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[The clinical and immunogenetic characteristics of reactive arthritis in children]
Insights
Reactive arthritis in children can stem from nasopharyngeal or intestinal infections. Nasopharyngeal infections typically lead to a favorable outcome, while intestinal infections may result in severe Reiter's syndrome, linked to specific genetic markers.
Area of Science:
- Pediatric Rheumatology
- Immunogenetics
- Infectious Diseases
Background:
- Reactive arthritis (ReA) is a form of inflammatory arthritis that can arise following infections.
- The etiology and clinical presentation of ReA in children can vary depending on the triggering infection.
- Genetic predisposition, particularly involving HLA antigens, is implicated in the development of certain types of arthritis.
Purpose of the Study:
- To investigate the clinical course and outcomes of reactive arthritis in children.
- To identify potential differences in ReA presentation based on the preceding infection (nasopharyngeal vs. intestinal).
- To explore the association between specific human leukocyte antigen (HLA) antigens and the development of ReA and Reiter's syndrome in pediatric patients.
Main Methods:
- Observation of 52 children diagnosed with reactive arthritis.
- Classification of patients based on the antecedent infection: nasopharyngeal or intestinal.
- Clinical assessment of disease course, duration, and laboratory activity.
- HLA antigen typing to identify genetic markers associated with ReA and Reiter's syndrome.
Main Results:
- Of 52 children, 45 developed ReA after nasopharyngeal infection, exhibiting a favorable and rapid course.
- Seven children with a history of intestinal infection developed Reiter's syndrome, characterized by severe, prolonged arthritis and high laboratory activity.
- HLA A10, B27, and DR2 antigens were more frequent in ReA patients with nasopharyngeal infections.
- In children with Reiter's syndrome, HLA A10 and B27 antigens showed a significant predisposition (RR = 5.93 and RR = 149.1, respectively).
Conclusions:
- The type of preceding infection significantly influences the clinical presentation and prognosis of reactive arthritis in children.
- Nasopharyngeal infections are associated with a milder form of ReA, while intestinal infections can lead to severe Reiter's syndrome.
- Specific HLA antigens, notably HLA B27, are strongly associated with the development of Reiter's syndrome in children.
Abstract:
Altogether 52 children suffering from reactive arthritis were placed under observation. In 45 patients arthritis developed after nasopharyngeal infection and was marked by a favourable course with a rapid positive dynamics. 7 children with a history of intestinal infection manifested Reiter's syndrome; in these children arthritis was characterized by a grave and prolonged course and by a high laboratory activity. HLA A10 (RR = 2.7), B27 (RR = 2.5) and DR2 (RR = 2.19) antigen were detected significantly more frequently in ReA patients who suffered nasopharyngeal infection. In children with Reiter's syndrome, the genetic markers of predisposition to the disease were HLA A10 (RR = 5.93) and B27 (RR = 149.1) antigens.