Clinical and diagnostic aspects of tonsillitis-associated arthritis

Aim. To identify clinical and diagnostic features of tonsillitis-associated arthritis.

Material and methods. In total, 150 patients were examined (97 women, 53 men, average age 27.6 years). Patients were divided into 2 groups of 75 people. Group 1 consisted of patients with chronic tonsillitis and arthralgia, group 2 – of patients with chronic tonsillitis without arthralgia. The examination included filling out a questionnaire, examination by an otolaryngologist, and laboratory testing consisting of measurements of C-reactive protein, rheumatoid factor, antistreptolysin O (ASO), antinuclear antibodies (ANA) in НЕр-2 cell line, antibodies against cyclic citrullinated peptide, vitamin D, antibodies against capsid and nuclear antigens of the Epstein–Barr virus (IgG). If necessary, patients were referred to a rheumatologist for consultation.

Results. Patients in group 1 were 2.3 times more likely to have a history of tonsillitis and peritonsillar abscesses (82 % versus 36 %). Most of the patients in group 1 had ASO levels above the reference values (37 % versus 19 %; p ≤0.05). Almost 1 / 3 (35 %) of the patients in group 1 had elevated antinuclear antibody titers compared to 11 % in the control group. In group 1, examination revealed 60 patients (80 %) with reactive arthralgia, 8 patients (11 %) with poststreptococcal reactive arthritis, and 7 patients (9 %) with systemic diseases of the connective tissues.

Conclusion. In the etiology of tonsillitis-associated arthritis, frequent episodes of acute tonsillitis have clinical and diagnostic value. According to certain laboratory parameters, such as ASO, ANA, etc., there are statistically significant differences in patients with tonsillitis-associated arthritis. Among patients with chronic tonsillitis and articular syndrome, the frequency of reactive arthralgia significantly prevails over “true” arthritis with signs of joint inflammation.