Læknablaðið : fylgirit - 01.10.1980, Blaðsíða 5

3
Börje Olhagen
ACUTE AND CHRONIC URO-ARTHRITIS
Introduction
As early as 1818 Brodie of London de-
scribed a number of cases of urethritis
which were probably of venereal origin
and which were followed by arthritis and
conjunctivitis.
A century later, Fiessinger & Leroy de-
scribed a symptom triad in 4 soldiers with
dysentery. The symptoms were nonspecific
urethritis, conjunctivitis and polyarthritis
— “Syndrome conjunctivo urethro-syno-
vial”.
Six days after the French presentation,
Reiter published his famous case in which
the onset of this triad also occurred in the
late course of dysentery.
In the French literature the syndrome is
known as Maladie de Fiessinger-Leroy. In
most other quarters, particularly in the
Anglo-American literature, Reiter‘s name
has been coupled with the syndrome, not
only to denote the classical acute triad but
also as a designation for any form of
arthritis with urologic focus, even though
not preceded by dysentery and even in the
absence of the complete triad. The term
„chronic Reiter‘s disease“ is also employed.
Personally I think that the term Reiter's
disease should be confined to post-enteritic
disease and the triad be labelled Reiter‘s
syndrome.
However, the linking of names with dis-
eases is to many people an abomination and
therefore several modified designations
have been proposed, for example Ford's
“venereal”arthritis.
In Anglo-American literature arthritis
after gonorrhoea is called “gonococcal ar-
thritis”. This is, however, an infectious
arthritis, in which gonococci are demonstra-
ted in the synovial fluid and/or the Peri-
pheral blood. This true purulent or septic
arthritis is now very rare in Sweden.
As “probable gonococcal arthritis” are
labelled those cases in which Neisseriae
are only found in the urogenital tract but
in whom there is dramatic improvement
within 2—3 days of penicillin administra-
tion.
Many rheumatologists belive that these
two types of gonococcal arthritis are the
only forms of joint disorder whish are
related to Neisseria gonorrhoeae infection.
I have introduced the term uro-arthritis,
by which I mean rheumatic conditions that
may develop in association with urogenital
infection:
Uro-arthritis thus comprises acute condi-
tions such as postgonorrhoeal arthritis as
well as complete and abortive forms of
Reiter‘s syndrome, after nongonococcal
urethritis, and, in addition, chronic dis-
orders similar in principle.
Interest is at present focused on two
etiologic agents, Chlamydia and Neisseria.
However other controversial elements are
being considered, namely the mycoplasmas
and the L-forms, as well as the Herpes
genitalis virus.
Chlamydia trachomatis (or ocule-genita-
lis) is now held responsible for about 40
per cent of the non-gonococcal urethritides
and consequently also has been incrimina-
ted as an etiopathogenetic factor of the
Reiter‘s syndrome by Delbarre and Amor
in France, by Kinsella and Ziff in Texas
and by Sychachter in California. The evi-
dence forwarded in favour of Chlamydia
infection as one of the causes of the Reiter's
syndrome is the demonstration of inclusion
bodies as well as cultures of chlamydial
from urethral or cervical smears, positive
complement fixation test and positive
lymphoblast transformation test in the pre-
sence of chlamydial antigen.
Ovvn investigation of uro-arthritis
Acute uro-arthritis is nowadays the most