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Reactive arthritis

Reactive arthritis is a condition with symptoms similar to arthritis or rheumatism. It is caused by another illness, such as Crohn's disease, and is thus "reactive", i.e. dependent on the other condition. more...

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Reactive Arthritis is the combination of three seemingly unlinked symptoms—an inflammatory arthritis of large joints, inflammation of the eyes (conjunctivitis and uveitis) and urethritis. It is also known as arthritis urethritica, venereal arthritis, seronegative spondyloarthropathy, Reiter's , polyarteritis enterica.

Reactive arthritis is a seronegative, HLA-B27-linked spondyloarthropathy (autoimmune damage to the cartilages of joints) often precipitated by genitourinary or gastrointestinal infections. It is more common in men than in women and more common in white men than in black men. People with HIV have an increased risk of developing Reactive arthritis as well.

It is set off by a preceding infection, the most common of which would be a genital infection with Chlamydia trachomatis. Other bacteria known to cause Reactive arthritis are gonococcus and Ureaplasma urealyticum. A bout of food poisoning by enteric bacteria such as Salmonella, Shigella, Yersinia, or Campylobacter, or a gastrointestinal infection such as Crohn's disease may also set off Reactive arthritis. Reactive Arthritis usually manifests about 1-3 weeks after a known infection.

Signs and symptoms

Symptoms generally appear within 1-3 weeks but can range from 4-35 days from onset of inciting episode of disease.

The classical presentation is that the first symptom experienced is a urinary symptom such as burning pain on urination (dysuria) or an increased need to urinate (polyuria or frequency). Other urogenital problems may arise such as prostatitis in men, and cervicitis, salpingitis and/or vulvovaginitis in women.

The arthritis that follows usually affects the large joints such as the knees causing pain and swelling with relative sparing of small joints such as the wrist and hand.

Eye involvement occurs in about 50% of men with urogenital Reactive Arthritis and about 75% of men with enteric Reactive Arthritis. Conjunctivitis and uveitis can cause redness of the eyes, eye pain and irritation, and blurred vision. Eye involvement typically occurs early in the course of Reactive Arthritis, and symptoms may come and go.

Roughly 20 to 40 percent of men with Reactive Arthritis develop penile lesions called balanitis circinata on the end of the penis. A small percentage of men and women develop small hard nodules called keratoderma blennorrhagica on the soles of the feet, and less often on the palms of the hands or elsewhere. In addition, some people with Reactive Arthritis develop mouth ulcers that come and go. In some cases, these ulcers are painless and go unnoticed.

About 10 percent of people with Reactive Arthritis, especially those with prolonged disease, will develop cardiac manifestations including aortic regurgitation and pericarditis.


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Can statins benefit patients with rheumatoid arthritis?
From American Family Physician, 4/1/05 by Anne D. Walling

Statins were developed for their antilipid properties, but they also act as anti-inflammatories. In vitro studies indicate that statins may be beneficial in treating rheumatoid arthritis. McCarey and colleagues studied the clinical effects of atorvastatin on patients with rheumatoid arthritis in a double-blind, random-ized, placebo-controlled trial.

One hundred and sixteen adults with continued active rheumatoid arthritis after at least three months of adequate disease-modifying antirheumatic drug therapy participated in the study. Active disease was defined as at least six swollen joints and at least two other features (six tender joints, 30 minutes or more of morning stiffness, or erythrocyte sedimentation rate [ESR] of 28 mm per hour or higher). Exclusion criteria included diabetes, elevated coronary heart disease risk, familial hypercholesterolemia, steroid intake of 10 mg or more per day, and significant renal insufficiency. Patients remained on all therapy for rheumatoid arthritis and other conditions throughout the study. After assessment, patients were randomized to receive 40 mg of atorvastatin or placebo. The primary outcome was change in the DAS28 scale, a validated composite disease activity score that incorporates ESR, visual analog score for pain, and number of swollen or tender joints. Additional outcomes included health assessment questionnaires, C-reactive protein, plasma lipids, and endothelial function markers. Physicians assessed patients after three and six months of therapy; evaluation included screening for changes in liver and kidney function.

The two groups were generally comparable on entry to the study, but pain scores and global assessments were slightly lower in the atorvastatin group. At six months, DAS28 was significantly reduced in the atorvastatin group compared with placebo. Thirty-one percent of the atorvastatin group achieved moderate or good DAS28 response com-pared with only 10 percent of the placebo group. The atorvastatin group also showed significant improvements in acute-phase reactants. Levels of C-reactive protein and ESR declined by 50 and 28 percent respectively in patients receiving atorvastatin compared with those receiving placebo. These results remained consistant after adjusting for all significant variables. Other indicators of disease activity, particularly the number of swollen joints, also improved during atorvastatin therapy. Very few adverse events occurred in either group. More atorvastatin patients completed the study than placebo patients (53 out of 58 compared with 45 out of 58, respectively). More placebo patients received intramuscular or intra- articular steriod injections during the study.

The authors conclude that atorvastatin was associated with a modestly beneficial but clinically useful effect in patients with rheumatoid arthritis. They speculate that statins provide vascular protective and adjunctive immune- modifying effects to disease-modifying antirheumatic drug therapy and could be effective in treating chronic inflammatory diseases.

McCarey DW, et al. Trial of atorvastatin in rheumatoid arthritis (TARA): double-blind, randomised placebo-con-trolled trial. Lancet June 19, 2004;363:2015-21.

COPYRIGHT 2005 American Academy of Family Physicians
COPYRIGHT 2005 Gale Group

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