Brief Answer:
Reactive arthritis, Viral arthritis

Detailed Answer:
Hello,
I am Dr. Shuba XXXXXXX and will be answering your query today.

I am sorry that your wife is going through this.
Would you please clarify a few things for me?

1) Did your wife have any signs or a cold (even mild) in the last two weeks of february? Any diarrhea, urinary /genital infection, eye infections that month?

2) does she currently have any of the above mentioned symptoms, rashes anywhere (specifically hands & soles)?

3) why was the partial knee replacement surgery done? Any evidence of rheumatoid arthritis? or other autoimmune disease?

4) does she have any inflammation, swelling, fluid collection in the affected knee?

5) have any diagnostic tests been performed for the current condition ?(x ray, ultrasound scan, blood tests?)

Based on the sequence of events and her symptom of pain I would like to primarily rule out
1) REACTIVE ARTHRITIS:
This type of arthritis occurs in response to an infective/inflammatory process elsewhere in the body (sometimes very subtle) and not due to a direct knee affectation.
It could also occur after a vaccine. symptoms appear suddenly or after a couple of days. Vaccines have antigenic bacterial /viral particles that elicit an immune response from the body resulting in the formation of antibodies that helps prevent more serious disease.
These antigens can provoke a hyper response in certain individuals(especially those predisposed with autoimmune diseases).
In certain others, the antigenic particles directly go and seat themselves on areas of the body that already have some inflammation (like a knee joint , in your wife's case). causing an accelerated immune & inflammatory response.

2) VIRAL ARTHRITIS:
This is a more common side effect after a viral infection (even minor) or vaccination against a virus (hepatitis virus, parvovirus, for instance).

I would do a physical exam, have an ultrasound/x-ray of the joint, look for signs of infection in other organ systems. I would also run some blood test to check for auto immune/inflammatory and infectious processes (ESR, CRP, Rhematoid factor, Anti-CCP antibody, complete blood count, renal function tests)
Based on my findings, I would start her on anti- inflammatory medications (indomethacin/celecoxib/diclofenac), and supportive therapy

PROGNOSIS:

Reactive arthritis - This condition usually resolves completely in 6 months (rarely longer, commonly sooner) and will need long term treatment. Symptoms severity may fluctuate during this time. Anti inflammatory medications (NSAIDs-non steroidal anti inflammatory drugs), ice pack/hot packs to reduce pain and inflammation, respectively, Fluid aspiration from the joint (if present), low dose steroids (if indicated) are the mainstay of treatment.
DMARDs -Disease modifying anti-rheumatic drugs may be require if no relief is found with the above measures.
The sooner the treatment starts. the better to avoid joint damage

Viral arthritis- lasts for a few days to weeks (4-6). and will have good prognosis with NSAIDs, ice/hot packs. This may rarely result in a Reactive arthritis.

I came across an article , in which a 24 year old male developed ankle joint swelling , two days after a tetanus toxoid vaccine. He showed complete resolution and was back to normal in 6 weeks of treatment.

I wish I could be of more help. please let me know if I can.
I hope this information helps.
If you do not have further queries, please close this discussion and rate my answer.
Wish you both good health
Regards,
Dr. Shuba XXXXXXX

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Brief Answer:
Immediate treatment as for an acute arthritis

Detailed Answer:
Hello,
Thank you for the follow up.

Reactive arthritis after a vaccine is rare.

Irrespective of the cause, the joint pain, inflammation & other associated problems, if any, should be treated appropriately to prevent damage.

I would:
- assess her overall conditions & rule out infection (urinary, genital, respiratory, gastrointestinal, eye) & inflammatory processes (autoimmune disorders-rheumatoid, inflammatory bowel disease)

-assess the affected knee by physical exam & imaging (ultrasound/MRI)

-start her intensive anti inflammatory therapy with frequent monitoring to check for response. If abnormal fluid is present within the joint, I would aspirate & test it to see for possible markers of infection /inflammation.

- physiotherapy once the acute phase (can last for a few weeks) is over or even before depending on the improvement. Ice packs help to relief pain. Heat packs help to improve blood flow to promote healing (heat pack first, anti inflammatory gels, then ice pack after 1hour-repeat twice to thrice a day.)

-suggest that you take it one day at a time. I can understand how frustrating & anxious you both may be in addition to the pain & disability she experiences. I'm sorry this is happening.

In any case treatment strategy should be based on the current problem (with trigger factors is mind) & not only the causative factor. Although it may take time, there is light at the end of the tunnel. Complete recovery is possible.

Answers to my previous questions could help to identify any other associated problem (which may be masked by the current pain symptoms).

Hope I've helped. Please let me know if you have further questions. If not, please close this discussion & rate my answer.

Hope she feels better soon.
Regards,
Dr. Shuba Hariprasad

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Brief Answer:
Treat Irrespective of cause.

Detailed Answer:
Hello,
Did her doctor say what he felt was causing her pain?
Irrespective of whether the cause is agreed upon or not, the symptoms should be treated and the joint assessed.

Right now it's best to approach the problem as a new issue. If there was no history of vaccination, what would be the cause of pain and how would we proceed (mentioned in my previous replies)?

Insist on addressing the current problem. Assess joint for post operative complications. If no complications, assess for other sources of inflammation.
In any case,her pain should be treated. The important this is to improve quality of life & prevent joint damage.
Talk to her current doctor about options, discuss about possible scenarios and request for treatment to he very real symptoms.
If you find that this is not being offered or dealt with adequately, you may want to seek a second opinion.

I hope you find help. Talking & discussing with her doctor helps & is has an advantage that he already knows her medical history & has her best interest in mind.

Hope I've helped.
Please let me if there is anything else I could help you with. If not, please close this discussion & rate my answer.
Wish you both good health

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