Clinical features of chlamydia-induced urogenital reactive arthritis in male patients

Background. Chlamydia-induced urogenic reactive arthritis (x/iUREA) is a complex interdisciplinary problem, as its clinical manifestations are characterized by a combined lesion of the urogenital tract, joints, skin, mucous membranes and other organs. Despite belonging to the group of spondylarthritides, the leading role in the primary diagnosis and management of patients belongs to the dermatovenereologist. Polymorphism and non-simultaneous manifestation of symptoms, along with the frequent subclinical course of urogenital inflammation, cause significant difficulties in timely diagnosis and often lead to the chronicization of the process.

Objective. To study and systematize the clinical features of x/uUREA in male patients living in the Moscow region, as well as to assess the diagnostic significance of immunomorphological examination of intact skin using direct immunofluorescence (DIF) in this disease.

Materials and methods. A prospective study was conducted on 65 men with a verified diagnosis of x/uUREA who were hospitalized in the Department of Dermatovenereology at the Moscow Regional Research Institute of Dermatology and Venereology. All patients underwent a comprehensive clinical and laboratory examination, which included detection of chlamydia infection, assessment of joint syndrome, urethroscopy, examination of prostate secretion, dermatological examination, and immunomorphological examination of intact skin biopsies.

Results. The average age of the patients was 30 [24; 39] years. The average duration of the disease before hospitalization was 12 [6; 24] months, and only 6.2% of patients were hospitalized in the first 3 months of the disease. All patients (100%) were diagnosed with a combination of arthritis and chronic urethroprostatitis of chlamydial etiology, and in 30.8% of cases, the urogenital inflammation was asymptomatic. Eye lesions were detected in 44 (67.7%) patients, and dermatological lesions (skin and/or mucous membranes) were detected in 60% of patients, with circinous/xerotic balanitis (46.2%) and psoriiform rashes (27.7%) being the most common. The classic triad of symptoms (urethritis-arthritis-eye damage) was diagnosed in 30.8% of patients, the tetrad (with inclusion of dermatological pathology) – in 36.9%. Axial lesions (mainly sacroiliitis) were found in 69.2% of patients. In an immunofluorescence study, diffuse deposits of IgG were detected in the reticular layer of the dermis of apparently healthy skin in 95.3% of cases.

Conclusion. Chronic urogenital reactive arthritis is characterized by pronounced clinical polymorphism. Its obligate, although often asymptomatic, manifestations include damage to the urogenital tract, as well as joint syndrome, which necessitates mandatory testing for chlamydia infection in all men with asymmetric arthritis. Although not pathognomonic, dermatological symptoms are observed in more than half of patients and have several distinctive features. The inclusion of an immunomorphological study (direct immunofluorescence method) in the diagnostic algorithm, aimed at detecting IgG deposits in the reticular layer of the dermis, can serve as an additional laboratory marker of the disease, reflecting the systemic immune-mediated nature of inflammation in this pathology.

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