Tonsillitis-associated arthropathies: new approaches to diagnosis and treatment

Objective. To identify and develop criteria for the tonsillogenic nature of reactive arthropathies in patients with chronic tonsillitis (CT). Material and methods. This prospective cohort study enrolled 150 patients with CT aged 18 to 35 years. The main group (Group I, n=75) consisted of patients with CT and arthralgia, the control group (Group II, n=75) included patients with CT without joint syndrome. All patients underwent questioning, clinical and laboratory examination (including CRP, ASL-O, RF, ACCP, ANA on HEp-2 cells, EBV IgG, vitamin D). When indicated, joint radiography was performed. Patients with confirmed tonsillitis-associated arthropathy (n=69) underwent bilateral tonsillectomy (TE) with histological examination of the tonsils and follow-up assessment after 6 months. Results. Patients with CT and arthralgia had a significantly more severe tonsillar history (frequent sore throats, paratonsillitis), and more often suffered from intoxication syndrome and low-grade fever (p<0.05). In the main group, elevated levels of CRP (36% vs. 20%), ASL-O (37% vs. 19%), vitamin D deficiency (32% vs. 11%), as well as serological markers of EBV reactivation (IgG to VCA and EBNA; OR up to 21.7) and autoimmune activity (ANA ≥1:160 in 32% vs. 11%; OR=4.44) were significantly more frequent. Six months after TE, joint syndrome resolved in all operated patients, with a significant decrease in CRP, ASL-O, ANA titers, and normalization of vitamin D levels (p<0.001). A diagnostic algorithm was developed to differentiate tonsillitis-associated arthropathies from rheumatic diseases. Conclusion. Chronic tonsillitis can be a cause of systemic joint syndrome. Bilateral tonsillectomy is an effective pathogenetic treatment for these patients. The proposed clinical and laboratory criteria optimize diagnosis and patient selection for surgical treatment.