Which Specialist to See for Suspected Reactive Arthritis?

If reactive arthritis is suspected, which specialty should be consulted first?

Recently, I have been experiencing pain in multiple joints, and rehabilitation has been ineffective.
Therefore, I went to the rheumatology department for an examination.
The doctor said the test results were normal and that there is no issue with my immune system.
The doctor asked if I frequently experience urinary tract infections, to which I replied yes.
I have had recurrent vaginal infections (itching) for many years, but after giving birth, it seemed to normalize as long as I drank enough water.
However, four years after giving birth, vaginal infections have started to recur.
Drinking water is no longer effective, and I need to take a course of antibiotics almost every month.
Recently, not only have the vaginal infections returned, but I also have developed urethritis.
Even after completing a 10-day course of antibiotics, I still experience frequent urination, with a constant urge to urinate and a feeling of incomplete bladder emptying.
I visited a urology clinic, and the results showed no signs of inflammation.
The doctor prescribed medication for overactive bladder, but it hasn't been effective.
The rheumatologist suspects that my recurrent urinary tract infections may be triggering arthritis.
Currently, the rheumatologist has prescribed a 14-day course of enteric-coated salazopyrin, sulfasalazine, and celecoxib.
On the first day, I felt some relief, but on the second day, the pain in my left shoulder seemed to return.
The pain persists in my left hand's index finger, right hand's little finger, and the second toe of my right foot, all at the joints closest to the nails.
There has been slight relief, but there is still limited bending and less stiffness.
The pain in my left ankle has not improved.
Should I see a urologist or a gynecologist for further examination, or should I continue taking the medications from the rheumatologist for a while before deciding on the next steps?

pony, 40~49 year old female. Ask Date: 2023/11/01

Dr. Chen Bingze reply Surgery

This is indeed quite special.
A rheumatologist is specialized in treating complex cases.
I recommend continuing to take the rheumatology medications for a while to see how they work and if there is any improvement.

Reply Date: 2023/11/01

More Info

When dealing with suspected reactive arthritis, especially in the context of recurrent urinary tract infections (UTIs) and joint pain, it is crucial to approach the situation methodically. Reactive arthritis is often triggered by an infection elsewhere in the body, commonly in the urogenital or gastrointestinal tract. Given your history of recurrent vaginal infections and the recent onset of joint pain, it is reasonable to consider the interplay between these conditions.

Understanding Reactive Arthritis
Reactive arthritis is characterized by joint inflammation that occurs following an infection, typically in the urinary or gastrointestinal systems. Symptoms may include joint pain, swelling, and stiffness, often affecting the knees, ankles, and feet. In your case, the joint pain in your fingers and toes, along with the history of UTIs, aligns with this condition.

Specialist Consultation
1. Rheumatologist: Since you have already consulted with an immunologist/rheumatologist, this is a good first step. They can evaluate your joint symptoms and determine if they are indeed related to reactive arthritis or another form of inflammatory arthritis. They may also perform blood tests to check for markers of inflammation and other autoimmune conditions.

2. Urologist: Given your recurrent urinary infections, it would be prudent to consult a urologist. They can assess whether there are underlying issues contributing to your recurrent UTIs, such as anatomical abnormalities or chronic infections that may be exacerbating your joint symptoms. A thorough evaluation may include urine cultures, imaging studies, or cystoscopy if necessary.

3. Gynecologist: If your vaginal infections are recurrent and not responding to treatment, a gynecologist can provide insights into potential underlying causes, such as hormonal changes, irritants, or other gynecological conditions. They can also help manage any ongoing symptoms related to vaginal health.

Treatment Considerations
You mentioned that the medications prescribed by your rheumatologist provided some initial relief but that the pain returned. It is essential to communicate this to your doctor, as they may need to adjust your treatment plan. Here are some considerations:
- Medication Adjustment: If the current regimen is not providing adequate relief, your rheumatologist may consider alternative medications or therapies. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first line of treatment for reactive arthritis, but if these are ineffective, disease-modifying antirheumatic drugs (DMARDs) or corticosteroids may be considered.

- Physical Therapy: Engaging in physical therapy can help improve joint function and reduce stiffness. A physical therapist can design a tailored exercise program that accommodates your pain levels and promotes mobility.

- Monitoring Symptoms: Keep a detailed log of your symptoms, including the severity of joint pain, any patterns related to your urinary symptoms, and the effectiveness of medications. This information will be valuable for your healthcare providers in making informed decisions about your treatment.

Conclusion
In summary, it would be beneficial to continue following up with your rheumatologist while also seeking consultations with a urologist and possibly a gynecologist. This multidisciplinary approach will help address both the joint pain and the recurrent infections, leading to a more comprehensive treatment plan. It is essential to communicate openly with your healthcare providers about your symptoms and treatment responses to ensure the best possible outcomes.

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