Laboratory diagnostics of reactive arthritis: modern possibilities for personalized treatment and monitoring of therapeutic response
Zhuraev R.K., Plavshudina E.I.
Summary. Aim: to summarize current approaches to the laboratory diagnosis of reactive arthritis and demonstrate their importance for etiological verification, prognosis, and treatment personalization, using a clinical case of Yersinia-associated reactive arthritis as an example. Materials and methods. The current scientific literature on the pathogenesis, laboratory diagnosis, and treatment of reactive arthritis was analyzed. Results of clinical, laboratory, and imaging examinations of a 21-year-old female patient with articular symptoms, skin manifestations, and a history of severe enterocolitis are presented. Markers of systemic inflammation, rheumatoid factor, anti-CCP, anti-MCV, ANA, HLA-B27, and IgA and IgG antibodies to Yersinia enterocolitica were assessed by Western blotting; magnetic resonance imaging of the sacroiliac joints was also performed. Results. HLA-B27 positivity, IgA and IgG antibodies to several Y. enterocolitica antigens, including the plasmid-encoded YopD protein, and MRI signs of bilateral sacroiliitis were detected. Laboratory markers of rheumatoid arthritis and systemic connective tissue diseases were not confirmed. The combination of medical history, serological, genetic, and imaging findings enabled the diagnosis of chronic HLA-B27-associated Yersinia-induced reactive arthritis with axial involvement. Conclusions. The integrated use of serological, molecular genetic, and imaging methods improves the accuracy of the etiological diagnosis of reactive arthritis, facilitates assessment of the risk of chronicity, and supports the evidence-based selection of a personalized therapeutic strategy.
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