[Mucocutaneous abnormalities in Chlamydia trachomatis-induced reactive arthritis].
Reactive arthritis (previously known as Reiters syndrome) is an inflammatory arthritis that is a type of spondyloarthropathy. The disease consists of the classical triad of arthritis, urethritis and conjunctivitis, but mucocutaneous abnormalities also frequently appear: balanitis circinata, keratoderma blennorrhagicum, aphthous ulcers in the mouth and nail disorders. These skin lesions are mainly found in reactive arthritis induced by Chlamydia trachomatis (Ct). Reactive arthritis is often triggered by a sexually transmitted infection (Chlamydia trachomatis) or an enteric infection (such as Salmonella or Shigella). It is thought that human antibodies against the pathogen cross-react with the HLA antigen (mainly HLA-B27). To distinguish between reactive arthritis and psoriatic arthritis, screening of the urine or synovium for Ct infection should be carried out. Acute reactive arthritis is treated with NSAIDs as the first choice. In addition, patients may receive an intra-articular injection of glucocorticoids. The mucocutaneous abnormalities respond well to topical glucocorticoids. Although in the Netherlands a Ct induced reactive arthritis is not yet treated with antibiotics, a recent published clinical trial in patients with a chronic Ct induced reactive arthritis showed a significant reduction in complaints in the group treated with a combination of antibiotics for 6 months, compared to the placebo group. Active genitourinary Ct infection should be treated with antibiotics, the first choice being azithromycin 1000 mg as a single dose. It is important that the patient's partner is tested at the same time and if necessary treated simultaneously to prevent reinfection.
Quint
Koen D
KD
Leids Universitair Medisch Centrum, Afd. Dermatologie, Leiden, the Netherlands. k.d.quint@umail.leidenuniv.nl
van der Helm-van Mil
Annette H M
AH
Bergman
Wilma
W
Lavrijsen
A P M Sjan
AP
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016918:Arthritis, Reactive / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000188:drug therapy; D002692:Chlamydia trachomatis; D003937:Diagnosis, Differential; D015796:HLA-B27 Antigen / Q000097:blood; D006801:Humans; D009061:Mouth Mucosa / Q000473:pathology; D011565:Psoriasis / Q000175:diagnosis; D012867:Skin / Q000473:pathology; D013256:Steroids / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D015796:HLA-B27 Antigen; D013256:Steroids