Poststreptococcal Reactive Arthritis (Probably)

BLOG readers begged for Calvin and Hobbes …

At the moment I feel sleepy but almost good, after a feeling very miserable all morning, and sleeping most of the rest of the day.

My rheumatologist, Dr. Eranki referred me to an infectious disease specialist, Dr. Strampfer.

We discussed all sort of symptoms and possibilities. He fell for our typical joke of, “I’ve had this pain in my neck for 16 1/2 years,” almost recording that as a symptom.

The two front-runners are Poststreptococcal Reactive Arthritis (PSRA) and Rheumatic Fever. Although the diseases present slightly differently, there is still debate among some doctors as to whether they are indeed separate diseases, and not merely different manifestations of the same thing. Rheumatic Fever can lead to heart damage, which I don’t have, although I may get long-term antibiotic treatment if Rheumatic Fever is considered a probable diagnosis.

Poststreptococcal Reactive Arthritis, however, is fascinating, and perhaps a better match. I had one blood test in which my ASO was elevated, showing a past Group A beta-hemolytic streptococcal infection. One of the ways in which PSRA differentiates from Rheumatic Fever is that the joint pain in PSRA responds very poorly to normal anti-inflammatory drugs, like ibuprofen, which has, indeed, provided me nearly no relief. Another strike against Rheumatic Fever is the lack of Sydenham’s chorea symptoms—“rapid, uncoordinated jerking movements affecting primarily the face, feet and hands.” (Although I have been described as an uncoordinated jerk, that isn’t quite the same.)

Other possibilities include Human Parvovirus B19, but it seems not quite as likely. Likewise, my retest in a few more weeks for Lyme disease will be carried out, although we don’t find that as likely, either, it’s very important to diagnose as early as possible, as it can cause very serious long-term damage if untreated.

Today I am back on prednisone (a corticosteroid), for a longer-term treatment. It’s offered the first significant relief in about two weeks. I cannot express how wonderful it is to be able to stand and sit without being in serious pain while moving, nor just to be able to sit or lay down for a while without being able to get comfortable. I still limp quite a bit, but my stride has gotten longer than 6 inches, and each step isn’t accompanied by pain. The fever continues, albeit more intermittently, making this day 21 with a fever, blowing away whatever my childhood chicken pox fever record was. I have been very sleepy today, but I think it’s just my body catching up on rest after being in constant pain for nearly three weeks.

But … by the next morning (18 hours later), the prednisone has mostly worn off. The fingers in my left hand are almost impossible to move, and my stride is much shorter again. :: sigh :

5 Replies to “Poststreptococcal Reactive Arthritis (Probably)”

  1. I’m so glad you’re feeling some relief, and I will continue to pray for long-term relief for you!

    Oh, and I’m also glad to see that you found a suitable Calvin and Hobbes cartoon. 😉

  2. You are blessed with some wonderfully aggressive,inquisitive doctors there! So glad you are getting to the root of things finally and feeling somewhat better! Wonderful news!!!

    This, however, confirms my theory that Florida is the medical community black hole of the universe where they send all the uselss doctors who couldn’t make a viable diagnosis if a text book fell from the sky and landed open on the exact page they needed to put it all together. Yes, you went to Yale…yes, you interned at Johns-Hopkins…you finished your residency and the next step is Beverly Hills, Florida????? Huh?

  3. After hearing so many stories about Florida healthcare, I am inclined to agree with you. (Like the hospital that released my Dad after an accident (despite my Mom’s strongly expressed opinion that he should stay overnight), and only altered their opinion when he collapsed on the way out. (If I remember the details correctly.)

    I guess with an aging demographic they just figure they don’t have to be very skilled; most of their patients will go away “of natural causes” if they wait long enough.

  4. Something cute…I’m sitting here using the computer and I hear Doug in the background moving about, and then hear, ow! ow! ow!. I turn around to see what was going on and he is up on the elliptical. Yup…he’s moving about and thinks, sure, let’s see what I can do. It was quite funny! What a riot he is. Can’t wait for him to be well again!!!!! His humor and sarcasm is still there and that’s great.

    A side note…it’s quite strange how we’ve switched roles here. I tell him to suck it up and get some faith, but that hasn’t worked yet. LOL

  5. Today I am actually at work, thanks to the prednisone. This morning, while I was waiting for it to start working, I was at the computer, and Naomi asked, “Dad, do you have any appointments today?”

    When I told her I did not, she said, “Well, I think you should call and get one for today.” Apparently she has really enjoyed going with me on appointments, probably because of how everyone tells her how cute she is, or because she hopes to snag a pastry from the little food kiosk that’s on the ground floor of one of my doctor’s office building.

    I have another appointment tomorrow, a follow-up with Dr. Eranki, my rheumatologist, so NaNi will get to accompany me on that.

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