| Abstract [eng] |
Reactive arthritis is the most accepted form of arthritis in connection to urogenital infection and continues to be a clinically relevant but pathogenetically complex condition. Most commonly, it is associated with an infection of Chlamydia trachomatis and can lead to acute, recurrent or chronic inflammatory disease. Even with decades of research, there are still important challenges remaining, regarding the mechanisms of disease development, the differences in clinical manifestations, a lack of accepted diagnostic criteria that is universally accepted, as well as limited evidence that could guide advanced treatment strategies. This thesis aims to synthesise and critically evaluate milestone studies and new evidence on arthritis and urogenital infection, with a special focus on reactive arthritis and its pathogenesis, clinical presentation, diagnosis and treatment. The main objectives were to summarise current evidence on pathogenesis, evaluate the clinical presentation, assess current diagnostic approaches, as well as their limitations and to review available therapeutic strategies and their effectiveness. The design of this thesis was a narrative literature review with a structured literature search mainly in PubMed and Google Scholar, with an additional manual review of reference lists and specific author searches for publications by Prof. I. Butrimienė. “Reactive arthritis” was used as a mandatory keyword in the search process. Selection of publications was done according to the thematic relevance of pathogenesis, clinical presentation, diagnosis, treatment and a focus on literature from the last 10 years, also including older milestone studies if necessary. The reviewed literature showed that reactive arthritis with urogenital infection is an inflammatory disease with multiple factors, in which persistent microbial components, dysregulated immune responses and host susceptibility interact closely. Chlamydia trachomatis is still the most strongly supported urogenital trigger. When looking at the clinical picture, the most typical findings is a patient with asymmetric oligoarthritis of the lower extremities, accompanied by symptoms such as enthesitis, dactylitis and extra-articular manifestations. Diagnosis is primarily clinical and can be supported by laboratory and microbiological findings as well as the exclusion of differential diagnoses. The treatment follows three steps and is individualised, with non-steroidal anti- inflammatory drugs forming the basis of the treatment, followed by glucocorticoids and conventional disease-modifying antirheumatic drugs and in selected refractory cases escalated to biological therapy. All in all, reactive arthritis is an infection-associated but immune-mediated disease with a high clinical variability and ongoing challenges regarding diagnostic, therapy and the pathogenesis of the disease. Further studies integrating microbiology, immunopathogenesis, clinical phenotype, treatment options and outcomes are needed. |
