Treatment Options for Reiter's Syndrome: Common Concerns and Questions

Treatment for Listeriosis

Dear Dr.
Gao,
I previously consulted with you, and I appreciate your professionalism! I have been seeing a specialist (who answered my questions vaguely), and I have been taking Celebrex for almost three months, one capsule in the morning and one in the evening.
Additionally, I have only taken two capsules of Humira in the past three months.
I have read many articles online over the past month, but I still have many uncertainties, so I would like to ask you a few questions.
1.
My condition has not improved over the past three months.
Should I increase my medication dosage or switch to another medication?
2.
I had extensive blood tests and X-rays done before starting medication and again after 20 days, but the doctor said everything was normal (except for B27).
Can the presence of inflammation in the blood during an acute episode determine if I have ankylosing spondylitis?
3.
I read online that there is a possibility of developing "circinate balanitis." If balanitis occurs, does that mean the source of infection is a sexually transmitted disease?
4.
Ten days before the onset of symptoms, I experienced a single episode of severe diarrhea (I held it for over an hour before going).
The stool was dark green and had a strange odor, but there were no other symptoms (like fever).
Could this be caused by Salmonella?
5.
If ankylosing spondylitis relapses, could I experience urethritis, eye inflammation, or other symptoms (such as circinate balanitis, oral lesions, or keratosis on hands and feet), or would it only present with joint inflammation?
6.
If I only take Celebrex and do not take any other analgesics, will it affect my recovery?
I apologize for the numerous questions, but these issues have been troubling me for a long time, and I have researched extensively.
I truly appreciate your response amidst your busy schedule!

Zhang, 30~39 year old female. Ask Date: 2017/09/04

Dr. Gao Jiankai reply Internal Medicine

Dear Mr.
Chang,
Thank you for your email.
I would like to respond to your questions as follows:
1.
If your attending physician believes you have Reiter's syndrome and your condition does not improve after a period of medication, I think it would be appropriate to adjust your medication.
Generally, the standard dosage of Sulfasalazine is 500 mg, and for an average-sized male, this medication can be taken at two tablets in the morning and two in the evening.
Your physician may have specific considerations, so I recommend discussing this further with him.
2.
The diagnosis of Reiter's syndrome largely depends on clinical symptoms rather than solely on blood tests.
Therefore, the initial physician you consulted may have the best understanding of whether you have Reiter's syndrome.
3.
Urological symptoms can also occur in patients with Reiter's syndrome due to gastrointestinal symptoms, which may explain the occurrence of balanitis.
Thus, not every case of balanitis is caused by a sexually transmitted infection.
4.
Salmonella gastroenteritis typically presents with fever, and besides Salmonella, other intestinal bacteria can also lead to Reiter's syndrome.
5.
Urethritis and conjunctivitis are usually early symptoms of Reiter's syndrome.
After treatment, inflammation of the urethra and eyes tends to decrease, while arthritis may have a longer duration.
Patients followed up in the outpatient clinic often only experience intermittent episodes of arthritis, with fewer symptoms outside of the joints.
6.
Sulfasalazine is the primary treatment.
If there is no joint pain, there is no need to take anti-inflammatory pain relievers, so not taking pain medication will not affect recovery.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, is concerned about your health.

Reply Date: 2017/09/04

More Info

Reiter's syndrome, also known as reactive arthritis, is a condition characterized by joint inflammation that occurs in response to an infection elsewhere in the body. It is often associated with urethritis, conjunctivitis, and arthritis. Understanding treatment options and addressing common concerns is crucial for managing this condition effectively.

1. Medication Adjustment: If you have been on medication (such as Celebrex, which is a nonsteroidal anti-inflammatory drug) for three months without improvement, it is essential to discuss this with your healthcare provider. They may consider adjusting your dosage or switching to a different medication. The effectiveness of treatment can vary significantly among individuals, and sometimes a combination of therapies may be necessary to achieve better control of symptoms.

2. Blood Tests and Diagnosis: The presence of HLA-B27 is a genetic marker often associated with spondyloarthritis, including Reiter's syndrome. However, its presence alone does not confirm the diagnosis. Blood tests can indicate inflammation (elevated ESR or CRP levels), but normal results do not rule out the condition. It is important to correlate clinical symptoms with laboratory findings. If you suspect an active infection, further evaluation may be warranted.

3. Circinate Balanitis: Circinate balanitis is a condition that can occur in Reiter's syndrome, characterized by inflammation of the glans penis. While it can be associated with sexually transmitted infections, it is not exclusively a sign of infection. If you experience symptoms of balanitis, it is advisable to consult a healthcare provider for appropriate evaluation and management.

4. Gastrointestinal Symptoms: The occurrence of diarrhea, especially if it was severe and accompanied by unusual stool characteristics, could be related to an infection. Salmonella and other gastrointestinal pathogens can cause such symptoms. If you suspect a gastrointestinal infection, it is important to seek medical advice, as this may require specific treatment.

5. Recurrence of Symptoms: Reiter's syndrome can indeed recur, and symptoms may vary with each episode. While joint inflammation is the hallmark, other manifestations such as urethritis and conjunctivitis can also occur. It is essential to monitor for any new symptoms and report them to your healthcare provider, as this can guide further management.

6. Impact of Medication Choices: If you choose to take only Celebrex and avoid other pain medications, it may affect your overall comfort and recovery. Pain management is an integral part of treating inflammatory conditions. Discussing your pain management strategy with your healthcare provider is important to ensure that you are adequately addressing your symptoms.

In conclusion, managing Reiter's syndrome requires a comprehensive approach that includes medication management, monitoring for symptoms, and addressing any potential infections. Open communication with your healthcare provider is key to finding the most effective treatment plan tailored to your needs. If you have ongoing concerns or feel that your treatment is not effective, do not hesitate to seek a second opinion or further evaluation from a specialist in rheumatology or infectious diseases.

Similar Q&A

Understanding Varicose Veins: Treatment Options and Risks Explained

Dear Dr. Ding, I recently discovered that my mother has been suffering from a long-standing issue with her legs, which seems to be varicose veins. I would like to ask you some questions regarding treatment options: 1. What are the common treatment methods available? 2. Is the t...

Dr. Ding Zhizhong reply Cardiology
Hello, Qingru: 1. There are various options available, ranging from conservative treatments (such as compression stockings, elevating the legs, and avoiding prolonged standing) to more aggressive treatments (including traditional surgery, laser therapy, radiofrequency ablation, ...

Understanding Retinal Proliferation: Concerns and Treatment Options

Hello Dr. Wang, my mother has been experiencing frequent falls while walking and has always felt that her vision is poor. Last week, she sought medical attention due to redness and swelling in her eyes, and during a vision check, it was found that her corrected vision in the righ...

Dr. Wang Zhangji reply Ophthalmology
Hello: Proliferative retinopathy is more commonly seen in patients with diabetes. Fluorescein angiography is not a surgical procedure; it is a diagnostic test that uses a contrast agent. Although there is a potential for serious side effects, the likelihood is very low. Retinal d...

Understanding Treatment Options for Macular Edema: A Patient's Guide

Hello, doctor. I would like to ask a few questions. I have noticed dark spots in my vision and visited a clinic where an optical coherence tomography (OCT) scan revealed signs of edema. The doctor did not diagnose me with macular degeneration but indicated that there is edema bas...

Dr. He Jianxian reply Ophthalmology
Hello, sir: If there is a suspicion of macular edema, it is recommended to first perform fluorescein angiography. If significant leakage points are found at a certain distance from the macula, direct laser treatment can be very effective and does not incur additional costs. If la...

Understanding Retinal Laser Treatment for High Myopia and Related Concerns

Hello Dr. Gao, I have high myopia of -9.00 and -10.00 diopters, along with floaters and some flashes of light. Recently, I underwent a follow-up examination for retinal holes and was diagnosed with lattice degeneration and some small holes in the peripheral retina. The doctor no...

Dr. Gao Pilin reply Ophthalmology
Hello Sandy: 1. The probability is low. 2. The hole will self-repair, which may result in pigmented scars; this is a normal phenomenon. In Taiwan, the Department of Ophthalmology at Puzi Hospital is open on Monday, Tuesday, Thursday, and Friday mornings from 8:00 AM to 12:00 PM, ...