ReA - can be HLA-B27 positive | Arthritis Information
Check this out - and YET another reason to do probiotics
Oops - forgot this one -
Pip - can you explain to me the significance of HLA-B27 again. I have it down for my 3-month check this week to ask for it, but I don't know why? Yikes - ty CathyWell, I always thought it meant you had RA - this wikilink shows some info - I'm posting it for Anna.
Pip
Crap - I think I tested positive for this when the Great U screwed up my 'its got to be an infection' when I was trying to get diagnosed. I'd look but I just get pissed off.
So I'm not a cookie cutter example but there are some patterns:
1999: inflammatory condition in my feet began (had to stop running, took vioxx for a while)
2000: BAD case of mono that took years to shake...low fevers, swollen glands
2003: first pregnancy, ended in miscarriage, but I feel like this pregnancy reset my body and I was able to shake mono/cfids/ra/whatever it was
2004: first successful pregnancy, felt great the whole time and right up until second
2006: second pregnancy...right before, thought I had bladder infection, they said no, it's IC (mast cell issue). Got pregnant, they said, oh wait, you have a Strep A (throat strep) bladder infection. That was June or so. During pregnancy, the next winter, I was sick all the time with a cold, but no sore throat. After a month, went to a nurse practitioner, who insisted on doing a strep test. I was positive despite 99 fever and no sore throat (but my throat looked awful).
2007: gave birth in February. Felt weak, having trouble with stairs. Thyroid panel run in April, was normal. THEN I got salmonella in June. 1 day of vomitting and 103 fever. AWFUL. In July, had weird episode of dizziness/weakness on right side. No one ever figured it out. But I had strep so bad (again, only 99 fever and no throat pain) that they had to put me through 2 courses of antibiotics (I was breastfeeing so the first dose was probably weak on purpose). Went to rheum in Oct because I still didn't feel right and no one could explain it. He ran FULL panel for connective tissue issues, lupus, etc.. ALL normal. In Nov, RA started with flare of pleurisy/costo, bladder pain, then my right wrist went from 0 to 60 in about 1 month. Was finally dx based on high ESR and CRP and MRI showing tons of joint fluid, looked like someone had taken a hammer to my hand.
So Mobic works awesome but my experiences with Plaq, MTX, and Arava have been so-so, still many issues. At my last visit the doctor said he was going to do a new interesting test. I was all excited to see my results online but found out that he ran ANA again which was normal again, CRP is now 9.8 though, still RF negative. So I'm suspecting that he ran HLA-B27 because he says he thinks I have Reactive Arthritis. My appt is Feb 5. Positive lab results aren't posted online, so...just have to wait and see.
I have a lot of trouble with my achilles/heel pain and same place/issues on my wrists with flexibility, have lost lots of ROM in my wrist--there are little erosions but no joint space narrowing despite loss of ROM. SO I think I have a lot of enthesitis.
I may ask him what he thinks about AP. I meant to last time and I just lose my mental facilities during dr. appts.
KatieG2009-01-25 16:13:26I can't write anything short to save my life. Sorry!Man, could it be that he leaky gut theory has a lot more credibility than I ever gave it credit for? Because it seems like more and more research is pointing in that direction.I think it is less associated with RA and more with seronegative RA, ie AS, psoriatic arthritis, reiters (aka reactive)
From Wiki:
Clinical Features of HLA-B27 Syndromes - Reactive Arthritis
Reactive arthritis refers to an acute nonpurulent arthritis complicating an infection elsewhere in the body. The term has been used primarily to refer to spondyloarthropathies following enteric or urogenital infections and occurring in individuals who are HLA-B27 positive. Included in this category is what was once referred to as Reiter syndrome and is now referred to as reactive arthritis, which originally was described as a triad of arthritis, nonspecific urethritis, and conjunctivitis, often accompanied by iritis.
Reactive arthritis occurs like ankylosing spondylitis in individuals who are HLA-B27 positive; in fact, 60-85% of patients are HLA-B27 positive. The disease is most common in persons aged 18-40 years, but it has been known to occur in children and older adults. The sex ratio varies, depending on whether the infection is enteric or venereally acquired. The sex ratio following gastrointestinal infection is 1:1, whereas the genitourinary disease primarily affects males. Prevalence of the disease also is high in homosexual and bisexual men, owing to the high rate of genitourinary and gastrointestinal infections in this group. A particular severe form of peripheral spondyloarthropathy following an infection has been described in patients with AIDS.
Etiology
The first bacterial infection noted to be causally related to reactive arthritis was Shigella flexneri. Other bacteria that have been implicated in reactive arthritis include several Salmonella species, Yersinia enterocolitica, Campylobacter jejuni, Chlamydia trachomatis, Chlamydia pneumoniae, Clostridium difficile, and Ureaplasma urealyticum.
Symptoms
The syndrome usually begins with urethritis followed by conjunctivitis and rheumatological findings. Arthritis begins within 1 month of infection in 80% of patients. It is usually acute, asymmetric, and oligoarticular and predominantly involves the joints of the lower extremities (eg, knees, ankles, feet, wrists). The arthritis is usually quite painful. Dactylitis or sausage digit is a diffuse swelling of a solitary finger or toe. This is a distinct feature of both reactive arthritis and psoriatic arthritis. Plantar fasciitis and Achilles tendonitis also are common. Sacroiliitis is present in as many as 70% of patients. The conjunctivitis is usually minimal and lasts for only a few days or weeks. It is mucopurulent and papillary.
Punctate and subepithelial keratitis may occur rarely, leading to permanent corneal scars. Acute nongranulomatous iritis recurs frequently in this condition. It may become bilateral and chronic and may result in blindness. Mucocutaneous lesions are common and appear in the mouth and palate and on the glans penis and palms and soles.
Two such conditions considered to be major diagnostic criteria, according to the American Rheumatological Association (ARA) guidelines, are as follows: (1) keratoderma blennorrhagicum, a scaly, erythematous, irritating disorder of the palms and soles of the feet, and (2) circinate balanitis, a persistent, scaly, erythematous circumferential rash of the distal penis. Keratoderma blennorrhagicum may resemble pustular psoriasis, which can make it difficult to distinguish between these two seronegative arthropathies. Minor diagnostic criteria include sacroiliitis, plantar fasciitis, Achilles tendonitis, nail bed pitting, palate ulcers, and tongue ulcers.
Diagnosis
Reactive arthritis is a clinical diagnosis without definitive laboratory or radiographic findings. The diagnosis should be considered when an acute asymmetric inflammatory arthritis or tendonitis follows an episode of diarrhea or dysuria. These diseases are also spondyloarthropathies involving the tendon insertion, not the synovium, primarily of weightbearing joints. HLA-B27 testing is not essential to confirm the diagnosis, but it may determine the eventual severity and chronicity of the condition.
Treatment
Treatment is empirical and aimed at relieving symptoms. Patient education, reassurance, and physical therapy are of paramount importance. Acute arthritis is treated with analgesics and nonsteroidal anti-inflammatory drugs, such as indomethacin. Whether antibiotics help in reactive arthritis is unclear. However, it is known that treatment of acute chlamydial urethritis may prevent subsequent reactive arthritis.
Systemic corticosteroids should be avoided because they can aggravate the cutaneous manifestations of the disease, but local administration can help persistent monoarthritis, fasciitis, and tendonitis. In chronic destructive arthritis, cytotoxic drugs, such as methotrexate or azathioprine, may be beneficial. Uveitis usually is treated with topical periocular or systemic corticosteroids depending on the severity of the condition.
So, it is accepted by medical doctors that a certain set of various bacterial infections are loosely related to reactive arthritis? Is reactive arthritis curable?
My understanding is that most people will get over it in a few months, but it sticks around for others. What I was trying to point out in my chronology is that while I've had flares around times that I had strep, etc., I also had problems before that. So my take is that the two are related but it's a complicated relationship and maybe more than just the infection involved (also certain HLA type, probably other things...)
I also wonder about the effect that being on antibiotics for acne in high school has had on all of this, and the fact that I wasn't diagnosed with strep for the first time until age 28.
JSNM - yes, ReA is curable from what I can see.
Katie - Strep needs different abx than Mino, from what I understand. You use Zith for that, so sayeth my AP doc. Here is a ACR page - whoever diagnosed you was supposed to give you abx at first. Notice, nowhere in here does it say 'biologic'.
http://www.rheumatology.org/public/factsheets/diseases_and_conditions/reactivearthritis.asp?aud=pat
I'm going to run over to Pubmed when I get done with dinner and will post here.
Pip
PS - I was on doxy for acne back in the dark ages - and NOT one of those docs ever said 'probiotics'. I wonder if thats how my system started to go 'wrong'.
ReA after tetanus vaccine -
What's the BCV vaccine?
Well, this explains my beyond sky high RF -
Didn't you say something about tendonitis? Sorry, can't see it from here.
And this -
If you run a search on Pubmed for - "reactive arthritis" antibiotic -in the search field, you'll get 353 studies. These are some of the highlights.
There are 78 studies in there for - 'reactive arthritis' vaccine. Hmmmm.
And JSNM - quite a lot for oral ulcers. I'd search 'reactive arthritis' oral ulcers and see what pops up.
Pip
Pip, you are amazing - is this what you usually do on Sunday nights?
I will bring this up with the new rheumy in March. I don't fit into this slot very well either, but I haven't fix into any box yet anyway, but I am surprised because of bitter complaining of mouth ulcers coming upon a decade now. Another started about three days ago and my gum is killing me and its so bright red I could be Frosty the Gumdeer.
I am just fascinating by the infection connection. I hadn't realized there was an accepted form of arthritis brought on secondarily from an infection.
I spent all weekend organizing my bloodwork into a 3-ring binder and tabbed, in date order, by doctor, for the new endo on Friday and the new rheumy in March. Filled out their prepaperwork and the rheumy's was very interesting in the questions asked - pertinent actually, so I am uncrossing my fingers (my new RA joke).
I found two items in this box of papers I have to followup on. My back surgery of 12/05 had an pre-op EKG which shows a problem, and is compared to an older EKG they had on file from one of my infamous ER trips before dx, and I am shocked no one ever said a word as its proof of the heart trouble I haven't been able to get any proof of.
Then I found a letter from my great opthamologist who wrote me about two questions I had called in after my two left eye blindness episodes during the field vision tests I had for the Plaquinel, and it said I wasn't complaining of three items, so whatever he was saying was okay. Well, one was scalp tenderness, and for months now my scalp has been killing me. I thought it was the weight of my long, grown-out hair, the longest its ever been.
Sometimes, a good weekend of reading your own health history is an interesting thing to do.
And I did myself in, because I would periodically just trash my records (chart notes) because I would get so enraged by the lies these doctors put in there (thank God my hubbie was around for most of them for a witness). I will never, ever understand this part.
[QUOTE=Pip!]What's the BCV vaccine?
It's my understanding that Reactive Arthritis can't always been cured. I really trust my RD, he used to be president of ACR. By the time I saw him and he mentioned it, it was 12 months after I had my first bad flare.
Katie -
What would happen to somebody who had an infection and 12 months later they were still not given antibiotics? I'm not trying to tell you what to do, but...used to be president of the ACR says 'old school' to me. Maybe he's not up on the latest research? I adore my AP doc...but I mention research I've seen and he's asked me to bring in copies. When they're working in the fields, so to speak, when do they get time to study all this stuff like we do? Or like they did in med school? How long do they get for continuing education courses to keep their licenses anyway? How much cutting edge info can be crammed into a few days?
Hugs,
Pip
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