Reactive arthritis (Poncet's Disease) as initial presentation of tuberculous peritonitis

AbstractReactive arthritis (ReA) is a form of sterile arthritis that occurs secondary to an extra-articular infection in genetically predisposed individuals. The extra-articular infection is typically an infection of the gastrointestinal tract or genitourinary tract. Infection-related arthritis is a sterile arthritis associated with streptococcal tonsillitis, extra-articular tuberculosis, or intravesical instillation of bacillus Calmette–Guérin (iBCG) therapy for bladder cancer. These infection-related arthritis diagnoses are often grouped with ReA based on the pathogenic mechanism. However, the unique characteristics of these entities may be masked by a group classification. Therefore, we reviewed the clinical characteristics of classic ReA, poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA. Considering the diversity in triggering microbes, infection sites, and frequency of HLA-B27, these are different disorders. However, the clinical symptoms and intracellular parasitism pathogenic mechanism among classic ReA and infection-related arthritis entities are similar. Therefore, poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA could be included in the expanding spectrum of ReA, especially based on the pathogenic mechanism.

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Musculoskeletal Tuberculosis: A Multifaceted Foe

Annals of the National Academy of Medical Sciences (India) ◽

10.1055/s-0039-1694070 ◽

2019 ◽

Vol 55 (01) ◽

pp. 003-005

Author(s):

Uma Kumar ◽

Sauvik Dasgupta

Keyword(s):

Reactive Arthritis ◽

Surgical Interventions ◽

Global Epidemic ◽

Antitubercular Treatment ◽

Poncet’S Disease ◽

Large Joint ◽

Special Cases ◽

Common Manifestation ◽

Necrosis Factor

AbstractTuberculosis (TB) still remains a global epidemic, and India accounts for one-fourth of the world's TB burden. The incidence of extrapulmonary TB has relatively remained constant, but with the introduction of antitumor necrosis factor, there has been a surge in pulmonary and extrapulmonary TB cases presenting to rheumatologists. Musculoskeletal TB accounts for 10 to 30% of all cases of extrapulmonary TB, with spondylitis (Pott's spine) being the most common manifestation. Manifestations mimicking autoimmune spondylitis are seen in 10% of cases. Tubercular arthritis most commonly presents with large joint monoarthritis, but oligo- or polyarticular involvement is also seen. Poncet's disease is a form of reactive arthritis occurring in patients with pulmonary or extrapulmonary TB, which is rarely seen with good response to antitubercular treatment. Quite often, there is delay in the diagnosis of musculoskeletal TB due to absence of constitutional symptoms. Treatment of musculoskeletal TB involves prolonged course of antitubercular treatment, and surgical interventions are limited to special cases.

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Poncet’s Disease: Reactive Arthritis Due to Tuberculosis

Çocuk Enfeksiyon Dergisi/Journal of Pediatric Infection ◽

10.5152/ced.2015.1789 ◽

2016 ◽

Vol 10 (2) ◽

pp. 72-75

Author(s):

Hacer Akturk ◽

Didem Soydemir ◽

Saygin Abali ◽

Ayper Somer ◽

Ensar Yekeler ◽

...

Keyword(s):

Reactive Arthritis ◽

Poncet’S Disease

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Images in Clinical Tropical Medicine: Reactive Arthritis (Poncet’s Disease) and Erythema Nodosum Accompanying Tuberculosis

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.2009.80.501 ◽

2009 ◽

Vol 80 (4) ◽

pp. 501-502 ◽

Cited By ~ 4

Author(s):

Ankit Shrivastav ◽

Bhaskar Mitra ◽

Jyotirmoy Pal

Keyword(s):

Reactive Arthritis ◽

Erythema Nodosum ◽

Tropical Medicine ◽

Poncet’S Disease

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Reactive arthritis after mycobacterium avium-intracellulare infection: Poncet's disease revisited

The American Journal of Medicine ◽

10.1016/0002-9343(90)90444-i ◽

1990 ◽

Vol 88 (5) ◽

pp. 549-550 ◽

Cited By ~ 12

Author(s):

Michael J. Maricic ◽

F.Paul Alepa

Keyword(s):

Mycobacterium Avium ◽

Reactive Arthritis ◽

Poncet’S Disease ◽

Mycobacterium Avium Intracellulare

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Poncet's disease: reactive arthritis accompanying tuberculosis. Two case reports and a review of the literature

Rheumatology ◽

10.1093/rheumatology/kel268 ◽

2007 ◽

Vol 46 (3) ◽

pp. 484-489 ◽

Cited By ~ 51

Author(s):

E. J. A. Kroot ◽

J. M. W. Hazes ◽

E. M. Colin ◽

R. J. E. M. Dolhain

Keyword(s):

Reactive Arthritis ◽

Case Reports ◽

Review Of The Literature ◽

Poncet’S Disease

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Poncet’s Disease – A Commonly Missed Diagnosis

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/472 ◽

2021 ◽

Vol 8 (28) ◽

pp. 2558-2561

Author(s):

Puneeta Gupta ◽

Rohit Raina

Keyword(s):

Reactive Arthritis ◽

Extrapulmonary Tuberculosis ◽

Total Duration ◽

The Body ◽

Health Concern ◽

Joint Involvement ◽

Tuberculous Arthritis ◽

Poncet’S Disease ◽

Inflammatory Drugs ◽

Anti Inflammatory

Tuberculosis (TB) is the leading cause of mortality among infectious diseases with estimated 1.5 million deaths from TB in 2018 -19 and presented as a public health concern. In 1897, the Frenchman Antonin Poncet first described Poncet's disease (PD) as a rare syndrome, where polyarthritis in an acute stage of TB, resolved without joint damage. Similar reports on patients of tuberculosis and joint pain led authors to improve the definition, and in 1978, PD was described as a para infective arthritis by Bloxham and Addy. Regardless of its doubtful existence, cases have been continued to be reported over the years. Poncet's disease is a form of reactive arthritis which is characterized by articular affection in patients diagnosed with TB where there is immune reaction to the tuberculous protein but there is no direct invasion by the micro-organism.1,2 PD is to be differentiated from tuberculous arthritis where there is monoarticular and direct tubercular involvement of the joint. Before more obvious features develop, the sole manifestation of the disease is joint involvement. Crippling pain is experienced during polyarthritis which limits the mobility and activities of patients. Polyarthritis can also occur in common causes such as rheumatological diseases as a symptom and thus can be easily misdiagnosed. Polyarthropathy, that is multiple large and small joints involvement in the body, is the one of the rarest presentations in both active pulmonary and extrapulmonary tuberculosis. This polyarticular impairment observed in patients with active TB, a form of reactive arthritis is known as Poncet’s disease. Since there is no direct bacillary invasion of the joints, it is an aseptic form of arthritis. It is not to be confused with tuberculous arthritis, which is usually monoarticular and where there is direct tuberculin infection. Poncet's disease remains a diagnosis of exclusion. Since case reports are very rare even in countries where tuberculosis is common thus no accepted diagnostic criteria is set for Poncet's disease. This diagnostic possibility becomes increasingly important as the use of corticosteroids, immune suppressants or biologicals can risk further dissemination of the disease. We describe the case of a 50-year-old woman, who presented with active tuberculosis where polyarthralgia was the first and only symptom for four months. Polyarthritis patients were being treated with both non-steroidal anti-inflammatory drugs and antitubercular therapy and to the surprise patients with antitubercular treatment had complete resolution of symptoms after 6-week therapy whereas non-steroidal anti-inflammatory drugs (NSAIDS) offer no benefit. The total duration of therapy was 6 months.

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