Topical issues of diagnosis and treatment of arthropathy associated with tonsillitis: a literature review
- Authors: Kryukov A.I.1,2, Klimenko A.A.2, Tovmasyan A.S.1, Ramazanov S.R.2, Golovatyuk A.A.1, Stepanova M.M.1
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Affiliations:
- Research Clinical Institute of Otorhinolaryngology named after L.I. Sverzhevsky
- N.I. Pirogov Russian National Research Medical University
- Issue: Vol 30, No 4 (2024)
- Pages: 408-416
- Section: Reviews
- Submitted: 14.03.2024
- Accepted: 21.06.2024
- Published: 09.09.2024
- URL: https://medjrf.com/0869-2106/article/view/629002
- DOI: https://doi.org/10.17816/medjrf629002
- ID: 629002
Cite item
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; MoscowAlesya 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, MoscowAnna 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, MoscowSaid 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
References
- Rybak NA, Tsyrkunov VM, Rybak RF. Microbiocenosis of the palatine tonsils in chronic tonsillitis. Zdravoohranenie (Minsk). 2014;(12):2–7. EDN: TJVZJV
- Nacharov PV, Konoplev OI, Preobrazhenskaya YuS, et al. Etiological issues of chronic tonsillitis. Patologicheskaja fiziologija i jeksperimental’naja terapija. 2021;65(3):91–97. EDN: XCJKMJ doi: 10.25557/0031-2991.2021.03.91-97
- Khafizova FA. Clinical, laboratory and immunomorphologic substantiation of treatment tactics for various forms of chronic tonsillitis different forms of chronic tonsillitis [dissertation abstract]. Moscow; 2012. (In Russ.)
- Maltseva GS. Streptococcal infection in chronic tonsillitis. Consilium Medicum. 2009;11(3):71–77. (In Russ.) EDN: RBCMJX
- Bassili A, Barakat S, Sawaf GE, et al. Identification of clinical criteria for group A-beta hemolytic streptococcal pharyngitis in children living in a rheumatic fever endemic area. J Trop Pediatr. 2002;48(5):285–293. doi: 10.1093/tropej/48.5.285
- Tovmasyan AS. The significance of symbiotic interactions of pyogenic streptococcus in chronic tonsillitis [dissertation]. Moscow; 2009. (In Russ.) EDN: VVMEXS
- Shpynev KV, Krechikova OI, Krechikov VA, Kozlov RS. Streptococcus pyogenes: characteristics of the pathogen, isolation, identification and susceptibility testing. Clinical Microbiology and Antimicrobial Chemotherapy. 2007;9(2):104–119. (In Russ.) EDN: KYKNPH
- Kriukov AI, Tovmasian AS, Drabkina IV, et al. The role of microflora in etiology of chronic tonsillitis. Russian Bulletin of Otorhinolaryngology. 2010;(3):4–6. EDN: TEUIUD
- Cunningham MW. Pathogenesis of group A streptococcal infections. Clin Microbiol Rev. 2000;13(3):470–511. doi: 10.1128/CMR.13.3.470
- Friedberg CK. Rheumatic fever in the adult: criteria and implications. Circulation. 1959;19(2):161–164. doi: 10.1161/01.cir.19.2.161
- Goldsmith DP, Long SS. Streptococcal disease of childhood — a changing syndrome. Arthr Rheum. 1982;25:18–26.
- Ahvonen P, Sievers K, Aho K. Arthritis associated with Yersinia enterocolitica infection. Acta Rheumatol Scand. 1969;15(3):232–253. doi: 10.3109/rhe1.1969.15.issue-1-4.32
- Arnold MH, Tyndall A. Poststreptococcal reactive arthritis. Ann Rheum Dis. 1989;48(8):686–688. doi: 10.1136/ard.48.8.686
- De Cunto CL, Giannini EH, Fink CW, et al. Prognosis of children with poststreptococcal reactive arthritis. Pediatr Infect Dis J. 1988;7(10):683–686. doi: 10.1097/00006454-198810000-00002
- Gibbas DL, Broussard DA. Poststreptococcal reactive polyarthritis — rheumatic fever or not? Arthritis Rheum. 1986;S92–S92.
- Gibofsky A, Kerwar S, Zabriskie JB. Rheumatic fever. The relationships between host, microbe, and genetics. Rheum Dis Clin North Am. 1998;24(2):237–259. doi: 10.1016/s0889-857x(05)70007-7
- Dajani A, Taubert K, Ferrieri P, et al. Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Heart Association. Pediatrics. 1995;96 Pt 4:758–764. doi: 10.1542/peds.96.4.758
- Baracco RE. Population structure and dynamics of helminthic infection: schistosomiasis. Microbiol Spectr. 2019;7(2). doi: 10.1128/microbiolspec.GPP3-0016-2018
- Facklam RR, Washington JA. Streptococcus and related catalase-negative gram-positive cocci. Manual of Clinical Microbiology. 1992;238–257.
- Braun J, Märker-Hermann E, Rudwaleit M, Sieper J. HLA-B27 and the role of specific T cell receptors in the pathogenesis of spondyloarthritis. Ann Rheum Dis. doi: 10.1136/ard-2024-225661
- Taniguchi Y, Nishikawa H, Yoshida T, et al. Expanding the spectrum of reactive arthritis (ReA): classic ReA and infection-related arthritis including poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA. Rheumatol Int. 2021;41(8):1387–1398. doi: 10.1007/s00296-021-04879-3
- Ahmed S, Padhan P, Misra R, Danda D. Update on post-streptococcal reactive arthritis: narrative review of a forgotten disease. Curr Rheumatol Rep. 2021;23(3):19. doi: 10.1007/s11926-021-00982-3
- Galushko EA, Nasonov EL. Prevalence of rheumatic diseases in Russia. Almanac of Clinical Medicine. 2018;46(1):32–39. EDN: YVSHGT doi: 10.18786/2072-0505-2018-46-1-32-39
- Khalmetova FI, Akhmedov XS, Alibekova GA, et al. Features of the course of the joint syndrome in various forms of reactive arthritis. Galaxy International Interdisciplinary Research Journal. 2023;11(4):832–837.
- Muşetescu AE, Florea M, ForŢofoiu MC, et al. Streptococcal tonsillitis related reactive arthritis — clinical, ultrasound imaging and immunohistochemical study. Rom J Morphol Embryol. 2017;58(3):801–807.
- Mackie SL, Keat A. Poststreptococcal reactive arthritis: what is it and how do we know? Rheumatology (Oxford). 2004;43(8):949–954. doi: 10.1093/rheumatology/keh225
- Dogan B, Rota S, Gurbuzler L, et al. The correlation between EBV viral load in the palatine tonsils of patients with recurrent tonsillitis and concurrent serum titers of VCA–IgG. Eur Arch Otorhinolaryngol. 2010;267(1):143–148. doi: 10.1007/s00405-009-0988-6
- Bawazir Y, Towheed T, Anastassiades T. Post-streptococcal reactive arthritis. Curr Rheumatol Rev. 2020;16(1):2–8. doi: 10.2174/1573397115666190808110337
- Stone JH. Reactive arthritis. A Clinician’s Pearls & Myths in Rheumatology. 2023:105–109. doi: 10.1007/978-3-031-23488-0_9
- Tatsumi H, Morikawa T, Takagishi K, Suyama Y. Post-streptococcal reactive arthritis visually emphasizing enthesitis. Intern Med. 2023;62(11):1699–1700. doi: 10.2169/internalmedicine.0191-22
- Bentaleb I, Abdelghani KB, Rostom S, et al. Reactive arthritis: update. Curr Clin Microbiol Rep. 2020;7(4):124–132. doi: 10.1007/s40588-020-00152-6
- Padhan P, Danda D. Clinical spectrum of post-streptococcal reactive arthritis (PSRA) revisited: Juvenile versus adult-onset disease. Int J Rheum Dis. 2019;22(4):750–751. doi: 10.1111/1756-185X.13524
- Shostak NA, Abeldyaev DV, Karpova NJ, Timofeev VT. Poststreptococcal arthritis. Scientific and Practical Rheumatology. 2003;41(4):77–82. EDN: QCXHKL doi: 10.14412/1995-4484-2003-1340
- Chun C, Kingsbury DJ. Poststreptococcal reactive arthritis: diagnostic challenges. Perm J. 2019;23:18. doi: 10.7812/TPP/18.304
- Johnston JJ, Douglas R. Adenotonsillar microbiome: an update. Postgrad Med J. 2018;94(1113):398–403. doi: 10.1136/postgradmedj-2018-135602
- Lucchino B, Spinelli FR, Perricone C, et al. Reactive arthritis: current treatment challenges and future perspectives. Clin Exp Rheumatol. 2019;37(6):1065–1076.
- Gaston JS. Reactive arthritis and undifferentiated spondyloarthritis. In: Kelley’s textbook of rheumatology. 9th edition. P. 1221–1231. doi: 10.1016/B978-1-4377-1738-9.00076-1
- Jansen TL, Janssen M, de Jong AJ. Reactive arthritis associated with group C and group G beta-hemolytic streptococci. J Rheumatol. 1998;25(6):1126–1130.
- Alexandrova EN, Novikov AA, Nasonov EL. The current standards for laboratory diagnosis of rheumatic diseases and their use in real clinical practice. Scientific and Practical Rheumatology. 2013;51(4):368–376. EDN: RCEJVL doi: 10.14412/1995-4484-2013-1246
- Novikov AA, Aleksandrova EN, Lukina GV, Kazakov SP. Methodological aspects of antinuclear antibodies detection: EFLM, EASI, ICAP and RAMLD recommendations. Medical Alphabet. 2024;(31):21–25. EDN: RKSXOA doi: 10.33667/2078-5631-2023-31-21-25
- Kobayashi S, Kida I, Makiyama Y, et al. Tonsillitis-related arthritis: advanced understandings of tonsillitis and sterile inflammatory arthritis. Case Rep Rheumatol. 2021;2021:2983267. doi: 10.1155/2021/2983267
- Pichichero ME, Edwards MS, Bond S. Treatment and prevention of streptococcal pharyngitis in adults and children. UpToDate. Waltham, MA: UpToDate. 2023.
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