Reactive Arthritis

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Anyone had experience of a reactive arthritis following an insect bite - mosquito or horse-fly - where the joint affected is distant from the bite? No sign of bacterial infection at bite site (forearm) but there was an acute allergic inflamatory response (Rx Clorphenamine Maleate) within 6 hours followed by a rapid onset of excruciating hip pain and imobility for 3 days, which eventually eased with high doses of ibuprofen. Inflamation and oedema of fore and upper arm present for 4 days. One previous episode of similar nature involving insect bite on lower leg leading to reactive arthritis in ankle and hallux with same prognosis.

Any ideas?

Mark Russell

 

The students get that lecture in a few weeks

 

Craig

Thanks for this - much appreciated. I had considers Reiter's but discounted it on the grounds that there was no urethritis or conjunctivitis present and that the precusror was an insect bite rather than infection from the sources you specify - the GI routes and STDs. The first symptom was the acute joint pain which occured nine hours following the bite and had a remarkably rapid onset - within 30 minutes. Localised inflamation and oedema around the bite site followed within six hours of the joint pain.

Is this still consistent with your understanding of Reiter's?

Best wishes

Mark

 

Different rheumatology texts do it differently and there is some variation in the terminology for the whole range of reactive arthritic conditions. Add to that the "confusion" of the desire in many places to do away with the terminology of "Reiters Syndrome" ... Reiter was Hitlers doctor and part of all the Nazi experiments and as such should not be honoured by having a condition named after him:

From Gabe Mirkin's essay on THE DESPICABLE DR. HANS REITER.

My preference is to use the term 'Reactive Arthitis' to refer to all conditions in that category of non-infectious arthritis following an infection resulting in immune reaction in a joint(s). What we used to call Reiter's Syndrome could be considered a specific pattern (the triad) or condition in this category.

 

Thanks again. Interesting view regarding Reiter and the desire of the medical community to delete all references on the basis of his questionable ethics, practice and alleigance to the Nazi dictator. One can't help but wonder whether history will judge John Edmondson and Ronald Sollock in the same vein - mind you, I'm not aware of any substantive academic work being attributed to them in the same way as Reiter.

http://www.straddle3.net/context/03/en/2006_03_24.html

 

wow! ...Thats interesting. I had no idea of the controversey surrounding Reiters Syndrome. Thanks.

 

Here in the USA,lyme disease is a malady that can occur post bite by insect.I do not know if it is endemic to where you are.If so,check for a target lesion,arthralgias,malaise,etc.

 

Every year I ask the students what they know about deer hunting in Connecticut .... once every few years a really smart one make the link

 

Medical Ethics

The Guantanamo suicides reopen a festering question of medical ethics.

 

Dear Mark

I Australia we have Ross River and Barnah Forrest viruses that come from mosquitoes.

The patient can have local arthralgias to total body arthralgias. They may also have myalgias from very mild to extreme.

Some aslo develop a true neuropathy with paraesthesia to the hands, feet and face on occassions.

Currelty there is a virus from Angola in Angola, Reunion Island, Mauritius and close by islands. It has not been well discussed because of tourism concerns.

It started by a mosquito bite. The patient develops severe total body arthritis and in some cases which are all fatal a pneumonia. From start to finish is 10 days.

A Mauritian patient of mine was telling me how serious it is. Apparently some Doctors from France went to help out in Reunion Island and several died from it so all went home.

The same patient was telling me that these souls probably moved the virus to the south of France where there has been a small outbreak of the disease.

I am sorry I cannot find it name, but if I do I will post it.

The only treatment is steroids +++ and aspirin and good luck.

Several of his relatives who have had the virus have not been back to work for over 4 months due to the arthritis.

May I suggest one stays at home!

Regards

www.musmed.com.au

 

Could be an atypical presenatation of reactive arthritis or Lymes disease (if there are any deer about). http://www.ncbi.nlm.nih.gov/pubmed/8609869.

The onset sounds too sudden as reactive arthritis is usually after 1 week to a month and lymes is usually 3-4 weeks post infection. If we are sure of previous diagnosis of reactive arthritis then this again swings the diagnosis in favour of reactive arthritis whch often recurrs.

Trouble is with a lot of these rheumatolgy conditions the history is not reliable as there are so many vague and atypical presnetations. You would need to do some bloods and the support of a rheumatologist. I have found the book Rheumatology by Cush et al invaluable when I get stuck like this. I read up then I go and talk to our Rheumatolgist lead. After discussing with him I would either refer on or treat.

A reactive arthritis is treated conservatively initially as most will resolve spontaneously. If it were manifesting in the foot and you are confident of the diagnosis you can go ahead and treat the symptoms with orthoses, NSIADS, pt education, BKCs, antibiotics (if infection still present) etc. If it then doesnt resolve within a couple of months then send to Rheumatology with a view to DMARDS.

Sorry went off track a bit. If you hare not in the privelidged postition of the support of a Rheumatologist this needs to be referred on to one without a doubt. Dont hold onto it. There are copious rheumatology conditions we pods will never know about or remit to diagnose.

hope this is helpful - Simon

PS - Here is a photo of the despicable Hans Reiter who currently burns in hell!