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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.
Reactive Arthritis (ReA) (Reiter’s syndrome)
Post-infectious disorder (not a local infection, but a reaction). Classic triad (Reiter – 1916) of arthritis, urethritis and conjunctivitis following infection. Reiter’s syndrome is now not the preferred name (Reiter was involved with Nazi politics and medical experiments).
Syndrome now considered consisting of:
1) Arthritis
2) Urethritis
3) Conjunctivitis
4) Mucocutaneous lesions
However, not all patients will exhibit all of these features.
Usually follows infection with Yersina, Salmonella, Campylobacter (gastrointestinal infections) and Chlamydia (genitourinary infection). A heightened immune reaction then occurs to the triggering infection --> increase in IgG/IgA antibodies and an enhanced antigen specific proliferation of synovial fluid lymphocytes.
Clinical features:
M>F. Usually 15 to 35 yrs. Abrupt onset with urethritis is usually first manifestation with low-grade fever. Urethritis in some may be asymptomatic. History should reveal recent infection. Conjunctivitis (usually mild) and arthritis follows urethritis.
Asymmetric arthritis – oligoarticular and usually lower extremity (knees, ankles and MPJ’s) – joints are tender and warm; joint stiffness is early predominant feature.
Some develop mucocutaneous lesions – small mouth ulcers
Involvement of foot:
• Asymmetric involvement of MPJ’s and IPJ’s.
• Achilles tendonitis and plantar fasciitis are common and may be severe (enthesitis).
Keratoderma blennorrhagia – psoriasis like lesion on sole of foot (in 5-30%) – appears as small reddish to yellow brown vesicles
• X-rays may show calcaneal erosions and ‘fluffy’ spurs; joint space loss, poorly joint defined erosions, periarticular osteoporosis, soft tissue swelling
• “Sausage toe” – toe is swollen (dactylitis) – shows up on bone scan as a ‘hot toe’.
• 50% have some form of polyarthritis in foot joints or heel pain
• Ankle and first metatarsophalangeal joint involvement are the most common joints affected in foot.
• Early reports --> reported exostoses of the calcaneus following gonococcal infection and hereditary syphilis.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Last edited by Admin : 17th April 2006 at 04:19 AM.
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?
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:
Quote:
Reiter's syndrome was named after one of the most heinous, hateful and despicable physicians who ever lived.
Quote:
Despicable and venomous Dr. Hans Conrad Julius Reiter was one of the first physicians to swear an oath of allegiance to Adolph Hitler in 1932 and was one of the most prominent members of a the eugenics movement that advocated killing all people who had any physical or mental disability whatever.
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.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Last edited by Admin : 17th April 2006 at 04:22 AM.
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.
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.
lyme disease is a malady that can occur post bite by insect
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
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Last edited by Admin : 23rd April 2006 at 08:50 PM.
Reason: typo
The Guantanamo suicides reopen a festering question of medical ethics.
Quote:
Originally Posted by The Times 26 June 2006
GUANTANAMO BAY, the US detention camp in Cuba, has become a synonym for inhumanity: prolonged isolation with no recourse to the law; alleged beatings and torture; forcible feeding of hunger strikers; and now suicides.
The recent deaths of three detainees are certain to reopen a festering debate among psychologists and psychiatrists about whether they should be sharing their expertise on the human mind with military interrogators. The rumours that particular prisoners have suffered unusual punishments — one is said not to have seen sunlight for years — have stoked suspicions that mental health experts with access to detainees’ medical records have customised interrogation techniques (the prisoner allowed out only at night is reported to have a phobia of the dark). In the eyes of many, such assistance constitutes a violation of an ethical code, because it is about breaking minds rather than healing them.
Last year the ethics committee of the American Psychological Association (APA) published a report suggesting that it was ethically acceptable for “psychologists to serve in consultative roles to interrogation or information gathering processes for national security-related purposes”. Stephen Behnke, the APA’s director of ethics, maintained that consulting with military personnel constituted a “very valuable contribution to law enforcement and to national security”.
The APA’s emphasis, said Dr Behnke, is on “benign” information-gathering. But critics suggest that, in such a context, information-gathering amounts to breaking a prisoner’s will and is anything but benign.
Michael Wilks, chairman of the British Medical Association’s ethics committee, has condemned the APA’s position, calling it an example of “governments and professional bodies rewriting existing ethical guidance in the service of abuse”. Earlier this year Dr Wilks wrote an unequivocal editorial in the British Medical Journal entitled “Guantanamo: a call for action”, in which he accused Guantanamo doctors of abandoning their ethical duty. He gave warning that a similar creeping complicity saw German doctors become part of Hitler’s killing machine.
Those running Guantanamo have apparently shown interest in studies by Martin Seligman, a past president of the APA, on “learned helplessness”. This theory, dating back to the Sixties, suggests that individuals who suffer persistent ill-treatment eventually submit wholly to their tormentor. Professor Seligman has since achieved worldwide fame as a researcher in the field of happiness. The irony is almost too grim to bear.
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"citing an indisposition due to special circumstances"
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
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.
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!
Last edited by NewsBot : 22nd February 2009 at 01:18 PM.
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Reactive Arthritis
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