Infectiologic differential diagnosis of chronic Lyme disease and so ...

In the diagnosis of a “reactive arthritis” anamnestic research is to be performed to
determine whether there are indications of one of the above-mentioned infections.
Accordingly, the following significant anamnestic aspects result:
- Chlamydia trachomatis infection
(with and without symptoms)
- Enteritis
- Atypical pneumonia
Additionally, it should be remembered that arthritides also are found in
Chlamydophila pneumoniae und Mycoplasma pneumoniae; and that in
Chlamydioses, Yersiniosis and also in cases of Mycoplasma pneumoniae, the
pathogen has been detected in the synovial fluid or in the articular effusion,
respectively.
Using laboratory tests (culture, serology), an existing or previous infection can be
detected in 50% of the cases. Other laboratory tests, particularly so-called
inflammation markers (BSG, CRP, leukocytosis) are not relevant in cases involving
reactive arthritis.
With regard to Chlamydia trachomatis, pathogen detection in a urethral smear or in
urine using PCR is appropriate.
Chronic courses, i.e. a duration of illness exceeding 6 months, are observed in
nearly 20% of the patients [222].
NSAIDs are used for treatment, but only for pain relief since they have no influence
on the disease course or disease duration. In contrast, sulfasalazines [224] and TNF
antibodies develop a certain efficacy.
An antibiotic treatment is recommended in cases of acute chlamydiosis with the
objective of reducing the frequency of reactive arthritis. However, corresponding
studies are not available [223]. In cases of chronic reactive arthritis, the findings on
the efficacy of an antibiotic treatment are a matter of controversy [220, 226, 227 -
231].
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