REACTIVE ARTHRITIS

Gabe Mirkin, M.D.

I am absolutely amazed that more doctors do not treat at least some of their arthritis patient with antibiotics because there are hundreds of papers showing that hundreds of different infections cause arthritis. Doctors do not have laboratory tests to diagnose many 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 can cause reactive arthritis: Salmonella intestinal infection (1), mononucleosis (2,21,25), parvovirus, chronic hepatitis B virus and hepatitis C) virus infections (3), Retroviruses (4,5). Venereal diseases, such as chlamydia, mycoplasma, ureaplasma, gonorrhea and Gardnerella cause arthritis (6,7,8), mycoplasma (9), Human T Cell Leukemia Virus-1 (10,33), chlamydia (11,15,16,17,18,24,34), urinary infections with chlamydia, ureaplasma and mycoplasma (12,26,27,39), many different intestinal infections (13,35,41,42,43,44,45,46), ureaplasma (14,27), Lyme disease (19,23), Salmonella diarrhea (20), parvovirus B19 (22,36), cytomegalovirus (25,26,32), streptococcal sore throat (28), cat scratch disease (29), human herpes virus-6 (30), hemophilus influenza bacteria (31), AIDS (HIV) (33), hepatitis B and C (36). staph aureus bacterial infections (37,38). Additional references are provided 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 rheumatoid 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.

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