Ask the Doctors August 2017 Issue

Reactive Arthritis & NSAIDs

Dr. Steven Maschke

Arthritis Advisor Editor-in-Chief Steven Maschke, MD, Department of Orthopaedic Surgery, Cleveland Clinic Orthopaedic & Rheumatologic Institute.

Q: I’ve been diagnosed with reactive arthritis. Is this a chronic condition or will it go away?

A: Many people don’t realize that there are over a 100 different types of arthritis. Reactive arthritis is a less common type. It occurs in some people after an infection with Chlamydia trachomatis, which is sexually transmitted and enters the bladder. It can also result from infection with bacteria that enter the gastrointestinal tract from contaminated food.

Most people who have these infections do not develop arthritis. It’s not entirely understood why some do. Men ages 20 to 50 are most susceptible, and genetics may play a role. 

Joint symptoms, which usually begin two to four weeks after infection, include pain, swelling and stiffness in the knees, ankles, toes and sometimes the fingers. Some people have low back pain or heel pain. Other symptoms include eye irritation and inflammation of the urethra, which can cause burning while urinating and the need to go frequently.

Early on, reactive arthritis is treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve®), diclofenac (Voltaren®), indomethacin (Indocin®) or celecoxib (Celebrex®), to relieve pain and reduce swelling. Some people benefit from injections of corticosteroids (powerful anti-inflammatory drugs). Exercise to strengthen muscles and improve flexibility is also recommended.

Most people fully recover, but it may take a few months to a year. Some people have long-term symptoms. If this happens, your doctor will probably prescribe a disease-modifying antirheumatic drug (DMARD), such as sulfasalazine or methotrexate. These are the drugs used for rheumatoid and other forms of arthritis. Stronger drugs called biologics also may be used.

Q: I’ve been taking Aleve® for my knee arthritis for several months. My doctor didn’t prescribe it. Should I be concerned about taking it long term?

A: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), which include naproxen (Aleve®) and ibuprofen (Advil®, Motrin®), can help relieve mild to moderate pain of osteoarthritis. While these pain medications are readily available without a prescription, you should definitely talk to your doctor.

First, you should be examined to make sure you have the right diagnosis. For knee osteoarthritis, your doctor will recommend a multipronged approach to treatment. The cornerstones of treatment are exercise and weight loss (if overweight). If you take an NSAID, your doctor will work with you to make the best choice. In addition to over-the-counter NSAIDs, there are prescription-strength ones. Whatever you take, use the lowest possible dose. This is because NSAIDs, like all drugs, can have side effects, especially when taken chronically.

NSAIDs can cause stomach problems, including ulcers. They can also cause kidney problems in people with compromised kidney function. As we age, our kidneys don’t function as well as they did when we were young. So your doctor will probably want to make sure you don’t have unrecognized kidney disease before recommending long-term use of NSAIDs. You should have blood tests periodically if you take NSAIDs for a long period of time. 

NSAIDs have also been linked to increased risk for heart disease. To reduce your risk, keep heart disease risk factors, such as high blood pressure, high cholesterol and diabetes, under control. This is an important reason you should get regular check-ups while taking NSAIDs, so your doctor can monitor you.


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