Реактивный артрит- современный взгляд на проблему

Аннотация

В обзорной статье приводятся современные сведения об этиологии, патогенезе, классификации, клинической картине и диагностике заболевания. Освещены вопросы медикаментозного лечения реактивного артрита. Ключевые слова: реактивный артрит, хламидии, лечение. Наргиза Мирза-Бахтиярхоновна АБДУРАХМАНОВА Халмурад Садуллаевич АХМЕДОВ Тошкент тиббиёт академияси РЕАКТИВ АРТРИТ- МУАММОГА ҚАРАТИЛГАН ЗАМОНАВИЙ НИГОХ АННОТАЦИЯ Мазкур мақолада реактив артритнинг этиология, патогенез, классификация, клиник манзара ва диагностикасига оид замонавий маълумотлар берилган. Реактив артритнинг медикаментоз даволаш усуллари, мавжуд муаммолар, хал қилинмаган вазифалар ёритилган. 196 БИОМЕДИЦИНА ВА АМАЛИЁТ ЖУРНАЛИ | ЖУРНАЛ БИОМЕДИЦИНЫ И ПРАКТИКИ | JOURNAL OF BIOMEDICINE AND PRACTICE №1 | 2021 Калит сўзлар: реактив артрит, хламидия, даволаш The medical and social significance of chronic arthritis is determined by the constant increase in their occurrence, the tendency to chronization and a steady progressive course with a sharp decrease in the quality of life of patients, high medical and social costs of society (VA. Nasonova, O. M. Folomeeva, 2001). Joint diseases occupy one of the first places among the causes of disability in the population aged 16-72 years and are the main cause of disability in people over 65 years of age [7]. Among chronic inflammatory diseases of the joints, one of the most common is reactive arthritis [8]. Reactive arthritis (ReA) is an immune — inflammatory joint disease that occurs within one month after an intestinal or genitourinary infection, associated with histocompatibility antigens HLA B-27, and is a systemic clinical manifestation of this infection [12]. The incidence of reactive arthritis in the general population is 0.1% [10]. In rheumatological hospitals, the proportion of patients with reactive arthritis is 10%, and chronic forms of the disease are accompanied by a significant violation of the functional activity of the joints due to the development of severe complications, often (up to 42% of cases), leading to disability [21]. An increase in the incidence of ReA, a predominant lesion of young people, frequent chronization of the pathological process, and not always satisfactory treatment results determine the medical and social significance of this problem. In addition, the widespread occurrence, high frequency of resistance to therapy, frequent formation of severe forms, and lack of effective prognostic criteria for early diagnosis of reactive arthritis determine the relevance of studying this problem [1] for a Long time, the term "Reiter's disease" (uretero-oculo- synovial syndrome) was used to determine ReA associated with urogenital infection. In recent years, discussions have been held on the terminology of ReA and Reiter's disease [8]. Reiter's disease is a systemic disease, inflammatory joint damage associated with sexually acquired chlamydia trachomatis infection, and is combined with urethritis and prostatitis in men, cervicitis and salpingitis in women, as well as eye and skin damage. If there is a lesion of the urogenital system, joints, eyes and skin, we speak of the Reiter tetrad, if there is no skin lesion, we speak of the Reiter triad. This disease was described by the military doctor Rance Reuter in 1916. There is a sporadic form, or Reiter's disease, associated with a sexually acquired infection, and endemic (Reiter's syndrome), associated with a trigger infection acquired in a non-sexual way (post- dysentery, post-enterocolitic) [21] There are 2 main forms of ReA – urogenital and postenterocolitic (enterogenic). In addition, there are 2 variants of the course – sporadic and epidemic. The sporadic variant usually observed in urinogenous the form ReA and epidemic – when potentialities. This variant occurs in closed groups (for example, in youth camps or army units), usually occurs in the summer and is associated with violation of sanitary conditions. Etiology. Etiological factors (triggers) of ReA are: Chlamydia trachomatis, Yersinia enterocolitica, Yersinia pseudotuberculosis, Campylobacter jejune, Salmonella enteriditis, Salmonella tiphimuri - and Shigella flexneri.Arthritis, the development of which is associated with streptococcal, borrelious, brucellosis, and viral infection, does not belong to Rea [15, 24]. When proving a trigger infection, the diagnosis must have an etiological characteristic. For example, when a chlamydia infection is detected, arthritis is called chlamydia-induced ReA. Chlamydia trachomatis, which is a pathogenic, obligate intracellular gram-negative bacteria, causes chlamydia-induced arthritis [23]. The main role in the pathogenesis of ReA is played by immunopathological processes associated with the development of a hyperimmune response to an infectious agent located inside the joint or extraarticularly. Trigger factors (for example, chlamydia and Yersinia) can initiate a cytotoxic T-cell response, which leads to proliferation and activation of CD8+ T