Ask the Doctors June 2003 Issue

Ask Dr. Marks: 06/03

What is “reactive” arthritis? What causes it? The symptoms? How is it treated?

The term “reactive” arthritis usually pertains to a group of inflammatory diseases that are triggered by an infectious agent. The most important disease in this group is Reiter's syndrome. The triggering agents are usually Salmonella or Shigella organisms. The organism does not infect the joint but triggers an immune response which causes inflammation of the joint. The syndrome can involve any joint but most commonly affects the knee. Reiter's syndrome also causes irritation of the eye and inflammation of the urethral genital system. Like most inflammatory arthritis, the symptoms are pain and swelling of the joint. Reactive arthritis is treated with anti-inflammatory medications.

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I understand that rheumatoid arthritis can vary in its course. Can you give me some idea of what to expect from the disease? Does rheumatoid arthritis ever just go away?

The clinical course of rheumatoid arthritis can be quite variable. Five percent of people with rheumatoid arthritis go into early remission. Ninety-five percent of rheumatoid arthritis patients will show progressive signs and symptoms. Active progressive rheumatoid arthritis can last in some patients for as long as 25 years and then burn out. Approximately half of the people will have this type of rheumatoid arthritis and will be left with a degree of joint problems. The remaining 50 percent will have classic progressive rheumatoid arthritis. As we have mentioned before in this column, today’s newer medications have been quite valuable in controlling this disease.

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I've heard that gold can work in the treatment of arthritis. How does it work? How is it given? Is it expensive?

Gold has been used since the 1960s for the treatment of rheumatoid arthritis. It can be given either orally or by injection. It has multiple effects on the immune system. By altering the immune system, the inflammation of the joints is decreased. At some point, gold therapy stops working. At five years after the onset of treatment, only 5 to 10 percent of patients receive benefit from gold therapy. The treatment is given for as long as 20 weeks. Gold therapy is prescribed less often now that newer and more effective drugs are available. Gold is no more expensive than other types of rheumatoid arthritis treatments.

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What is the difference between“NSAIDs” and "Coxibs"? How do they prevent pain?

A Coxib anti-inflammatory is a type of NSAID. Like a NSAID, it is effective in reducing inflammation and relieving pain. Coxib medications include Celebrex, Vioxx and Bextra. Their anti-inflammatory effect is thought to be no greater than the more common NSAID medications. They differ, however, in their side effects and are less likely to cause gastrointestinal irritation and possibly bleeding.