Doury P
Bull Acad Natl Med. 1990 Jun-Jul;174(6):743-51; discussion 751-4.
Parasitic rheumatism is a rare condition characterized by inflammatory joint manifestations due to a parasitic infestation without parasites into joint cavity, (but, with circulating immune complexes, in serum, and synovial fluid; and with immunoglobulins and complement deposits in synovium in some cases reported in the literature). The number of parasites (now 15) which can induce such an arthritis by immune mechanisms is steadily increasing. In all, but few cases of parasitic rheumatism, usual parasitic manifestations (diarrhea, abdominal pain, nausea...) are mild or absent; but, if present, they are a very good criteria to evoke the diagnosis. Clinical pictures of arthritis induced by parasitic infestation are very polymorphic, and non specific of the involved parasite; they seem to depend on genetic predisposition: the symptoms are monoarticular, pauciarticular, or polyarticular, involving small, medium, and or large joints. They can mimic the clinical picture of different inflammatory rheumatic diseases. The most striking feature of parasitic rheumatism is the failure of antirheumatic agents (especially non steroidal anti-inflammatory agents), contrasting with the dramatic efficacy of specific anti-parasitic treatment. The proof of the responsibility of parasitic infestation by indirect mechanism is given by an exceptional case report of a patient with arthritis, dramatically cured after removal of larvae from Anisakiasis gastric granuloma. To explain the uncommon occurrence of this variety of reactive arthritis, due to parasitic infestation, despite the high prevalence of parasitic infestation in the world, hypothesis of genetic predisposition seems valuable. Among 34 well documented reported cases of parasitic rheumatism in the literature, HLA B 27 antigen has been researched in 13; out of these 13, HLA B 27 is absent in 9; in 7 out of these 9, clinical picture is symmetrical polyarthritis. Out of the 13 cases, HLA B 27 is present in 4: In all these 4 cases, clinical picture is asymmetrical pauciarthritis, mimicking arthritis of Reiter's disease.
寄生虫性风湿病是一种罕见病症，其特征为寄生虫感染引发炎症性关节表现，但寄生虫并不进入关节腔（不过，血清和滑液中有循环免疫复合物；文献报道的某些病例中，滑膜有免疫球蛋白和补体沉积）。通过免疫机制可诱发此类关节炎的寄生虫种类（目前有15种）在不断增加。除少数寄生虫性风湿病病例外，常见的寄生虫表现（腹泻、腹痛、恶心等）通常较轻或无；但如果存在，则是引发诊断的很好依据。寄生虫感染所致关节炎的临床表现非常多样，且与所涉及的寄生虫无特异性关联；它们似乎取决于遗传易感性：症状可为单关节、少关节或多关节，累及小关节、中关节和/或大关节。它们可模仿不同炎症性风湿性疾病的临床表现。寄生虫性风湿病最显著的特征是抗风湿药物（尤其是非甾体抗炎药）治疗无效，而特异性抗寄生虫治疗效果显著。一例罕见的病例报告为寄生虫感染通过间接机制致病提供了证据，该患者患有关节炎，在从胃内异尖线虫病肉芽肿中取出幼虫后病情显著好转。尽管世界范围内寄生虫感染普遍，但寄生虫感染所致这种反应性关节炎却不常见，对此，遗传易感性假说似乎很有价值。文献中34例有充分记录的寄生虫性风湿病报告病例中，对13例研究了HLA B 27抗原；其中9例不存在HLA B 27；这9例中的7例临床表现为对称性多关节炎。13例中有4例存在HLA B 27：所有这4例的临床表现均为不对称少关节炎，类似赖特综合征关节炎。
