Topical issues of diagnosis and treatment of arthropathy associated with tonsillitis. (Literature review)

Abstract

The problem of chronic tonsillitis (CT) and its complications remains one of the most urgent in modern otorhinolaryngology today. The high probability of developing associated diseases, such as rheumatic heart disease, nonspecific arthritis and glomerulonephritis, emphasizes the high importance of this nosological unit both in the practice of an otorhinolaryngologist and doctors of other specialties. Reactive arthritis occupies a special place among the complications of CT. Acute rheumatic fever (ARF) used to be the most common disease that was associated with streptococcal tonsillitis and was accompanied by reactive arthritis. Since 1959, patients with ARL have become less common, but cases of "aseptic" arthritis in patients with acute tonsillitis continued to be recorded, however, they did not have any other major criteria to confirm the diagnosis of ARL. This type of arthritis is called "Post-streptococcal reactive arthritis" (PSRA). Despite the fact that this disease has been known since the middle of the XIX century, there is very little information about its etiology and pathogenesis in the literature. The main symptoms of PSRA are usually similar to the articular syndrome in classical reactive arthritis and are clinically manifested by acute asymmetric non-migrating polyarthritis. Laboratory diagnosis of PSRA, in particular, the determination of titers of streptococcal antibodies plays an important role in confirming the diagnosis. A special place is occupied by the differential diagnosis of PSRA with rheumatic diseases (RH). The main diagnostic laboratory markers of RH are antinuclear antibodies, rheumatoid factor and antibodies to citrullinated proteins. Joint syndrome in PSRA is often stopped when nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed only in combination with antibacterial drugs. If arthritis does not respond to long-term treatment with antibiotics and NSAIDs, and especially if the patient has a history of recurrent CT, a planned tonsillectomy is required to prevent the development of a chronic form of tonsillitis-associated arthritis. The article presents an analytical review of domestic and foreign publications on the topic of CT complicated by reactive arthritis. The possible diagnostic methods necessary to confirm the diagnosis and exclude a wide range of arthritis of a different etiology are described.