The Case of Reactive Arthritis Secondary toEchinococcusInfestation

Abstract

Reactive arthritis is an inflammatory joint disease that develops after an infection and it usually occurs following a gastrointestinal or genitourinary system infection and it belongs to the family of arthritis called “spondyloarthritis.” We wanted to represent a rare case of reactive arthritis secondary to Echinococcus infestation. Cyst hydatid disease is common in endemic regions like Turkey. Internal organ involvements, especially liver and lung, are most frequent involvements. Primary bone involvement is rare complication of Echinococcus infestation. In our case, the patient with Echinococcus infection developed right knee arthritis and sacroiliitis. Other reactive and oligoarthritis causes were excluded and diagnosis of reactive arthritis secondary to cyst hydatid infestation was done with the present findings. Cold pack and TENS treatment were applied as symptomatic treatment to the right knee of the patient. Acemetacin was given as medical treatment. On the 5th day of treatment, right knee and ankle arthritis were clinically regressed. In regions where the disease is seen as endemic, such as Turkey, patients with musculoskeletal symptoms should consider the possibility of musculoskeletal involvement due to the hydatid cyst.

Humoral immune status in patients with parasitic arthritis

“…At the present time, the following hypothesis is accepted "atopy has appeared as an evolutionary adaptation to the increased antigenic load, but in the absence of timely antigenic exposure, it does not protect, but leads to the development of allergic and autoimmune diseases" [2,5,9] As known, the production of common serum immunoglobulins IgE and IgG is regulated by IL-4 [6,8,10]. These immunoglobulins, and especially IgE -are an important physiological regulator of immunological homeostasis [2][3][4], a fact also proven by our study.…”

“…It is known that an increased content of granulocytes is one of the first, and sometimes the only sign of the pathological process caused by helminthic invasion. According to the authors, in the acute phase, the content of eosinophils reaches 20-40%, sometimes up to 90% [6,9]. At the same time, in the chronic stage, according to various authors, eosinophilia occurs in about half of the patients -from 44 to 59% [2,4,7].…”

“…One of the main functions of eosinophils is cytotoxicity [4,10]. The products of the granules of these cells can participate both in oxygen-dependent lysis, when toxic oxygen metabolites are released, and independent of oxygen, which is mainly associated with the release of a large base protein, eosinophilic cationic protein and peroxidase [6,11]. These mechanisms can act both in isolation and synergistically, which in this case ensures the maximum efficiency of the lysis [8,9].…”

“…Thus, the authors stipulate that the increase in the blood level of IgA is evidentiary for the hypothesis of infectious triggers in the mucous tunics in parasitic arthritis [2,4]. Cases of IgA-induced nephropathies in patients with parasitic arthritis have been described [3,5,6]. Similarly, it is known that IgG and IgM have a protective effect and are able to damage the body of helminths, to conjugate the enzymes secreted by them, to form precipitation around their membranes, disrupting the physiological processes of the parasite.…”

Clinical expression of parasitic arthritis – joint inflammatory process

“…In the later stages of the disease, especially in multiple echinococcosis, immunopathological reactions play an important role. There are heterogenous clinical manifestations of echinococcosis and symptoms are determined by localization, size, multiplicity of invasion, rapid growth of the echinococcal cyst [4][5][6][7][8].…”