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Diagnosed with reactive arthritis. Prescribed Salazar. HLA B 27 positive. Sugestions

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Internal Medicine Specialist
Practicing since : 2005
Answered : 507 Questions
My daughter has been diagnosed of reactive arthritus after severe stomach infection .The doctor put her on Salazar on 28 XXXXXXX .There was no improvement , she has been put on Methotrixate 4weeks back, still there is no improvement. she has a swollen ankle , right foot toe ,hip joint, low back and shoulders pain , right hand knuckle and middle finger now it has moved on to left hand index finger . She is HLA B 27 positive . Five months of medicine has not shown improvement . My worry is has this been diagnosed correctly ? She has to take a lot of physical and mental stress due to her studies and practical work ( BDS) . How much time will it take to go into remission ? Can it change into any long term arthritus? Thanks Mrs XXXXXXX
Posted Sat, 1 Jun 2013 in General Health
Answered by Dr. Omer 3 hours later

Thanks for your question. My name is Dr Omer and I am here to help you today with your question. I will be happy to assist you with your follow up questions also. I am sorry to hear about your problem

As you have said that your daughter 20 years old , HLA B27 positive ,had multiple joints pain and swelling, started after stomach infection.

First of all i want to tell the mechanism of your child disease, that is, Reactive arthritis = reiters arthritis=ankylosing spondylitis=arthritis after stomach infection(YOA) , meaning yes she had stomach infection and got post infection arthritis wihich is more supported by HLA B27, as your daughter is positive for that, HLA B27 is hall XXXXXXX for young onset arthritis(YOA) starting/triggered most often by stomach bug.

Swelling of fingers happens in young onset arthritis(YOA)
Total treatment of YOA is 6 months with pain killers + methotrexate or salazar
IF above fails TNF-alpha treatment is available and is really effective, for cases like your daughter who are resistant to salazar or methotrexate

She has to take pain killers for long time.
Pain killers+YOA do damage the kidneys ,both of them, if pain killers are used more than 2 years continuously, so do check her urine protein + kidney function tests on monthly basis.

The prognosis of YOA is good , meaning it will go away spontaneously into remission in 2/3 patients(methotrexate,salazar or TNF alpha) , while rest have long term disease, with complications.
Your treating doctor is exactly following the international guidelines, so keep on following him , just discuss about TNF alpha + Joint aspiration if swelling occurs.

I wish you good luck that you get well soon, if you have any question, please ask because our discussion always remains open so you can always ask more till you are satisfied, You can click the smiley to rate the answer. You can come back here to ask anything even after you have rated the answer. I will be glad to assist you always.
Above answer was peer-reviewed by
Follow-up: Diagnosed with reactive arthritis. Prescribed Salazar. HLA B 27 positive. Sugestions 43 hours later
Thanks for the answer. I would like to ask you a few more questions. She has a swollen ankle for 5 months , could this lead to any joint damage ? Once this goes into remission what are the chances of re-occurrence ? What kind of an arthritis will it convert into over a period of time? She is doing dentistry ,will she be able to pursue her profession or will she need to change it? What is the difference between reactive arthritis and Ankylosing spondylitis? Can you let me know more about TN F blockers? Thanks for your kind help.
Answered by Dr. Omer 1 hour later

Spondyloarthritis is a family of arthritis, of which ankylosing spondylitis is the most common member. The other members are:

Reactive arthritis
Arthritis associated with psoriasis (psoriatic arthritis)
Arthritis associated with inflammatory bowel diseases
Ankylosing spondylitis

What is ankylosing spondylitis? — Ankylosing spondylitis is a disease that causes pain and stiffness in the back, neck, and hips. It begins with inflammation around the bones in the spine or in some joints. Later, it causes the bones in the spine to fuse together.

Postural abnormalities may become apparent with years of disease activity. Increasing flexion deformity of the neck, increased thoracic kyphosis(bending) and loss of normal lumbar lordosis(straightening) may lead to a stooped posture

Nonerosive and nondeforming involvement of a single joint (monoarthritis) or a few joints (oligoarthritis) are more typical than chronic arthritis joint destruction.

Patients with AS sometimes complain of considerable fatigue. The degree of fatigue is one of the parameters used to assess disease activity

As is associated with a higher risk for cardiovascular diseases.

Many patients with AS have restriction in chest expansion due to costovertebral rigidity (lower part of chest expansion)

Ileal and colonic(intestinal) mucosal ulcerations, which are almost always asymptomatic

Bone mineral density decreases in patients with AS in association with persistently active disease. Osteopenia or XXXXXXX osteoporosis may predispose to vertebral fracture.

For patients with axial disease who do not respond to NSAIDs we recommend an anti-TNF agent . Traditional nonbiologic DMARDs (eg, sulfasalazine, methotrexate, leflunomide, or penicillamine) are ineffective for those with axial disease.

What is Anti -TNF drug used for?
.• It is used to treat ankylosing spondylitis.

How does Anti -TNF drug work?
• It is an arthritis-changing drug. It lowers swelling and helps lower signs and protect joints from more harm.
• It helps lower GI (gastrointestinal) swelling and other signs.

How is Anti -TNF drug best taken?
• It is given as a shot into a vein over a period of time.

What are some side effects of Anti -TNF drug?
• Chance of getting an infection. Avoid people with infections, colds, or flu.
• Fever, chills, itching, hives, chest pain or pressure, or shortness of breath when drug is given.
• Headache.
• Belly pain.
• Upset stomach or throwing up. Many small meals, good mouth care, sucking hard, sugar-free candy, or chewing sugar-free gum may help.
• Loose stools.
• Cough.
• Harm to the liver may rarely happen.
• In fistula patients, an abscess may rarely happen.

What do I need to watch for when using Anti -TNF drug?
• Change in the health problem being treated. Is it better, worse, or about the same?
• You will need a TB (tuberculosis) test before starting this drug

Ankylosing spondylitis: I.V.: 5 mg/kg at 0, 2, and 6 weeks, followed by 5 mg/kg every 6 weeks thereafter
Prophylaxis of infusion reactions: Premedication with acetaminophen and diphenhydramine 90 minutes prior to infusion may be considered in all patients

Central nervous system: Headache (18%)

Gastrointestinal: Nausea (21%), diarrhea (12%), abdominal pain (12%, Crohn’s 26%)

Hepatic: ALT increased (risk increased with concomitant methotrexate)

Respiratory: Upper respiratory tract infection (32%), sinusitis (14%), cough (12%), pharyngitis (12%)


Stop smoking cigarettes. People who smoke and have ankylosing spondylitis can have problems with their breathing. Ankylosing spondylitis can limit the movement of the chest and reduce the amount of air the lungs can hold.

Maintain correct posture and participate in an exercise program.

Consuming an adequate amount of calcium and vitamin D can reduce the risk of bone loss (osteoporosis). Products that contain calcium and vitamin D include dairy products like milk, cheese, and yogurt or non-prescription calcium and vitamin D supplements.


What will my life be like? — Ankylosing spondylitis can make it hard to do simple things, such as getting dressed, getting up from a sitting position, and looking side to side. You might need help from family or friends.

Your condition puts you at risk of serious back injury. To reduce the chances that you will get hurt:

Remove loose rugs, electrical cords, and any clutter that could make you trip.
Do not drink a lot of alcohol or take sleeping pills.
Avoid sports or activities that might cause injury.
Always wear a seatbelt while riding in a car.
Take care,
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