反応性関節炎，炎症性関節炎の病態と診断

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  • Pathogenesis and Diagnosis of Reactive Arthritis, Inflammatory Bowel Disease-associated Spondyloarthropathy, Juvenile Idiopathic Arthritis, and Adult-onset Still’s Disease
  • ダイ38カイ ニホン カンセツビョウ ガッカイ キコウ ハンノウセイ カンセツエン エンショウセイ カンセツエン ノ ビョウタイ ト シンダン

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Reactive arthritis and inflammatory bowel disease (IBD)-associated spondyloarthropathy are diseases requiring differentiation from rheumatoid arthritis. Reactive arthritis occurs after preceding infection of the urogenital tract with Chlamydia trachomatis or after a preceding infection of the gut with enterobacteriae and runs a relatively rapid clinical course. The typical joint pattern is an asymmetric arthritis that develops predominantly in the lower limbs and presents as an oligo- or monoarthritis in the majority of patients. Moreover, the disease is frequently complicated by sacroiliac arthritis and is often associated with extra-articular manifestations such as urethritis, diarrhea, and ophthalmic symptoms (conjunctivitis, uveitis) . IBD-associated spondyloarthropathy is induced by IBDs such as ulcerative colitis and Crohn's disease and is characterized by clinical manifestations such as peripheral or axial arthritis and also by extra-articular manifestations such as ophthalmic and mucocutaneous symptoms. Juvenile idiopathic arthritis (JIA) is the general term for chronic arthritis of unknown cause occurring in children under the age of 16 years. JIA is classified into seven types: systemic, rheumatoid factor (RF)-negative polyarticular, RF-positive polyarticular, oligoarticular, psoriatic, enthesitis-related, and undifferentiated arthritis. Systemic JIA is characterized by systemic symptoms such as high fever (spiking fever), skin rash, pericarditis, and lymphadenopathy, as well as joint symptoms; however, polyarticular JIA is mainly characterized by joint symptoms, suggesting the existence of differences between these pathologic conditions. Moreover, most children with RF-positive polyarticular JIA are positive for anti-cyclic citrullinated peptide (anti-CCP) antibodies, but those with systemic and oligoarticular JIA are negative for anti-CCP antibodies. In general, the pathologic manifestations of polyarticular JIA are considered to be similar to those of adult rheumatoid arthritis, while systemic JIA is called Stills disease; if this condition occurs after the age of 16, it is referred to as adult-onset Stills disease. Adult-onset Stills disease is an important cause of fever of unknown origin, requiring differentiation from seronegative rheumatoid arthritis or malignant rheumatoid arthritis.

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