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--- home:diseases:reactive_arthritis [01.05.2019] – [Notes and comments] sallieq
+++ home:diseases:reactive_arthritis [01.15.2019] – [Notes and comments] sallieq
@@ Line 11: / Line 11: @@
-<blockquote>Nat Rev Rheumatol. 2011 Nov 22;8(1):55-9. doi: 10.1038/nrrheum.2011.173.
+<blockquote>
-Chlamydia-induced ReA: immune imbalances and persistent pathogens.
-Gracey E, Inman RD.
-Source
-Toronto Western Hospital, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada.
-Abstract
 Reactive arthritis (ReA), an inflammatory arthritic condition that is commonly associated with Chlamydia infections, represents a significant health burden, yet is poorly understood. The enigma of this disease is reflected in its problematic name and in its ill-defined pathogenesis. The existence of persistent pathogens in the arthritic joint is acknowledged, but their relevance remains elusive. Progress is being made in understanding the underlying mechanisms of ReA, whereby an imbalance between type 1 and type 2 immune responses seems to be critical in determining susceptibility to disease. Such an imbalance occurs prior to the initiation of an adaptive immune response, suggesting that innate cellular and molecular mechanisms in ReA should be prioritized as fruitful areas for investigation. (({{pubmed>long:22105240}}))
 </blockquote>
+Combination antibiotics for Chlamydia-induced arthritis: breakthrough to a cure?  (({{pubmed>long:20155826}}))
+Editorial
+Reactive arthritis (ReA) and its association with an extra-articular bacterial infection have first been described almost a century ago. From the view of the entry site of the pathogen, there is a post-urethritic and a post-dysenteric ReA form mainly caused by Chlamydia trachomatis and Enterobacteria (such as Yersinia, Salmonella, or Shigella), respectively. In addition, numerous other but less frequent organisms have been implicated in ReA, including Chlamydophila pneumoniae causing respiratory tract infections at the primary site.
-Arthritis Rheum. 2010 May;62(5):1203-7.
+In order to cause ReA, a pathogen must be specifically equipped, i.e. it needs to be an obligate or facultative intracellular organism, travel from mucosal surfaces to the joint, modify its metabolic state in order to evade the host defense mechanism, and survive as a persistent agent. Given all this, Chlamydia trachomatis is the best studied pathogen. This is also because epidemiological work has established this pathogen as the most common organism leading to ReA in the course of a urogenital infection.
-Combination antibiotics for Chlamydia-induced arthritis: breakthrough to a cure?(({{pubmed>long:20155826}}))
-Rihl M, Kuipers JG, Köhler L, Zeidler H.
-Comment on:
-Arthritis Rheum. 2010 May;62(5):1298-307.
-Editorial
-Reactive arthritis (ReA) and its association with an extra-articular bacterial infection have first been described almost a century ago. From the view of the entry site of the pathogen, there is a post-urethritic and a post-dysenteric ReA form mainly caused by Chlamydia trachomatis and Enterobacteria (such as Yersinia, Salmonella, or Shigella), respectively. In addition, numerous other but less frequent organisms have been implicated in ReA, including Chlamydophila pneumoniae causing respiratory tract infections at the primary site (1).
-In order to cause ReA, a pathogen must be specifically equipped, i.e. it needs to be an obligate or facultative intracellular organism, travel from mucosal surfaces to the joint, modify its metabolic state in order to evade the host defense mechanism, and survive as a persistent agent. Given all this, Chlamydia trachomatis is the best studied pathogen. This is also because epidemiological work has established this pathogen as the most common organism leading to ReA in the course of a urogenital infection (2).
+"Combination antibiotics as a treatment for chronic Chlamydia-induced reactive arthritis."   (({{pubmed>long:20155838}}))
+BACKGROUND:: Chlamydia trachomatis (Ct) and Chlamydophila (Chlamydia) pneumoniae (Cpn) are known triggers of reactive arthritis (ReA). These chlamydial species exist in a persistent metabolically active infection state in the synovium suggesting that persistent chlamydiae may be susceptible to antimicrobial agents. The goal of this study was to investigate whether a six-month course of combination antibiotics is an effective therapy for patients with chronic Chlamydia-induced ReA.
-Jd, C., E. Lr, et al. (2010). "Combination antibiotics as a treatment for chronic Chlamydia-induced reactive arthritis." Arthritis Rheum.  (({{pubmed>long:20155838}}))
+METHODS:: This study was a 9-month, double-blind, triple-dummy prospective trial assessing a 6-month course of combination antibiotics as a treatment for Chlamydia-induced ReA. Eligible patients were age 18 to 70 years, fulfilled the European Spondyloarthropathy Study Group (ESSG) Criteria, and had disease duration equal to or longer than 6 months. Subjects had to be polymerase chain reaction (PCR)-positive for Ct or Cpn in order to be randomized to therapy; randomization was performed in a 1:1:1 fashion. Treatment was for 6 months; the 3 groups included doxycycline 100mg twice daily and rifampin 300mg daily, azithromycin 500mg daily x 5 days then twice weekly and rifampin 300mg daily, or matching placebos. The primary efficacy endpoint was to assess the number of responders in the combination antibiotic group vs. placebo at month 6 compared to baseline. Responders were defined as those subjects who improved 20% or more in at least 4 of 6 variables without worsening in any one variable.
-BACKGROUND:: Chlamydia trachomatis (Ct) and Chlamydophila (Chlamydia) pneumoniae (Cpn) are known triggers of reactive arthritis (ReA). These chlamydial species exist in a persistent metabolically active infection state in the synovium suggesting that persistent chlamydiae may be susceptible to antimicrobial agents. The goal of this study was to investigate whether a six-month course of combination antibiotics is an effective therapy for patients with chronic Chlamydia-induced ReA. METHODS:: This study was a 9-month, double-blind, triple-dummy prospective trial assessing a 6-month course of combination antibiotics as a treatment for Chlamydia-induced ReA. Eligible patients were age 18 to 70 years, fulfilled the European Spondyloarthropathy Study Group (ESSG) Criteria, and had disease duration equal to or longer than 6 months. Subjects had to be polymerase chain reaction (PCR)-positive for Ct or Cpn in order to be randomized to therapy; randomization was performed in a 1:1:1 fashion. Treatment was for 6 months; the 3 groups included doxycycline 100mg twice daily and rifampin 300mg daily, azithromycin 500mg daily x 5 days then twice weekly and rifampin 300mg daily, or matching placebos. The primary efficacy endpoint was to assess the number of responders in the combination antibiotic group vs. placebo at month 6 compared to baseline. Responders were defined as those subjects who improved 20% or more in at least 4 of 6 variables without worsening in any one variable. RESULTS:: 80 subjects were screened and 42 were randomized to treatment (27 to combination antibiotics and 15 to placebo). Subjects in each group had similar demographics and baseline characteristics. At month 6, 17/27 subjects (63%) randomized to combination antibiotics were responders compared to 3/15 (20%) on placebo (P-value = 0.01). Secondary efficacy endpoints showed similar results with significant improvement in the modified swollen joint count, tender joint count, physician global assessment (P-values 0.0007, 0.002, and 0.0009, respectively), and a trend with the erythrocyte sedimentation rate (P-value = 0.07) in those patients on combination antibiotics compared to placebo. 6/27 (22%) subjects on combination antibiotics experienced complete resolution of their symptoms whereas 0/15 subjects on placebo achieved this endpoint. There were significantly more subjects who became PCR negative at month 6 in the active therapy group than in the placebo group (P-Value = 0.03). Adverse events (AE's) were mild; there were no significant differences between the groups. CONCLUSION:: These data suggest that a 6-month course of combination antibiotics is an effective therapy for chronic Chlamydia-induced ReA.
+RESULTS:: 80 subjects were screened and 42 were randomized to treatment (27 to combination antibiotics and 15 to placebo). Subjects in each group had similar demographics and baseline characteristics. At month 6, 17/27 subjects (63%) randomized to combination antibiotics were responders compared to 3/15 (20%) on placebo (P-value = 0.01). Secondary efficacy endpoints showed similar results with significant improvement in the modified swollen joint count, tender joint count, physician global assessment (P-values 0.0007, 0.002, and 0.0009, respectively), and a trend with the erythrocyte sedimentation rate (P-value = 0.07) in those patients on combination antibiotics compared to placebo. 6/27 (22%) subjects on combination antibiotics experienced complete resolution of their symptoms whereas 0/15 subjects on placebo achieved this endpoint. There were significantly more subjects who became PCR negative at month 6 in the active therapy group than in the placebo group (P-Value = 0.03). Adverse events (AE's) were mild; there were no significant differences between the groups.
-===== Evidence of infectious cause =====
+CONCLUSION:: These data suggest that a 6-month course of combination antibiotics is an effective therapy for chronic Chlamydia-induced ReA.
-Sample PubMed cite(({{pubmed>long:18200565}}))
+===== Patient information =====
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-{{tag>disease incomplete}}
+{{tag>disease arrange}}
-<note>Dear MPKB Reader: You have arrived at one of the articles that has not yet completed the development and review process in the knowledge base. Some of the content here may be helpful, but please know that this page is not complete. There are about 400 articles in the KB, and this is one we are still working on. Thanks for your patience.</note>
 ===== Notes and comments =====
-possible content https://www.marshallprotocol.com/forum35/2852.html Peter (vda)
+My diagnosis was Reiter's Syndrome (10 yrs) was on methotrexate and cortizone,until i found Dr Browns protocol,now on arthrexin and sulphasalazine,My diet contains quite a lot of dairy,variety of breads rye and white,pastas and meat.
+Starting   BENICAR Q6HR  Mar 13th, 2005
+Have some pain in my back behind heart has been there for weeks at least also pain in centre of chest severity varies but has improved markedly since wearing noirs and avoiding sun and light,also changing diet,stopped sulpasalazine and mino 3 days ago,have not noticed any major change in level of pain.
+Day 9
+The pain in front of my chest has decreased about 40%,still got pain in the back on both sides of the spine(but decreased)seem to sweat easily,no headache,neck stiff and painful to turn(ok if i dont turn head) had some slight pain in right side of head,main knuckle on left hand has sharp pain when clenching fist,(middle finger,middle knuckle)knuckle on little finger right hand has some tenderness when pressed(this knuckle started to swell physically under the skin about 10 months ago)but has not been tender till now,still got some tenderness under left foot(ball of foot)was worse last week,knees are better,was very light headed yesterday almost passed out a couple of times,certainly fee something is happening(generally less pain this week,a lot due to diet change and body adjusting
+Day 15
+ AM  taking benicar 20mg every 2 hrs have been for approx 36hrs now,did not have a lot of pain last night,decreased considerably (50%) was reasonably comfortable today,but am beginning to get increase in pain in the left side of my neck,back is sore where my lungs are down both sides,but reduced,left middle finger ok now(no pain)knees ok,side of left foot and ball of foot tender (no improvement)lower back and left hip much better, spine pain much better,no headache,a little nausea,hands good,
+This dosing of benicar seens to have helped a lot
+Day 17
+ Had a very painful night last night,the pain in the left of my neck diminished about 80%,still had some pain on left side of neck just above collar bone but at rear of neck,had breathtaking pain on right side of neck at the base of my scull,could not lift my head had to lift my head physically with my hands,trying to lift my head without aiding the movement was unbearable could not even turn my head while in bed (quite a dilemma)ok if i did not move,the pain in my back (lung area)has improved some(40%)had some pain in my spine but insignificant compared to my neck,had some shooting pains in my left leg and left arm,my left shoulder has some pain,my knees are ok,my left foot was more painful underneath the ball (difficult to put weight on)the side of my left foot(half way along left side)quite painful 6/10,the front of my chest is stable,my left wrist had *severe*pain when i tried to pick up a plate with a chicken on it,had to take weight off could not hold plate,this has happened a few times since and i have to be careful what i do with this hand because it may give way,can not remember if i mentioned this before but when i clenched mr right before my little finger locked and did not want to straighten immediately(this is o,k now,my fatigue in my shoulders has improved a lot (50%)no head ache ,no nausea,did not sleep (vert little from exhaustion i think) ps i do not take any pain relief other than benicar at the moment.
+Day 19 I spoke too soon about the pain,it came back with a vengeance last night,did not sleep all  night,it is strange that most of my pain is on my left side,and this is the side which was first involved with my Reiter's syndrome,another member told me that carbs are bad if you have ankleosing/spondilosis which involves spinal pain,is this correct ??,i am  handling the pain at the moment but feel that my diet is exascerbating my condition,the way i am seesawing from mild to extreme pain sounds like what i read about in sun flares and eating sea food or high "D"  foods,but i am not to my knowledge guilty of either of these,i am starting to log my meals to see if i an see any connection,
+April
+The pain has decreased a lot,neck still quite sore(acute pain)am doing all i can to stabilise my condition,would like a "little" more improvement before i start minocin,i noted some where on the site that lime patients are treated slightly differently to other th1 patients,the reason  bring this up is because possibly 20 yrs ago i done a lot of horse riding,and after one outing in the bush ended up i the emergency DR surgery with my leg all red and infected
+Day 27
+ Had a fairly restless night,plenty of pain in the usual places,neck,back,left hip,left foot,chest,lower back,my left knee,my left foot is quite sore at the moment 6/10,my knee is about the same as my foot both are quite painful,my centre finger on my left hand has started to ache again,no nausea.no headache,no let up in pain,just keeps moving around(chest pain has improved greatly
+Day 29  BENICAR  20MG  Q2HR,  MINO 25MG  Q24HR
+had a lot of pain in my left foot and left knee saturday might ,they are both playing up quite a bit lately,but on the other hand i have had a lot of relief in my upper torso,far outweighs any pain in my foot or knee,the knee is at about 8/10 in the pain leval (very sharp pain in the front centre)my left foot is also very painfull to put weight on,the fire in my chest has gone out but the skin is still sensative to touch,still have some pain in my lungs,and neck (reduced)but this did get *very*painfull last night(sun)when i left mino 30hrs,left hip varies in intensity ,but i am sure if i left mino this would flare up
+$$$$$
+possible content https://www.marshallprotocol.com/forum35/2852.html Peter (vda) p5, 7 10, 12, 16-17BCC, 19, 22, 4 [**p__27__** no sign of reA at post-op (4 yrs on MP)]  29, __39__**Bold
+Text**,   8yr on MP by 2013 and weans off, after career as owner/mechanic of service station is peersuing detox of heavy metals
 REVISE

home/diseases/reactive_arthritis.txt · Last modified: 09.14.2022 by 127.0.0.1