Topical issues of diagnosis and treatment of arthropathy associated with tonsillitis: a literature review

Abstract

Currently, chronic tonsillitis and its complications remain an urgent concern in modern otorhinolaryngology. The high probability of developing associated diseases, such as rheumatic heart disease, nonspecific arthritis, and glomerulonephritis, emphasizes the significance of this nosological unit in the practice of an otorhinolaryngologists and doctors of other specialties. Reactive arthritis is a critical complication of chronic tonsillitis.

Acute rheumatic fever was the most common disease associated with streptococcal tonsillitis, as well as reactive arthritis. Since 1959, patients with acute rheumatic fever have become less common, but cases of “aseptic” arthritis in patients with acute tonsillitis continued to be recorded. However, no other major criteria were established to confirm the diagnosis of acute rheumatic fever. This type of arthritis is called “post-streptococcal reactive arthritis.” Despite the fact that this disease has been known since mid-19^th century, information about its etiology and pathogenesis is limited. The main symptoms of post-streptococcal reactive arthritis are usually similar to the articular syndrome in classical reactive arthritis and are clinically manifested by acute asymmetric non-migrating polyarthritis. Laboratory diagnosis of post-streptococcal reactive arthritis, particularly the determination of titers of streptococcal antibodies, plays a crucial role in confirming the diagnosis. Differential diagnosis of post-streptococcal reactive arthritis with rheumatic diseases is critical. The main diagnostic laboratory markers of rheumatic diseases are antinuclear antibodies, rheumatoid factor, and antibodies to citrullinated proteins. Joint syndrome is often prevented in post-streptococcal reactive arthritis when nonsteroidal anti-inflammatory drugs are prescribed in combination with antibacterial drugs. If arthritis does not respond to long-term treatment with antibiotics and nonsteroidal anti-inflammatory drugs, a planned tonsillectomy is required to prevent the development of a chronic form of tonsillitis-associated arthritis, especially in patients with a history of recurrent chronic tonsillitis.

This study presents an analytical review of domestic and foreign publications on chronic tonsillitis complicated by reactive arthritis. The possible diagnostic methods warranted to confirm the diagnosis and exclude a wide range of arthritis of a different etiology are described.

Keywords

chronic tonsillitis / joint syndrome / post-streptococcal arthritis / tonsillitis-associated arthropathy

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