REACTIVE ARTHRITIS:GENITAL OR LUNG INFECTION?

Report #7212

Reactive arthritis occurs when a person develops pains in many muscles and tendons and in one or more joints, often after intimate contact followed by burning on urination (1),/ or intestinal upset such as typhoid fever (2),/ or a chronic cough associated with a chlamydia or mycoplasma infection.

An infected person may suffer pain and burning in the eyes and small ulcers in the throat and mouth. Some have a genetic predisposition for arthritis with a positive blood test for HLA-B27. Parts of dead, but not live, bacteria have been found in the fluid removed from painful joints (3,4,5,6,7,8,9,10,11) even after many months of antibiotic treatment (12). Even the sophisticated PCR test can fail to reveal chlamydia, when the more sensitive ligase chain reaction finds the germ (13). For some, joint and muscle pains disappear after 6 month, but for most, the pains continue for many years. The most useful test to diagnose the cause is a special urinary swab for chlamydia, ureaplasma and mycoplasma (14). Almost 60% of young people who develop reactive arthritis have positive cultures for these infections, whereas only 22% have positive blood antibody tests. A lesser number are infected with helicobacter, the bacteria that causes stomach ulcers; salmonella, the bacteria that causes diarrhea; hepatitis B and C, or Borrelia, the spirochete that causes Lyme disease. I find that short-term antibiotic treatment does not relieve the joint pains, but several months treatment with azythromycin, clarithromycin, doxycycline or minocycline often does. Symptoms can return after the medication is stopped. See reports #J106 and #J159.

By Gabe Mirkin, M.D., for CBS Radio News

1) E Rich, EW Hook, GS Alarcon, LW Moreland. Reactive arthritis in patients attending an urban sexually transmitted diseases clinic. Arthritis and Rheumatism 39: 7 (JUL 1996):1172-1177. Conclusion. Nongonococcal genital infections, often asymptomatic, can trigger a relatively mild Reactive Arthritis in a larger number of exposed patients than previously thought, irrespective of the individual's HLA status.

2) B Svenungsson. International Journal of STD & AIDS 6: 3:(MAY-JUN 1995):156-160.

3) SC Tayal, P Watson. Musculoskeletal disorders: Genitourinary medicine perspective. International Journal of STD & AIDS 7: 6 (OCT 1996):396-399.

4) MR Lovy, G Starkebaum, S Uberoi. Hepatitis C infection presenting with rheumatic manifestations: A mimic of rheumatoid arthritis. Journal of Rheumatology 23: 6 (JUN 1996):979-983.

5) B Svenungsson. International Journal of STD & AIDS 6: 3:(MAY-JUN 1995):156-160.

6) R Nanagara, F Li, A Beutler, A Hudson, HR Schumacher. Alteration of Chlamydia trachomatis biologic behavior in synovial membranes: Suppression of surface antigen production in reactive arthritis and Reiter's syndrome. Arthritis and Rheumatism 38: 10 (OCT 1995):1410-1417.

7) JSH Gaston, KHO Deane, RM Jecock, JH Pearce. Identification of 2 Chlamydia trachomatis antigens recognized by synovial fluid T cells from patients with Chlamydia induced reactive arthritis. Journal of Rheumatology 23: 1 (JAN 1996):130-136. These are the first 2 chlamydial antigens to be identified as targets of the synovial T cell response in chlamydia induced ReA. Both have properties that are shared with target antigens identified in ReA induced by enteric infection and relevant to the pathogenesis of joint inflammation. 10 missing

8) B Svenungsson. International Journal of STD & AIDS 6: 3:(MAY-JUN 1995):156-160.

9) L Erlacher, W Wintersberger, M Menschik, A Benkestudnicka, K Machold, G Stanek, J Soltzszots, J Smolen, W Graninger. Reactive arthritis: Urogenital swab culture is the only useful diagnostic method for the detection of the arthritogenic infection in extra-articularly asymptomatic patients with undifferentiated oligoarthritis. British Journal of Rheumatology 34: 9 (SEP 1995):838-842.

10) J Wollenhaupt, F Kolbus, H Weissbrodt, C Schneider, T Krech, H Zeidler. Manifestations of Chlamydia induced arthritis in patients with silent versus symptomatic urogenital chlamydial infection. Clinical and Experimental Rheumatology 13: 4(JUL-AUG 1995):453-458.

11) F Li, R Bulbul, HR Schumacher, T Kieberemmons, PE Callegari, JM Vonfeldt, D Norden, B Freundlich, B Wang, V Imonitie, CP Chang, I Nachamkin, DB Weiner, WV Williams Molecular detection of bacterial DNA in venereal-associated arthritis. Arthritis and Rheumatism 39: 6 (JUN 1996):950-958.

12) R Nanagara, F Li, A Beutler, A Hudson, HR Schumacher. Alteration of Chlamydia trachomatis biologic behavior in synovial membranes: Suppression of surface antigen production in reactive arthritis and Reiter's syndrome. Arthritis and Rheumatism 38: 10 (OCT 1995):1410-1417.

13) S Nikkari, M Puolakkainen, U Ylikerttula, R Luukkainen. Ligase chain reaction in detection of Chlamydia DNA in synovial fluid cells. British Journal of Rheumatology 36: 7 (JUL 1997):763-765.

14) L Erlacher, W Wintersberger, M Menschik, A Benkestudnicka, K Machold, G Stanek, J Soltzszots, J Smolen, W Graninger. Reactive arthritis: Urogenital swab culture is the only useful diagnostic method for the detection of the arthritogenic infection in extra-articularly asymptomatic patients with undifferentiated oligoarthritis. British Journal of Rheumatology 34: 9 (SEP 1995):838-842.

15) Keating RM, Vysd AS. Reactive arthritis following ckostridium difficile colitis. WJM 1995(Jan);162(1):3-5.

Reported 8/30/97; Checked 9/5/05