AB0099 Arthroscopic peculiarities of the inflammatory process of synovial shell in urogenic arthritis
Authors: M. Salokhiddinov, I. Xodjanazarov
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> In recent years there has been an increase in the incidence of reactive arthritis (ReA), associated with urogenital infection. Chronic synovitis of urogenital etiology is a nonspecific process, pathogenesis is very close to rheumatoid arthritis (RA), which complicates differential diagnosis. According to the literature, the inflammatory process in the synovial membrane (SM) supports the persistence of chlamydia, which reduces the effectiveness of standard anti-inflammatory therapy of arthritis in patients with undifferentiated seronegative oligoarthritis, spondyloarthropathy, RA. <h3>Objectives</h3> Arthroscopic assessment of the level of the inflammatory process in the synovial membrane, depending on the duration of the disease and the activity of the pathological process in patients with urogenital arthritis. <h3>Methods</h3> The study involved 39 patients with RA of urogenital etiology complicated by synovitis of knee joint (KJ) were examined; 23 of them were women and 16 men; mean age was 35.5±38.0 years. They received inpatient treatment at the Department of Traumatology and Orthopaedics of the 2nd TMA Clinic in 2014–2016 years. All these patients underwent diagnostic arthroscopy of KJ. Laboratory tests included enzyme-linked immunosorbent assay (ELISA) for TORCH infection, a polymerase reaction (PCR), determination of a rheumatic factor in synovial fluid and blood before and after treatment, arthroscopy of the joint. <h3>Results</h3> In arthroscopic examination in the acute phase (early period) of ReA, dull SM, vasodilation, and oedema are revealed, which is accompanied by an increase in the production of turbid synovial fluid (SF). On the surface of SM there are sections of fibrin filaments, expansion and hyperemia along the vessels. In the long-term (subacute phase) these violations partially disappear. The surface of the synovium can again become single-rowed, with moderate hyperemia of the vessels. The deposits of fibrin on the entire surface of SM can be significant. However, with reduced immunoreactivity of the organism, the reactive synovitis persists for a long time, and the chronic course of the pathological process leads to abundant deposits of fibrin masses and to the formation of villi in the form of large and flat petals. In some parts of the vascular vessels are pale, accompanied by disorganisation of the collagen frame of SM, which directly affects the cells of the articular cartilage. <h3>Conclusions</h3> Thus, reactive urogenital arthritis due to the persistence of an infectious agent is characterised by the polymorphism of the damage to the joint and cartilage of the joint. The arthroscopic changes revealed at various stages of the inflammatory process reflect the reactivity of the pathological process and determine the extent of the lesion. Arthroscopic examination of biopsy specimens of SM and cartilage allows to determine the dynamics of the disease, the degree of lesion, evaluate the effectiveness of the preventive and therapeutic measures being carried out, and also to determine the indications for joint synovcapsullectomy. <h3>References</h3> [1] Sweeney SE, et al. Clinical features of rheumatoid arthritis. In GS Firestein, et al., (eds.), Kelley's Textbook of Rheumatology, 9th ed., 2013;2:1109–1136. Philadelphia: Saunders. [2] Yasuda GT, et al. Rheumatoid arthritis. In JE Pizzorno, MT Murray, (eds.), Textbook of Natural Medicine, 4th ed., 2013:1769–1784. St. Louis: Elsevier. <h3>Disclosure of Interest</h3> None declared