Reactive polyarthritis yog suav tias yog ntau yam mob ntawm cov ntaub so ntswg. Ob qho tib si ua ntu zus thiab kev puas tsuaj rau ntau lub pob qij txha tuaj yeem ua tau. Qhov laj thawj tseem ceeb rau kev txhim kho cov txheej txheem pathological yog qee yam kev tiv thaiv kab mob, cov kab mob metabolic, nrog rau qee yam kab mob tsis tshwj xeeb thiab tshwj xeeb. Polyarthritis manifests nws tus kheej nyob rau hauv daim ntawv ntawm mob, o, hyperemia thiab hyperthermia nyob rau hauv lub cheeb tsam. Kev kuaj mob yog tsim los ntawm kev sim hauv kev sim, cov txiaj ntsig ntawm CT, MRI, radiography, scintigraphy, cytological thiab microbiological kev tshawb fawb ntawm cov kua dej sib koom. Kev kho mob feem ntau yog kev saib xyuas.
Ntse
Reactive polyarthritis - ib txhij lossis ua ntu zus ntawm pob qij txha. Nws tuaj yeem ua tus kab mob ywj pheej lossis tsim los ntawm lwm yamkab mob, raug mob, metabolic ntshawv siab thiab tiv thaiv kab mob pathologies nyob rau hauv tus me nyuam. Nws yog manifested los ntawm ib tug pronounced mob syndrome, impaired functionality, o ntawm cov pob qij txha, lub zos hyperthermia thiab hyperemia. Qhov mob syndrome feem ntau muaj tus cwj pwm zoo li nthwv dej, qhov mob hnyav zuj zus thaum sawv ntxov thiab yav tsaus ntuj. Cov phenomena ntawm daim ntawv mob ntawm tus kab mob yog reversible kiag li; Hauv cov kab mob ntev, kev hloov pauv pathological tshwm sim hauv cov pob qij txha uas tsis tuaj yeem hloov pauv. Qhov laj thawj tseem ceeb ntawm reactive polyarthritis nyob rau hauv cov me nyuam yog ib qho tshuaj tiv thaiv rau lwm yam kab mob inflammatory, uas kis tau mus rau lwm yam kabmob thiab cov ntaub so ntswg, nrog rau cov articular sawv daws yuav.
Yuav ua li cas?
Kev ua txhaum ntawm kev ua haujlwm tuaj yeem tshwm sim los ntawm ob qho tib si mob thiab kev hloov pauv hauv cov qauv ntawm cov ntaub so ntswg. Hauv hom mob me me ntawm tus kab mob no, kev muaj peev xwm ua haujlwm thiab kev txav mus los yog khaws cia, thaum mob hnyav, nws ploj tag lossis txwv. Lub polyetiology ntawm pathology txiav txim siab qhov tseem ceeb ntawm kev kuaj mob kom raug thiab xaiv txoj kev kho kom zoo, suav nrog qhov ua rau, qhov sib txawv ntawm cov kab mob thiab nws daim ntawv. Nyob ntawm cov xwm txheej hauv kev txhim kho cov mob polyarthritis, cov kws kho mob orthopedists, kws kho mob, kws kho mob, kws kho mob rheumatologist thiab lwm tus kws kho mob tuaj yeem kho cov txheej txheem no.
Risk group
Reactive polyarthritis feem ntau tshwm sim hauv cov menyuam yaus tom qab kis kab mob, kab mob, chlamydia thiab kab mob fungal. Cov txheej txheem inflammatory hauv cov pob qij txha tuaj yeem tshwm sim tom qab kis kab mob ntawm txoj hnyuv hauv tus menyuam (salmonellosis,shigellosis), kab mob ntawm cov kab mob genitourinary (urethritis, cystitis), kab mob ntawm cov kab mob ua pa sab saud thiab ua pa (pneumonia, sinusitis, bronchitis, pharyngitis, tonsillitis). Feem ntau, cov txheej txheem pathological no tau pom hauv cov tub. Qhov tshwm sim ntawm qhov tshwm sim yog qhov mob ntev ntawm kev kis kab mob, kev tawm dag zog ntau dhau, kev raug mob ntawm ko taw thiab hypothermia.
Cov tsos mob ntawm tus kab mob
Reactive polyarthritis pib nrog cov tsos mob ntawm intoxication: malaise, qaug zog, hyperthermia, o lymph nodes, tsis qab los noj mov. Yav tom ntej, kev hloov ntawm cov leeg thiab pob qij txha koom nrog cov cim no:
- mob hauv tes, taw, ntawm kev txav thiab so;
- khov kho;
- cim qhia ntawm cov txheej txheem inflammatory hauv cov ntaub so ntswg periarterial - o, liab, kub taub hau;
- asymmetry ntawm qhov txhab;
- dactylitis - mob ntawm cov ntiv tes thiab cov ntiv taw.
Nyob ntawm hom kab mob sib kis, cov kab mob npog:
- qhov muag - qhov no, iris (iridocyclitis), conjunctiva (conjunctivitis) ua rau mob, uas tshwm sim nws tus kheej hauv daim ntawv ntawm tearing, hlawv, liab, txawv teb chaws lub cev hnov;
- daim tawv nqaij thiab mucous daim nyias nyias - yaig nyob rau hauv qhov chaw mos, qhov ncauj, keratoderma (tus ntsia thawv detachment, keratinization ntawm daim tawv nqaij);
- genitourinary system - hlawv thaum tso zis, mob, rub qhov mob hauv plab.
Nyob rau theem tom ntej ntawm kev txhim kho ntawm cov mob polyarthritis hauvCov menyuam yaus thiab cov neeg laus koom nrog kev ua haujlwm tsis zoo ntawm lub plawv, ob lub raum, lub ntsws, lub paj hlwb hauv nruab nrab.
Ntau yam kab mob
ICD code rau reactive polyarthritis - M13.
Cov txheej txheem pathological no, uas tshwm sim thaum menyuam yaus, muaj ntau yam - rheumatic fever, Reiter's syndrome thiab kis-xws li polyarthritis. Cia peb xav txog txhua yam kom ntxaws ntxiv.
Rheumatic fever
hom kab mob no tshwm sim kwv yees li 15-20 hnub tom qab streptococcal tonsillitis. Nyob rau hauv cov ntaub ntawv no, ib tug mob tshwm sim yog heev yam ntxwv nrog nce nyob rau hauv kub txog 40 ° C, tawm hws ntau heev, ua daus no, o ntawm cov qog nqaij hlav, tsis muaj zog heev, thiab los ntshav los ntawm lub qhov ntswg. Tom qab ntawd, ob peb lub pob qij txha loj tau koom nrog hauv cov txheej txheem. Cov kab mob feem ntau yog symmetrical, muaj ib tug wandering cim, txav mus rau txawv pob qij txha, nrog rau mob, o, liab ntawm daim tawv nqaij nyob rau hauv lub pob qij txha.
Cov tsos mob ntawm ntau yam ntawm cov mob polyarthritis yog qhov tsis txaus siab.
Ntau yam pathologies ntawm sab kuj koom nrog:
- CNS - mob taub hau, tsis meej pem hais lus, twitching ntawm lub ntsej muag cov leeg, kev xav tsis txaus ntseeg, tsis muaj kev sib koom tes;
- lub plawv (rheumatic mob plawv) - palpitations, ua tsis taus pa, arrhythmia, nyob rau hauv loj theem - tsim ntawm lub plawv tsis xws luag thiab kev loj hlob ntawm nws insufficiency;
- ntawm daim tawv nqaij - rheumatic nodules - mob tsis muaj qhov sib sib zog nqus uas nyob hauv qab ntawm daim tawv nqaij ntawm cov pob qij txha, los yog daj ntseg liab me ntsis ntawm cov ceg thiabtus me nyuam lub cev, tsis khaus, blanching ntawm siab.
Reiter's Syndrome
Hom kab mob polyarthritis no tshwm sim tom qab tus kab mob chlamydial urogenital rau cov neeg laus thiab menyuam yaus. Nyob rau tib lub sijhawm, cov kab mob nkag mus rau hauv lub cev los ntawm cov kwj dej urogenital thiab kis mus rau lwm lub cev thiab lub cev. Thaum menyuam yaus, qhov no tuaj yeem pom thaum kis tus kab mob los ntawm leej niam thaum yug menyuam. Txoj kev loj hlob ntawm cov txheej txheem pathological yog ua kom yooj yim los ntawm qhov tsis zoo ntawm kev huv hauv lub neej, nrog rau kev loj hlob ntawm yersiniosis, salmonellosis, shigellosis. Cov caj ces tseem ua lub luag haujlwm. Clinically, tus kab mob no tshwm sim los ntawm peb cov tsos mob tseem ceeb: mob caj dab, conjunctivitis thiab urethritis.
Ua tiav hauv peb theem:
- Urethritis - tus me nyuam txhawj txog khaus, kub hnyiab, mob tso zis, hyperemia nyob rau hauv lub urethra.
- Conjunctivitis, uas tshwm sim symmetrically ntawm ob lub qhov muag, feem ntau mus unnoticed.
- Arthritis - tshwm sim kwv yees li 2 lub hlis tom qab pib ntawm urethritis. Qhov no yog tus cwj pwm los ntawm asymmetric lesions ntawm nruab nrab thiab me pob qij txha ntawm qis extremities. Arthralgia intensifies hmo ntuj thiab thaum sawv ntxov, cov ntaub so ntswg periarticular yog hyperemic, ib tug effusion yog tsim. Tsis tas li ntawd, nyob rau hauv ob peb hnub, muaj ib tug generalization ntawm cov txheej txheem pathological los ntawm lub hauv qab mus rau. Muaj o ntawm cov leeg thiab ligaments ntawm pob taws, qhov mob tshwm nyob rau hauv qaum.
Zooib hom kab mob pathology, zoo li Reiter's syndrome, tuaj yeem nrog cov teeb meem hauv kev ua haujlwm ntawm lub plawv, ntsws, raum, lymphatic thiab paj hlwb. Cov tsos mob thiab kev kho mob ntawm reactive polyarthritis yog sib cuam tshuam.
Kab mob-ua xua polyarthritis
Cov tsiaj no tshwm sim kwv yees li 8-10 hnub tom qab kis kab mob ntawm cov kab mob ua pa (pharyngitis, tonsillitis, sinusitis, tonsillitis tshwm sim los ntawm streptococci thiab staphylococci). Lub ntsiab predisposing yam yog qhov tsis muaj zog ntawm lub cev, kev hloov pauv hloov pauv (yog tias cov niam txiv muaj mob rheumatism lossis mob hawb pob), ua xua rau staphylococci lossis streptococci, hormonal tsis txaus.
Kev kho mob tshwm sim los ntawm qhov mob me me lossis nruab nrab ntawm pob taws thiab hauv caug pob qij txha nrog hnyav effusion mus rau hauv cov kab noj hniav synovial, uas nce zuj zus txhua hnub. Lwm cov tsos mob (mob, liab, kub taub hau nyob rau hauv cov cheeb tsam cuam tshuam), raws li txoj cai, ploj mus rau hauv keeb kwm yav dhau thiab yog ib tug thib ob yam.
Txhua yam ntawm txhua hom
Kab mob-allergic polyarthritis hauv cov menyuam yaus npog cov pob qij txha ntawm ntau qhov ntau thiab tsawg tib lub sijhawm. Tus kab mob no tshwm sim rau cov menyuam yaus hnub nyoog qis dua ob xyoos uas tau kis tus kab mob Haemophilus influenzae lossis Staphylococcus aureus los ntawm lawv niam. Nyob rau tib lub sij hawm, tus me nyuam yog lethargic, nws tsis kam noj, mis. Tej zaum nws yuav muaj kua muag, lameness. Cov txheej txheem pathological tuaj yeem yog subacute lossis mob hnyav. Hauv cov menyuam yaus hnub nyoog 3 txog 10 xyoo, kev mob caj dab ntev feem ntau tshwm sim hauv cov pob qij txha loj, uas tshwm sim tom qab tonsillitis, tonsillitis, pharyngitis.
Reiter's syndrome kis tau rau cov menyuam yaus hauv lub tsev menyuam, los ntawm huab cua, tais diav, tes qias neeg, khoom, tiv tauj nrog tsiaj lossis noog.
Kab mob tsis muaj qhov ua rau txo qis kev tiv thaiv yuav tsis tshwm sim nws tus kheej. Lawv tuaj yeem ua rau mob khaub thuas, hypothermia, kev ntxhov siab. Conjunctivitis tshwm sim thawj zaug thiab tsuas yog cov tsos mob rau lub sijhawm ntev (cov kws kho mob tshwj xeeb feem ntau tsis xav tias qhov kev loj hlob ntawm tus mob). Polyarthritis tshwm sim tom qab ob peb xyoos thiab tsis muaj suab ntau dua li cov neeg laus.
Cov yam ntxwv ntawm cov kab mob reactive polyarthritis yog:
- ntxiv rau lub duav, hauv caug, pob taws pob taws, feem ntau qhov mob cuam tshuam rau cov pob qij txha ntawm cov ntiv taw loj;
- cov pob qij txha me me hauv cov txheej txheem pathological muaj feem cuam tshuam me ntsis, blush;
- tus yam ntxwv mob tuaj yeem hnov lub siab, tsis nrog txav, lub peev xwm ntawm lub cev tau khaws cia;
- puffiness yog pronounced;
- hauv cov menyuam yaus ua xua, muaj cov tshuaj tiv thaiv kab mob ua npaws, dyspepsia, mob hnyav;
- Cov tub ntxhais hluas tuaj yeem tsim kab mob sacroiliac sib koom ua ke ntawm spondyloarthritis.
ntsuas ntsuas
Kev kuaj mob ntawm tus mob polyarthritis (ICD code 10 - M13) hauv cov menyuam yaus yog nyob ntawm anamnesis (ua rau muaj feem cuam tshuam, kis kab mob yav dhau los), kev kuaj mob, kev tshawb fawb lub cev thiab kev sim.
Cov txheej txheem kuajsuav nrog:
- kuaj ntshav dav dav txhawm rau kuaj pom cov txheej txheem inflammatory (leukocytosis, nce ESR);
- kuaj kab mob ntawm cov zis, cov kua dej synovial, smear los ntawm cov mucous daim nyias nyias los txiav txim seb hom kab mob kis tau licas;
- tshuaj tiv thaiv kab mob rau kev kawm txog cov tshuaj tiv thaiv kab mob rau qee yam kab mob (tom qab kis tau tus kab mob, nws muaj peev xwm pom tias cov tshuaj tsis raug kuaj pom, tab sis cov tshuaj tiv thaiv tseem nyob);
- urinalysis txhawm rau txheeb xyuas cov kab mob ntawm cov kab mob genitourinary;
- tsom xam ntawm cov kua dej sib txuas.
Lub cev txoj hauv kev koom nrog cov kev ntsuas hauv qab no:
- X-ray, CT, MRI - kev txiav txim siab ntawm kev hloov pauv hauv cov pob qij txha, periarticular thiab pob txha nqaij;
- biopsy - kawm txog cov ntaub so ntswg;
- diagnostic arthroscopy yog ib hom endoscopy uas muaj kev cuam tshuam ntawm cov pob qij txha raug txiav txim;
- Echocardiography, ECG txhawm rau txheeb xyuas cov kab mob plawv thiab cov hlab ntsha;
- YUltrasound.
Kev kho mob
Kev kho mob ntawm cov kab mob polyarthritis feem ntau yog nyuaj. Nws yog tsom rau kev tshem tawm qhov tshwm sim ntawm kev kis kab mob, cov tsos mob ntawm polyarthritis (mob, o, ua haujlwm tsis zoo ntawm cov pob qij txha), o, comorbidities, tiv thaiv kev ua haujlwm autoimmune thiab teeb meem.
Tshuaj kho rau cov mob polyarthritis muaj xws li:
- broad-spectrum tshuaj tua kab mob uas neutralize ob peb pawg kab mob, nrog raucov tshuaj tshwj xeeb, qhov kev txiav txim ntawm uas yog qhia rau ib hom microbe;
- tshuaj tiv thaiv kab mob tsis yog tshuaj steroidal uas txo qhov mob thiab mob;
- tshuaj tua kab mob;
- glucocorticoids - tshuaj hormonal uas tshem tawm qhov mob;
- immunosuppressors uas txwv cov txheej txheem autoimmune;
- chondroprotectors uas rov qab cov pob txha mos;
- vitamin uas ua kom muaj zog ntawm kev tiv thaiv;
- nrog kev ntxhov siab ntawm qhov pib ntawm tus kabmob - sedatives.
Reviews
Kev tshuaj xyuas ntawm cov neeg mob uas muaj tus kab mob no, nrog rau lawv niam lawv txiv, nyob rau hauv cov ntaub ntawv ntawm kev loj hlob ntawm pathology nyob rau hauv cov me nyuam, hais txog cov tsos mob tsis kaj siab heev nyob rau hauv lub sij hawm ntev thiab mob heev. Txawm li cas los xij, kev kho sai sai rau kev mob caj dab ntawm cov pob qij txha pib, qhov zoo dua.
Cov neeg mob nco ntsoov tias nrog kev mus ntsib kws kho mob raws sij hawm ntawm thawj cov tsos mob, tus kab mob tuaj yeem tiv thaiv tau thaum ntxov, uas yuav cawm tau los ntawm ntau yam tsis zoo. Kev kho mob, raws li cov neeg mob, kuj yog ib txoj kev ntev uas yuav tsum tau ua raws li tag nrho cov ntawv kho mob. Cov npe ntawm cov tshuaj yog dav heev, thiab ntau ntawm lawv ua rau muaj kev phiv ntau yam.
Peb tau saib cov tsos mob thiab kho mob caj dab reactive. Daim duab ntawm tus kab mob sib koom tau raug xa mus.
