnym zapaleniem stawów to: chlamydia, salmonella, shigella, yershinia, campylobacter.
Jakie są objawy reaktywnego zapalenia stawów?
Szacuje się, że reaktywne zapalenie stawów rozwija się około 4 tygodnie po infekcji bakteryjnej, która sama w sobie może przebiegać łagodnie, a nawet nie dawać objawów. Przebieg często jest samoograniczający się, ale u części pacjentów może dojść do rozwoju przewlekłego reaktywnego zapalenia stawów.
Głównym objawem ReA jest ból i obrzęk pojedynczego lub kilku stawów zazwyczaj w kończynach dolnych. U chorych obserwowane są również bóle pleców, krzyża, pośladków. Może również pojawić się bolesność i obrzęk pięt, co znacznie utrudnia chodzenie.
Reaktywne zapalenie stawów często manifestuje się również na skórze, np. w postaci pęcherzyków, nadżerek i plamek na narządach płciowych. Objawom tym może towarzyszyć wyciek z cewki moczowej lub pochwy oraz ból przy oddawaniu moczu. Skórne objawy choroby dotyczą również wysypki i nadmiernego łuszczenia się skóry na podeszwach stóp. Zmiany pojawiają się również na dłoniach w postaci krostkowej wysypki. U chorych obserwowane są również przebarwienia na paznokciach, np. żółte lub szare, a także zgrubienia i bruzdowate wgłębienia. W obrębie jamy ustnej mogą z kolei wystąpić afty, oraz owrzodzenia skóry i jamy ustnej. Niekiedy do objawów skórnych dołącza również rumień guzowaty, czyli czerwone guzy na skórze.
Choroba może dotykać również narząd oka i powodować zapalenie spojówek objawiające się zaczerwienieniem, łzawieniem, a czasem obrzękiem powieki. Może dojść również do ostrego zapalenia przedniego odcinka błony naczyniowej oka, co objawia się bólem, niewyraźnym widzeniem, łzawieniem, zaczerwienieniem. Ponadto choroba może manifestować się ogólnie, np. poprzez złe samopoczucie, osłabienie, gorączkę.
Rozpoznanie reaktywnego zapalenia stawów
W rozpoznaniu reaktywnego zapalenia stawów, po przeprowadzeniu dokładnego wywiadu, lekarz zleca podstawowe badanie krwi. U chorych na ReA najczęściej obserwuje się zwiększone OB oraz stężenie białka C-reaktywnego, czyli wskaźników toczącego się stanu zapalnego w organizmie. Zlecane są także badania na obecność antygenu HLA-B27, który jest obecny u większości chorych z reaktywnym zapaleniem stawów. Specjalista może również zlecić badania bakteriologiczne stolca, moczu, a także płynu pobranego podczas nakłucia stawu, badania serologiczne krwi.
W diagnostyce reaktywnego zapalenia stawów przydatne są również badania obrazowe, np. rentgen, ultrasonografia lub rezonans magnetyczny. Pomogą one ustalić występowanie stanu zapalnego w stawach kręgosłupa, kostnienia więzadeł i ścięgien.
Leczenie: ogólne i objawowe
W początkowym okresie reaktywnego zapalenia stawów, w praktyce klinicznej, stosuje się przeważnie niesteroidowe leki przeciwzapalne (aspiryna, ibuprofen). Chorzy otrzymują również glikokortykosteroidy w postaci zastrzyków oraz doustnie. W przypadku niepowodzenia terapii, lekarz może wdrożyć leki reumatologiczne, np. sulfasalazyna, metotreksat, azatiopryna lub sole złota. W ciężkim przypadkach stosowane są leki biologiczne, np. infliksymab lub etanercept.
Podczas terapii stosuje się także preparaty łagodzące objawy pozastawowe. Np. na zmiany skórne i błony śluzowe narządów płciowych zaleca się miejscowe stosowanie kremów i maści, które powodują zmiękczenie zrogowaciałych warstw naskórka i jego szybsze złuszczenie. W przypadku symptomów ocznych, lekarz może zalecić krople z glikokortykosteroidami lub rozszerzające źrenice. Jeżeli infekcja bakteryjna jest czynna wdrażana jest również antybiotykoterapia.
Istotnym elementem leczenia jest ograniczenie aktywności fizycznej oraz fizjoterapia. Choroba ustępuje w większości przypadków, nawet u pacjentów z ciężkimi objawami. Powikłania choroby są rzadkie i najczęściej dotyczą nawrotowej formy reaktywnego zapalenia stawów, w pewnym stopniu niepełnosprawności ruchowej, zesztywniającego zapalenia kręgosłupa.
Źródła:
B. Kwiatkowska, M. Maślińska, Postępy w diagnostyce i leczeniu reaktywnego zapalenia stawów, Reumatologia 2011; 49, 5:3540-360
mp.pl
Przeczytaj także: Owrzodzenia kończyn dolnych w przebiegu reumatoidalnego zapalenia stawów
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