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REACTIVE ARTHRITIS

I am amazed that more doctors do not treat at least some of their arthritis patient with antibiotics because there are hundreds of papers showing that many different infections cause arthritis. Doctors do not have laboratory tests to diagnose all of the germs that cause arthritis. Failure to treat arthritis early can cause permanent cartilaginous damage so that no treatment can be effective later. The most common cause of arthritis, particularly in people under 50, is reactive arthritis that often follows an infection.

If you develop sudden unexplained pain in one or more joints, your doctor should check you for an infection. You should be asked if you have a urinary tract infection: burning on urination, discomfort when your bladder is full, a feeling that you have to urinate all the time, getting up in the middle of the night to urinate. Check for a stomach infection: belching and burning in stomach or chest. Check for a lung infection: chronic cough, shortness of breath, wheezing, burning in your nose or soreness in your throat. Check for intestinal infection: diarrhea, belly cramps or blood in stool. Also check for gum disease, chronic stuffy nose, chills or fever.

The following are just some of the infections that can cause reactive arthritis: Salmonella, mononucleosis, parvovirus, chronic hepatitis B virus and hepatitis C virus, retroviruses, chlamydia, mycoplasma, ureaplasma, gonorrhea, gardnerella, Human T Cell Leukemia Virus-1, many different intestinal infections, Lyme disease, cytomegalovirus, streptococcal sore throat, cat scratch disease, human herpes virus-6, hemophilus influenza bacteria, AIDS (HIV), and staph aureus. References are listed below.

I treat my reactive arthritis patients with Minocycline 100 mg twice a day, but this must still be considered experimental; many doctors are not yet ready to accept antibiotics as a treatment for reactive arthritis. Many patients with reactive arthritis do not feel better for the first few months after they start taking minocycline. If a patient does nor feel better after taking 100 mg of minocycline twice day for 2 months, I add Zithromax 500 mg twice a week. If the patient does not feel better after taking the two antibiotics for 6 months, I do add the immune suppressants that most rheumatologists prescribe. But as soon as they feel better, I stop the immune suppressants and continue the antibiotics. The treatment of reactive arthritis with antibiotics is controversial and not accepted by many doctors; discuss this with your doctor. More on treatment of arthritis

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2) T Schifter, UH Lewinski. Adult onset Still's disease associated with Epstein-Barr virus infection in a 66-year-old woman. Scandinavian Journal of Rheumatology 27: 6 (1998):458-460.

3) LB Siegel, EP Gall. Viral infection as a cause of arthritis. American Family Physician 54: 6 (NOV 1 1996):2009-2015. (parvovirus, chronic hepatitis B virus and hepatitis C) virus infections.

4) K Nakagawa, V Brusic, G Mccoll, LC Harrison. Direct evidence for the expression of multiple endogenous retroviruses in the synovial compartment in rheumatoid arthritis. Arthritis and Rheumatism 40: 4 (APR 1997):627-638.

5) K Eguchi, T Origuchi, H Takashima, K Iwata, S Katamine, S Nagataki. High seroprevalence of anti-HTLV-I antibody in rheumatoid arthritis. Arthritis and Rheumatism 39: 3 (MAR 1996):463-466.

6)S Francois, G Guyadiersouquieres, C Marcelli. Reactive arthritis due to Gardnerella vaginalis - A case-report. Revue du Rhumatisme 64: 2 (FEB 1997):138-139.

7) 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.

8) T Schaeverbeke, JP Vernhes, L Lequen, B Bannwarth, C Bebear, J Dehais. Mycoplasmas and arthritides. Revue du Rhumatisme 64: 2 (FEB 1997):120-128.

9) A Franz, ADB Webster, PM Furr, D Taylorrobinson. Mycoplasmal arthritis in patients with primary immunoglobulin deficiency: Clinical features and outcome in 18 patients. British Journal of Rheumatology 36: 6 (JUN 1997):661-668.

10) High seroprevalence of anti-HTLV-I antibody in rheumatoid arthritis. Arthritis and Rheumatism 39: 3 (MAR 1996):463-466.

11) M Leirisalorepo. Therapeutic aspects of spondyloarthropathies - A review. Scandinavian Journal of Rheumatology 27: 5 (1998):323-328.

12) U Lange, M Berliner, W Weidner, HG Schiefer, KL Schmidt, K Federlin. Ankylosing spondylitis and infections of the male urogenital tract: Exploration of urinary tract infection in correlation to rheumatologic parameters. Zeitschrift Fur Rheumatologie 55: 4 (JUL-AUG 1996):249-255.

13) H Mielants, M Devos, C Cuvelier, EM Veys. The role of GUT inflammation in the pathogenesis of spondyloarthropathies. Acta Clinica Belgica 51: 5 (OCT 1996):340-349.

14) O Vittecoq, T Schaeverbeke, S Favre, A Daragon, N Biga, C Cambonmichot, C Bebear, X Leloete. Molecular diagnosis of Ureaplasma urealyticum in an immunocompetent patient with destructive reactive polyarthritis. Arthritis and Rheumatism 40: 11 (NOV 1997):2084-2089.

15) L Cirasino, A Marccotti, C Barosi, F Massaro, A Silvani. Misdiagnosis of post-traumatic splenic rupture in a patient with acute cold agglutinin disease due to Mycoplasma infection. Scandinavian Journal of Infectious Diseases 29: 5(1997):522-524.

16) Y Aihara, M Mori, T Kobayashi, S Yokota. A pediatric case of polymyositis associated with Mycoplasma pneumoniae infection. Scandinavian Journal of Rheumatology 26: 6 (1997):480-481.

17) Braun et al. Chlamydia pneumoniae- a new causitive agent of reactive arthritis and undifferentiated arthritis. Ann Rheum Dis 1994;53:100-105.

18) Gerard HC et al. Screening of synovial tissue from reactive arthritis patients for the presence of chlamydia pneumoniae. Arthritis Rheum 1995;38:S394.

19) IT Kufko, OM Lesnyak, VG Melnikov, NS Baranova, OF Ryabitseva, ZI Sokolova. Comparative clinical and laboratory characteristics of Lyme arthritis and reactive arthritis. Terapevticheskii Arkhiv 69: 5 (1997):12-15.

20) F Kanakouditsakalidou, G Pardalos, P Pratsidougertsi, A Kansouzidoukanakoudi, H Tsangaropouloustinga. Persistent or severe course of reactive arthritis following Salmonella enteritidis infection - A Prospective study of 9 cases. Scandinavian Journal of Rheumatology 27: 6 (1998):431-434.

21) T Schifter, UH Lewinski. Adult onset Still's disease associated with Epstein-Barr virus infection in a 66-year-old woman. Scandinavian Journal of Rheumatology 27: 6 (1998):458-460.

22) P Roblot, F Roblot, A Ramassamy, B Becqgiraudon. Lupus syndrome after parvovirus B19 infection. Revue du Rhumatisme 64: 12 (DEC 1997):849-851.

23) S Priem, GR Burmester, T Kamradt, K Wolbart, MG Rittig, A Krause. Detection of Borrelia burgdorferi by polymerase chain reaction in synovial membrane, but not in synovial fluid from patients with persisting Lyme arthritis after antibiotic therapy. Annals of the Rheumatic Diseases 57: 2 (FEB 1998):118-121.

24) HC Gerard, PJ Branigan, HR Schumacher, AP Hudson. Synovial Chlamydia trachomatis in patients with reactive arthritis/ Reiter's syndrome are viable but show aberrant gene expression. Journal of Rheumatology 25: 4 (APR 1998):734-742.

25) M Mousavijazi, L Bostrom, C Lovmark, A Linde, M Brytting, VA Sundqvist. Infrequent detection of cytomegalovirus and Epstein-Barr virus DNA in synovial membrane of patients with rheumatoid arthritis. Journal of Rheumatology 25: 4 (APR 1998):623-628.

26) T Schaeverbeke, M Clerc, L Lequen, A Charron, C Bebear, B Debarbeyrac, B Bannwarth, J Dehais, C Bebear. Genotypic characterization of seven strains of Mycoplasma fermentans isolated from synovial fluids of patients with arthritis. Journal of Clinical Microbiology 36: 5 (MAY 1998):1226-1231.

27) TV Poggio, N Orlando, L Galanternik, S Grinstein. Microbiology of acute arthropathies among children in Argentina: Mycoplasma pneumoniae and hominis and Ureaplasma urealyticum. Pediatric Infectious Disease Journal 17: 4 (APR 1998):304-308.

28) S Ahmed, EM Ayoub, JC Scornik, CY Wang, JX She. Poststreptococcal reactive arthritis: Clinical characteristics and association with HLA-DR alleles. Arthritis and Rheumatism 41: 6 (JUN 1998):1096-1102.

29) MC Jendro, G Weber, T Brabant, H Zeidler, J Wollenhaupt. Reactive arthritis after cat bite: A rare manifestation of cat scratch disease - Case report and overview of the literature. Zeitschrift Fur Rheumatologie 57: 3 (JUN 1998):159-163.

30) A Krause, G Krause. Arthritis in a patient with erythema infectiosum. Zeitschrift Fur Rheumatologie 57: 3 (JUN 1998):164-165.

31) C Alba, B Bailly, C Sauviat, B Depernet. Arthritis due to Haemophilus aphrophilus: A case report. Medecine et Maladies Infectieuses 28: 6-7(JUN-JUL 1998):529-530.

32) HJ Anders, FD Goebel. Cytomegalovirus polyradiculopathy in patients with AIDS. Clinical Infectious Diseases 27: 2 (AUG 1998):345-352.

33) D Vassilopoulos, LH Calabrese. Rheumatologic manifestations of HIV-1 and HTLV-I infections. Cleveland Clinic Journal of Medicine 65: 8 (SEP 1998):436-441.

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

35) S Aoki, K Yoshikawa, T Yokoyama, T Nonogaki, S Iwasaki, T Mitsui, S Niwa. Role of enteric bacteria in the pathogenesis of rheumatoid arthritis: Evidence for antibodies to enterobacterial common antigens in rheumatoid sera and synovial fluids. Annals of the Rheumatic Diseases 55: 6 (JUN 1996):363-369.

36) LB Siegel, EP Gall. Viral infection as a cause of arthritis. American Family Physician 54: 6 (NOV 1 1996):2009-2015. (parvovirus, chronic hepatitis B virus and hepatitis C) virus infections.

37) D Tabarya, WL Hoffman. Staphylococcus aureus nasal carriage in rheumatoid arthritis: Antibody response to toxic shock syndrome toxin-1. Annals of the Rheumatic Diseases 55: 11 (NOV 1996):823-828.

38) T Origuchi, K Eguchi, Y Kawabe, I Yamashita, A Mizokami, H Ida, S Nagataki. Increased levels of serum IgM antibody to staphylococcal enterotoxin B in patients with rheumatoid arthritis. Annals of the Rheumatic Diseases 54: 9 (SEP 1995):713-720.

39) TV Poggio, N Orlando, L Galanternik, S Grinstein. Microbiology of acute arthropathies among children in Argentina: Mycoplasma pneumoniae and hominis and Ureaplasma urealyticum. Pediatric Infectious Disease Journal 17: 4 (APR 1998):304-308.

40) M Wuorela, K Granfors. Infectious agents as triggers of reactive arthritis. American Journal of the Medical Sciences 316: 4(OCT 1998):264-270.

41) H Mielants, M Devos, C Cuvelier, EM Veys. The role of GUT inflammation in the pathogenesis of spondyloarthropathies. Acta Clinica Belgica 51: 5 (OCT 1996):340-349.

42)RQ Silva, JB Garcia, JAF Sanchez, FJ Casillas, CO Calvo, RH Mesia, JLS Lombrana, AR Perez. Silent axial arthropathy in inflammatory bowel disease. Clinical, radiological and genetic characteristics. Revista Clinica Espanola 198: 3 (MAR 1998):124-128. high frequency of asymptomatic sacroileitis in patients with IBD.

43) M Leirisalorepo. Therapeutic aspects of spondyloarthropathies - A review. Scandinavian Journal of Rheumatology 27: 5 (1998):323-328.

44) F Dekeyser, D Elewaut, M Devos, K Devlam, C Cuvelier, H Mielants, EM Veys. Bowel inflammation and the spondyloarthropathies. Rheumatic Disease Clinics of North America. 24: 4(NOV 1998):785.

45) E Markerhermann, T Hohler. Pathogenesis of human leukocyte antigen B27-positive arthritis: Information from clinical materials. Rheumatic Disease Clinics of North America 24: 4(NOV 1998):865.

46) F Dekeyser, D Elewaut, M Devos, K Devlam, C Cuvelier, H Mielants, EM Veys. Bowel inflammation and the spondyloarthropathies. Rheumatic Disease Clinics of North America 24: 4(NOV 1998):785.

47) RD Inman, JA WhittumHudson, HR Schumacher, AP Hudson. Chlamydia and associated arthritis. Current Opinion in Rheumatology, 2000, Vol 12, Iss 4, pp 254-262.

48) TL Moore. Parvovirus-associated arthritis. Current Opinion in Rheumatology, 2000, Vol 12, Iss 4, pp 289-294.

49) D Buskila. Hepatitis C-associated arthritis. Current Opinion in Rheumatology, 2000, Vol 12, Iss 4, pp 295-299.

50) A Toivanen, P Toivanen. Reactive arthritis. Current Opinion in Rheumatology, 2000, Vol 12, Iss 4, pp 300-305.

51) EM Ayoub, HA Majeed. Poststreptococcal reactive arthritis. Current Opinion in Rheumatology, 2000, Vol 12, Iss 4, pp 306-310.

52) J Evans. Lyme disease. Current Opinion in Rheumatology, 2000, Vol 12, Iss 4, pp 311-317

53) J Haier, M Nasralla, AR Franco, GL Nicolson. Detection of mycoplasmal infections in blood of patients with rheumatoid arthritis.Rheumatology, 1999, Vol 38, Iss 6, pp 504-509.Nicolson GL, Inst Mol Med, 15162 Triton Lane, Huntington Beach,CA 92649 USA.

54) M vanderHeijden, B Wilbrink, LM Schouls, JDA vanEmbden, FC Breedveld, PP Tak.Detection of mycobacteria in joint samples from patients with arthritis using a genus-specific polymerase chain reaction and sequence analysis. Rheumatology, 1999, Vol 38, Iss 6, pp 547-553.

55) Mayo Clinic Proceedings 2000(Feb);75(2):144-147.

56) S Johnson, D Sidebottom, F Bruckner, D Collins. Identification of Mycoplasma fermentans in synovial fluid samples from arthritis patients with inflammatory disease. Journal of Clinical Microbiology, 2000, Vol 38, Iss 1, pp 90-93.

57) A Csepregi, B Rojkovich, E Nemesanszky, G Poor, M Hejjas, M Horanyi. Chronic seropositive polyarthritis associated with hepatitis B virus-induced chronic liver disease: a sequel of virus persistence. Arthritis and Rheumatism, 2000, Vol 43, Iss 1, pp 232-233

58) M Rudwaleit, J Braun, J Sieper. Treatment of reactive arthritis - A practical guide. Biodrugs, 2000, Vol 13, Iss 1, pp 21-28.

59) JR ODell, KW Blakely, JA Mallek, PJ Eckhoff, RD Leff, SJ Wees, KM Sems, AM Fernandez, WR Palmer, LW Klassen, GA Paulsen, CE Haire, GF Moore. Treatment of early seropositive rheumatoid arthritis - A two-year, double-blind comparison of minocycline and hydroxychloroquine. Arthritis and Rheumatism, 2001 (October), Vol 44, Iss 10, pp 2235-2241. O'Dell JR,Univ Nebraska,Med Ctr,Nebraska Med Ctr 983025,600 S 42nd St,Omaha,NE 68198 USA 60) Persistent Chlamydiae and chronic arthritis. Arthritis Research, 2002, Vol 4, Iss 1, pp 5-9. C Villareal, JA WhittumHudson, AP Hudson. Hudson AP.

Checked 11/2/12

August 22nd, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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