تظاهرات استخواني و مفصلي بيماران نقص ايمني اوليه: مقاله مروري

Bone and joint manifestations of primary immunodeficiency patients: review article

نقايص ايمني اوليه يك گروه از اختلالات ارثي مي باشند كه سيستم ايمني ذاتي يا اكتسابي و يا تركيبي از اين دو را درگير مي كنند. اين اختلالات بيماران را مستعد عفونت هاي راجعه، اتوايمني و بدخيمي مي كند. اختلال زمينه اي ممكن است مربوط به كاهش سطح يا كاهش عملكرد و يا به طوركلي فقدان كامل يك يا چند جزء از سيستم ايمني باشد. اين بيماري ها مي توانند با شيوعي در حدود يك مورد در 10000 تولد زنده رخ دهند. اين گروه از بيماري ها طيف وسيعي از علايم را دارند كه شناخت سريع و درمان به موقع آنها مي تواند به مقدار قابل توجهي عوارض بيماري ها را كاهش دهد. از جمله اين علايم، عفونت هاي مكرر يا شديد، سوء رشد، اختلالات اتوايميون و همچنين تظاهرات اسكلتي مفصلي مي باشد. تظاهرات اسكلتي متنوعي در بيماران دچار نقص ايمني اوليه ديده مي شود كه دراين ميان، آرتريت سپتيك ناشي از باكتري هاي پيوژنيك يا آرتريت هاي مايكوپلاسمايي شايعترين تظاهرات استخواني مفصلي محسوب مي شوند. از آنجا كه درگيري هاي اسكلتي مفصلي كمتر به عنوان سر نخ نقايص ايمني اوليه قلمداد مي شوند و به خاطر اهميت شناخت زودرس اين دسته از بيماران در كاهش هزينه هاي درمان و بهبود كيفيت زندگي آنها، در اين مطالعه سعي شد تا شايعترين تظاهرات مفصلي و استخواني بيماران دچار نقص ايمني اوليه، درمان هاي در دسترس در مورد نظاهرات شايع و نيز علايمي از درگيري هاي مفصلي كه ممكن است سر نخي براي نقص ايمني اوليه باشد مورد مطالعه قرار گيرند.

Primary Immune Deficiencies are a group of heterogeneous disorders that involve the innate or acquired immune system, or a combination of them. The underlying disorder may be related to decreased levels or function, or a complete lack of one or more components of the immune system in general. These diseases can occur with a prevalence of about 1 in 10000 live births. According to the fourth update on the Iranian national registry of Primary Immune Deficiency in October 2018, the total number of registered PIDs in Iran are 3056 patients. However, it is supposed to be more prevalent and it seems increasing awareness shall reveal many new cases, especially in societies with prevalent consanguineous marriages like Iran. These disorders predispose patients to recurrent infections, autoimmunity and malignancy and can cause a huge burden on health care systems. This group of diseases has a wide range of symptoms, which quick recognition and timely treatment of them, can greatly reduce the complications of the disease. These symptoms may include recurrent or severe infections, failure to thrive, autoimmune disorders, as well as articular-skeletal manifestations. A variety of skeletal manifestations are seen in patients with primary immunodeficiency, among which septic arthritis caused by pyogenic bacteria or mycoplasma arthritis is the most common joint-bone manifestation. Joint and skeletal involvement is less commonly seen as a sign of primary immune defects. This issue is importance in reducing the cost of diseases and improving the patients’ quality of life. Our review attempted to introduce the most common manifestations of bone and joint in patients with primary immunodeficiency and available treatments for these manifestations. Because of the wide range of symptoms in these patients, it is recommended to observe the rare and suspicious manifestations in the patients with any atypical bone and joint presentations such as: recurrent septic arthritis, infection with unusual germs, immunodeficiency in their relatives, and any history of well-known red flags of PIDs. The Rheumatologist should consider these manifestations and think about the possibility of deficiency disorder.