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},
"code": "M02",
"name": "Реактивные артропатии",
"icd_name": "Реактивные артропатии",
"gender": 0,
"age_min": 0,
"age_max": 94,
"cause": [
3,
2,
5,
7,
8,
9
],
"periodicity": 1,
"slug": "m02_reaktivnye_artropatii",
"lead": "Нарушение здоровья, относящееся к группе инфекционные артропатии",
"description": "Реактивная артропатия — это воспалительное поражение суставов, которое возникает после перенесенных инфекций мочеполовой системы, кишечника или органов дыхания. ",
"etiology": "<p>Peaктивный apтpит paзвивaeтcя вcлeдcтвиe cлeдyющих пpичин: </p>\r\n<ul>\r\n<li>paзличных виpycных инфeкций (caльмoнeллa, шигeллa, кaмпилoбaктep); </li>\r\n<li>инфeкциoнных зaбoлeвaний (дизeнтepия); </li>\r\n<li>иммyнных aнoмaлий; </li>\r\n<li>гeнeтичecкoй пpeдpacпoлoжeннocти к дaннoмy нeдyгy (зaбoлeвaниe чaщe paзвивaeтcя y нocитeлeй aнтигeнa HLA- B 27; </li>\r\n<li>инфициpoвaниe микpoopгaнизмaми, пpoникaющими в мoчeпoлoвyю cиcтeмy (хлaмидии, ypeaплaзмa). </li>\r\n</ul>",
"pathogenesis": "<p>Наиболее частой причиной реактивного артрита является урогенитльная или кишечная инфекция. Однако манифестация реактивного артрита напрямую не связана с попаданием инфекции в сустав, а вторичное воспаление суставов развивается не у всех пациентов, перенесших инфекционное заболевание. </p>\r\n<p>Подобная избирательность, с точки зрения иммуногенетической теории, объясняется предрасположенностью к реактивному артриту лиц с гиперреакцией иммунной системы на микробных агентов, циркулирующих в крови и персистирующих в суставной жидкости и тканях. Вследствие микробной мимикрии – сходства антигенов инфекционного возбудителя и суставных тканей – иммунный гиперответ обращен не только на микроорганизмы, но и на аутоткани сустава. В результате сложных иммунохимических процессов в суставах развивается асептическое (негнойное) реактивное воспаление. </p>",
"diagnostics": "<p>Диагноз реактивный артрит устанавливается на основании истории болезни (наличие первичного инфекционного заболевания), клинических проявлений, и данных лабораторного и инструментального обследования. </p>\r\n<p>В общем анализе крови отмечается лейкоцитоз, ускорение СОЭ и анемия. </p>\r\n<p>В общем анализе мочи – протеинурия (потеря белка), микрогематурия (потеря эритроцитов) и лейкоцитурия (выделение лейкоцитов). </p>\r\n<p>В крови отсутствует повышение ревматоидного фактора, зато высокий титр антител к возбудителю инфекции (чаще всего – к хламидиям) и главное – выявляется HLA-B27 антиген. </p>\r\n<p>Реактивный артрит имеет характерную картину синовиальной внутрисуставной жидкости (низкая вязкость, плохое образование муцинового сгустка, лейкоцитоз). Важное значение имеет рентгенологическое исследование пораженных суставов. Для реактивного артрита не свойственно изменение суставных поверхностей. </p>",
"treatment": "<p>Основным принципом терапии реактивного артрита является устранение первичного инфекционного очага в урогенитальном или кишечном тракте. Назначается этиологически обоснованная противомикробная терапия в оптимальных дозировках сроком не менее 4-х недель. При реактивном артрите, обусловленном хламидийной инфекцией, используются препараты групп макролидов, тетрациклинов, фторхинолонов. Одномоментному лечению подлежат половые партнеры даже при отрицательных анализах на хламидиоз. В случае отсутствия динамики после проведенного антибактериального курса повторно назначают препараты другой группы. </p>\r\n<p>Для ликвидации воспалительной реакции в суставах проводится лечение нестероидные противовоспалительные средства (НПВС); при тяжелом течении артрита - глюкокортикостероидами, как системно, так и с помощью внутрисуставных и периартикулярных инъекций. Затяжное течение реактивного артрита может потребовать назначения противовоспалительной терапии базисными цитостатическими препаратами – сульфасалазином, метотрексатом. </p>\r\n<p>С помощью препаратов-ингибиторов фактора некроза опухоли (ФНО) поддаются лечению даже резистентные к терапии формы болезни, купируются признаки артрита, спондилита, острого увеита. </p>\r\n<p>Введение стволовых клеток при реактивном артрите помогает восстановить структуру поврежденного хряща, нормализовать метаболизм, ликвидировать воспаление в суставе. </p>\r\n<p>При образовании воспалительного выпота производят его эвакуацию из полости сустава. Локально используются противовоспалительные кремы, мази, гели, аппликации димексида. </p>\r\n<p>Из методов физиотерапиипри реактивном артрите предпочтение отдается фонофорезу гидрокортизона, синусоидально-модулирующим токам (СМТ), криотерапии, ЛФК. </p>\r\n<p>После купирования острой степени воспаления назначаются процедуры, направленные на восстановление функций суставов - лечебные ванны, грязелечение. </p>",
"prevention": "<p>Профилактика реактивного артрита сводится к профилактике вызывающих его инфекций: соблюдение гигиенического режима в отношении кишечных инфекций, кипячение воды, мытье рук, соблюдение правил хранения и приготовления пищи. Людям, имеющим положительный антиген HLA-B27, рекомендуется профилактический прием антибиотиков во время путешествий. Для профилактики хламидиоза применяются средства защиты при случайных половых контактах. </p>",
"clinical_picture": "<p>Поражение суставов. Развивается в течение месяца после перенесенной инфекции. Поражаются преимущественно крупные суставы нижних конечностей (коленные, голеностопные, больших пальцев) с одной стороны. Также могут быть вовлечены и другие суставы, редко более шести, часто возникает артрит крестцово-подвздошных суставов и вышележащих отделов позвоночника. </p>\r\n<p>При развитии заболевания симптоматика следующая: </p>\r\n<ul>\r\n<li>Болезненность в пораженных суставах наблюдается при любой двигательной активности, усиливается в ночное время и в покое. Характер боли тупой, ноющий, выкручивающий. </li>\r\n<li>Скованность суставов обусловленная затруднением оттока жидкости из пораженного сустава. Она чаще наблюдается после длительной неподвижности сустава и проходит при возобновлении движения. </li>\r\n<li>Припухлость. </li>\r\n<li>Локальное повышение температуры в зоне больного сустава. </li>\r\n</ul>\r\n<p>Поражение сухожилий. Вместе с суставами часто поражаются и сухожилия, в месте их прикрепления к кости, сухожильные сумки пальцев стоп и кистей с развитием дактилита. </p>\r\n<p>Поражение слизистых оболочек. Конъюнктивит — чаще малосимптомный или бессимптомный, кратковременный. Могут развиваться неинфекционные уретрит, кольцевидный баланит, цервицит, эрозии полости рта, увеит. </p>\r\n<p>Поражение кожи. Кератодермия — безболезненное ороговение кожи с высыпаниями в виде папул (узлов) и бляшек чаще на подошвенной части стоп и ладонях. </p>\r\n<p>Поражение ногтей. Чаще выявляется на пальцах стоп - жёлтое окрашивание, шелушение и разрушение ногтя. </p>\r\n<p>Системные проявления. Увеличение лимфоузлов, особенно паховых. Перикардит, миокардит, приводящий к нарушениям проводимости сердца; недостаточность аортального клапана, плеврит, воспаление почек (гломерулонефрит). Возможно развитие полиневрита </p>\r\n<p>Классическое проявление реактивного артрита, сочетает в себе «триаду Рейтера»: поражение суставов (артрит, синовит), глаз (конъюнктивит, увеит), и слизистых мочеполовых органов (уретрит). В случае присоединения кожных проявлений (кератодермия) носит название «тетрада Рейтера». </p>",
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