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Arthritis (Expert Forum)
Reactive Arthritis
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions and support regarding arthritis issues such as: Arthritis, Autoimmune Disease, Bursitis, Fibromyalgia, Gout, Juvenile Rheumatoid Arthritis, Lupus, Myositis, Neuralgia, Osteoarthritis, Polymyalgia Rheumatica, Rheumatoid Arthritis, Sciatica, Tendinitis, Vasculitis.
Reactive Arthritis
by JeffFL, Sep 25, 2003 12:00AM
I am a 39 year old Male and was diagnosed with Spondyloarthropathy about 1 year and a half ago. Since then, I have developed sclerosis of the right Sacroiliac Joint as well as disk degeneration between the L-5 and S-1 vertebrae. The 6-month comparative x-rays appear to show no additional sclerosing of the SI Joints. There has, however, been progressive involvement in the Arthritis including Achilles Tendonitis and enthesitis of the elbow as well as bursitis and knee involvement. Corticosteroid shots have been successful with the enthesitis, however, not with the bursitis.
There has been gastrointestinal involvement associated with the arthritis which has lead my Rheumatologist to believe this is Reactive Arthritis due to an ongoing bacterial infection in the GI tract. Colonoscopy and endoscopy revealed chronic and acute inflammation of the upper GI, but no findings of Crohn's or Ulcerative Colitis. Fecal Samples revealed high levels of Gram Positive Bacilli and Gram Positive Cocci (Greater than 10/1000x). There has been chronic episodes of epididymitis and prostatitis, however, no casuative bacteria has been able to be located.
Blood results have not indicated a high Sed Rate and have been normal except for occasional elevated liver enzymes, AST (48 U/L) and ALT (43 U/L). Also, I was found to be HLA-B27 negative.
I was placed on several 3-week courses of Cipro to clear the bacteria, but Cipro has not been successful in eradicating the bacteria. My Rheumatologist wants to continue to try and culture the bacteria, hoping to find an antibiotic to get rid of the bacterial infection. My primary care physician, however, thinks this is a bit too optimistic and may be impossible to culture the precise bacterial strain. NSAID's appear not to be controlling the arthritis, and it is his thought, I should be starting a disease modifying drug to try and halt the progression of the disease. My rheumatologist feels this could be dangerous since there are signs of infection and an immunosuppressive drug could make the scenario worse.
Meanwhile, we still can't find the bacteria, and the Arthritis is progressing! I would appreciate any thoughts you could share on this. I am also concerned about the typical progression of this disease. The major flare ups can be quite intense and seem to be causing some irreversable damage.
There has been gastrointestinal involvement associated with the arthritis which has lead my Rheumatologist to believe this is Reactive Arthritis due to an ongoing bacterial infection in the GI tract. Colonoscopy and endoscopy revealed chronic and acute inflammation of the upper GI, but no findings of Crohn's or Ulcerative Colitis. Fecal Samples revealed high levels of Gram Positive Bacilli and Gram Positive Cocci (Greater than 10/1000x). There has been chronic episodes of epididymitis and prostatitis, however, no casuative bacteria has been able to be located.
Blood results have not indicated a high Sed Rate and have been normal except for occasional elevated liver enzymes, AST (48 U/L) and ALT (43 U/L). Also, I was found to be HLA-B27 negative.
I was placed on several 3-week courses of Cipro to clear the bacteria, but Cipro has not been successful in eradicating the bacteria. My Rheumatologist wants to continue to try and culture the bacteria, hoping to find an antibiotic to get rid of the bacterial infection. My primary care physician, however, thinks this is a bit too optimistic and may be impossible to culture the precise bacterial strain. NSAID's appear not to be controlling the arthritis, and it is his thought, I should be starting a disease modifying drug to try and halt the progression of the disease. My rheumatologist feels this could be dangerous since there are signs of infection and an immunosuppressive drug could make the scenario worse.
Meanwhile, we still can't find the bacteria, and the Arthritis is progressing! I would appreciate any thoughts you could share on this. I am also concerned about the typical progression of this disease. The major flare ups can be quite intense and seem to be causing some irreversable damage.
Doctor's Answer
by Kevin Pho, MD, Sep 29, 2003 12:00AM
, Sep 29, 2003 12:00AM
Studies have asked the same question that you are asking. Cipro is normally used in treating enteric infections - it is unlikely that an exact cause of the bacteria can be found. In general, antibiotics do *not* alter the course of reactive arthritis, even when given for more than 7 to 10 days - this has been shown in several studies.
If the antibiotics are not working, I would suggest inquiring about sulfasalazine, tumor necrosis factors, or methotrexate. They have all been shown in studies to have success in varying degrees.
It would seem that you have already been tried on multiple courses of antibiotics without success, and it may be time to go for the next step.
You may want to inquire about a second rheumatological opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
If the antibiotics are not working, I would suggest inquiring about sulfasalazine, tumor necrosis factors, or methotrexate. They have all been shown in studies to have success in varying degrees.
It would seem that you have already been tried on multiple courses of antibiotics without success, and it may be time to go for the next step.
You may want to inquire about a second rheumatological opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
