Topical issues of diagnosis and treatment of arthropathy associated with tonsillitis: a literature review

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Abstract

Currently, chronic tonsillitis and its complications remain an urgent concern in modern otorhinolaryngology. The high probability of developing associated diseases, such as rheumatic heart disease, nonspecific arthritis, and glomerulonephritis, emphasizes the significance of this nosological unit in the practice of an otorhinolaryngologists and doctors of other specialties. Reactive arthritis is a critical complication of chronic tonsillitis.

Acute rheumatic fever was the most common disease associated with streptococcal tonsillitis, as well as reactive arthritis. Since 1959, patients with acute rheumatic fever have become less common, but cases of “aseptic” arthritis in patients with acute tonsillitis continued to be recorded. However, no other major criteria were established to confirm the diagnosis of acute rheumatic fever. This type of arthritis is called “post-streptococcal reactive arthritis.” Despite the fact that this disease has been known since mid-19th century, information about its etiology and pathogenesis is limited. The main symptoms of post-streptococcal reactive arthritis are usually similar to the articular syndrome in classical reactive arthritis and are clinically manifested by acute asymmetric non-migrating polyarthritis. Laboratory diagnosis of post-streptococcal reactive arthritis, particularly the determination of titers of streptococcal antibodies, plays a crucial role in confirming the diagnosis. Differential diagnosis of post-streptococcal reactive arthritis with rheumatic diseases is critical. The main diagnostic laboratory markers of rheumatic diseases are antinuclear antibodies, rheumatoid factor, and antibodies to citrullinated proteins. Joint syndrome is often prevented in post-streptococcal reactive arthritis when nonsteroidal anti-inflammatory drugs are prescribed in combination with antibacterial drugs. If arthritis does not respond to long-term treatment with antibiotics and nonsteroidal anti-inflammatory drugs, a planned tonsillectomy is required to prevent the development of a chronic form of tonsillitis-associated arthritis, especially in patients with a history of recurrent chronic tonsillitis.

This study presents an analytical review of domestic and foreign publications on chronic tonsillitis complicated by reactive arthritis. The possible diagnostic methods warranted to confirm the diagnosis and exclude a wide range of arthritis of a different etiology are described.

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About the authors

Andrey I. Kryukov

Research Clinical Institute of Otorhinolaryngology named after L.I. Sverzhevsky; N.I. Pirogov Russian National Research Medical University

Email: nikio@zdrav.mos.ru
ORCID iD: 0000-0002-0149-0676
SPIN-code: 9393-8753

MD, Dr. Sci. (Medicine), Professor, Corresponding Member of the Russian Academy of Sciences

Russian Federation, Moscow; Moscow

Alesya A. Klimenko

N.I. Pirogov Russian National Research Medical University

Email: aaklimenko@yandex.ru
ORCID iD: 0000-0002-7410-9784
SPIN-code: 8396-9251

MD, Dr. Sci. (Medicine), Associate Professor

Russian Federation, Moscow

Anna S. Tovmasyan

Research Clinical Institute of Otorhinolaryngology named after L.I. Sverzhevsky

Email: 7svetlana@mail.ru
ORCID iD: 0000-0002-1214-4939
SPIN-code: 7501-5250

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Said R. Ramazanov

N.I. Pirogov Russian National Research Medical University

Author for correspondence.
Email: saidramazanov97@mail.ru
ORCID iD: 0000-0001-5122-7270
SPIN-code: 4779-4411
Russian Federation, Moscow

Anastasia A. Golovatyuk

Research Clinical Institute of Otorhinolaryngology named after L.I. Sverzhevsky

Email: nastyusha5534@mail.ru
ORCID iD: 0000-0002-0629-7226
SPIN-code: 2164-3678
Russian Federation, Moscow

Maria M. Stepanova

Research Clinical Institute of Otorhinolaryngology named after L.I. Sverzhevsky

Email: mmariestepanova@gmail.com
ORCID iD: 0000-0003-2970-4055
Russian Federation, Moscow

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