Reactive Arthritis
Reactive arthritis is a group of sterile arthritides that occur following infection in specific parts of the body, such as the intestines or genitourinary tract, and are associated with an abnormal immune response. Symptoms do not necessarily occur at the same time as the primary illness, and the joint changes are not caused by direct invasion by the pathogen. In general, reactive arthritis does not cause bone erosion in the joints or leave residual effects. In 1981, the American College of Rheumatology defined reactive arthritis as arthritis persisting for more than one month after urethritis or cervicitis. In 1982, Goldsmith-Long reported transient arthritis in children following an upper respiratory tract streptococcal infection. This is now known as poststreptococcal reactive arthritis (PSRA). As suggested by Ahvonen, reactive arthritis is defined as sterile arthritis caused by a microbial infection. In Europe and the United States, the term also currently includes incomplete forms of Reiter syndrome. In traditional Chinese medicine, all of these disease types fall within the category of “Bi syndrome.”
TCM Pattern Identification and Medication Reference
|Common Symptoms
Clinical description:
Severe joint swelling and pain, aversion to cold and preference for warmth, loose stools, copious clear urine or frequent urination, a pale, enlarged tongue with a white, greasy coating, and a wiry, tight or deep-wiry pulse.
In plain language:
- The joints may swell and become very painful, especially with movement or pressure.
- You may feel cold easily, with discomfort worsening in cold conditions and improving with warmth.
- Stools may be loose, soft, and poorly formed.
- Urine may be pale and plentiful, with longer-lasting urination, or you may urinate more often.
- The tongue may appear pale and enlarged when extended.
- The tongue coating may appear white and greasy, making the surface look coated.
- On pulse examination, the pulse may feel taut and tight, like a drawn string, or wiry when palpated more deeply.
|Treatment Approach
Clinical description:
Warm the channels, dispel cold, eliminate dampness, and unblock the collaterals to relieve pain.
In plain language:
- Warm the channels → Warm the channels and dispel cold from the network pathways, helping ease stiffness and cold-related pain.
- Dispel cold → Disperse cold affecting the body or a particular area, easing discomfort that worsens with cold and improves with warmth.
- Eliminate dampness → Transform excess dampness in the body, helping ease heaviness, a sticky sensation, swelling, and a feeling of heaviness in the joints.
- Unblock the collaterals (written as “relieve pain in the collaterals” in your text) → Promote the flow of qi and blood through the channels and collaterals, helping improve numbness, pulling pain, and restricted movement.
|Related Products
The following products are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
|Common Symptoms
Clinical description:
Red, swollen, hot, painful joints; sticky stools or constipation; dark yellow urine; a red tongue with a yellow, greasy coating; and a wiry, rapid or fine, hurried pulse.
In plain language:
- The joints may become red and swollen, feel hot, and be noticeably painful; they may feel warm to the touch.
- Stools may be sticky and difficult to pass, or hard and dry.
- Urine may appear yellow or dark yellow, darker than usual.
- The tongue may appear red, with a yellow, greasy coating.
- On pulse examination, the pulse may feel taut and faster than usual, or fine and somewhat hurried.
|Treatment Approach
Clinical description:
Clear heat, drain dampness, regulate the channels, and unblock the collaterals.
In plain language:
- Clear heat → Reduce internal heat, helping ease redness, swelling, burning sensations, thirst, sore throat, and restlessness.
- Drain dampness → Promote the elimination of dampness, helping ease heaviness, stickiness, swelling, discharge, and difficulty urinating.
- Regulate the channels → Relax the sinews and channels and ease tightness and spasms, helping improve joint and muscle flexibility.
- Unblock the collaterals → Promote flow through the channels, collaterals, and microcirculation, helping ease numbness, aching and distension, and restricted movement.
|Related Products
The following products are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
|Common Symptoms
Clinical description:
Dull joint pain, fatigue, aversion to cold and preference for warmth, loose stools or diarrhea, undigested food in the stool, a pale, dull tongue with a thin white or moist coating, and a fine-wiry, deep, or slow pulse.
In plain language:
- The joints may ache dully and feel uncomfortable with movement.
- You may feel fatigued and have less energy for everyday activities.
- You may feel cold easily, with discomfort worsening in cold conditions and improving with warmth.
- Stools may be loose and more frequent, with a tendency toward diarrhea.
- Undigested food may be visible in the stool.
- The tongue may look pale and somewhat dusky rather than bright red.
- The tongue coating may be thin and white, or the tongue surface may look moist and shiny.
- On pulse examination, the pulse may feel fine and wiry, deep and easier to feel with firmer pressure, or relatively slow.
|Treatment Approach
Clinical description:
Warm and tonify the spleen and kidney, warm the channels, unblock the collaterals, dispel cold, and eliminate dampness.
In plain language:
- Warm and tonify the spleen and kidney → Warm and support spleen and kidney yang, supporting the generation and transformation of qi, blood, and fluids, and easing poor appetite, loose stools, aversion to cold, fatigue, soreness and weakness of the lower back and knees, and excess fluid retention.
- Warm the channels → Warm the channels and dispel cold, helping ease tightness, stiffness, and cold-related pain.
- Unblock the collaterals → Promote flow through the collaterals and microcirculation, helping ease numbness, pulling pain, and restricted movement.
- Dispel cold → Disperse cold affecting the body or a particular area, easing discomfort that worsens with cold and improves with warmth.
- Eliminate dampness → Transform accumulated dampness and support fluid metabolism, helping ease heaviness, stickiness, swelling, and a feeling of heaviness in the joints.
|Related Products
The following products are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
|Common Symptoms
Clinical description:
Dull joint pain and a localized burning sensation, constipation, dark yellow urine, a red tongue with a scant coating, and a fine, rapid or fine-wiry pulse.
In plain language:
- The joints may ache dully and feel locally hot or burning.
- Stools may be hard and difficult to pass.
- Urine may appear yellow or dark yellow, darker than usual.
- The tongue may look red, with a scant coating.
- On pulse examination, the pulse may feel fine and rapid, or fine and wiry.
|Treatment Approach
Clinical description:
Nourish and tonify the liver and kidney, and invigorate blood and unblock the collaterals.
In plain language:
- Nourish and tonify the liver and kidney → Nourish the liver and kidney essence, blood, yin, and yang, helping address soreness and weakness in the lower back and knees, dizziness, tinnitus, and fatigue, and support stamina and recovery.
- Invigorate blood → Promote blood circulation and resolve stasis, helping ease swelling, stabbing pain, and stiffness.
- Unblock the collaterals → Promote flow through the channels, collaterals, and microcirculation, helping improve numbness, pulling pain, and restricted movement.
|Related Products
The following products are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.
References
- Li Zhanguo, Tang Fulin, trans. Kelley’s Textbook of Rheumatology [M]. 8th ed. Beijing: Peking University Medical Press, 2011: 1266-1271.
- Su Zhetan. Reactive arthritis [J]. Chinese Journal of Rheumatology, 2011, 5(2): 49-51.
- Shigeto Kobayashi. Reactive arthritis—recent advances [J]. Journal of the Japanese Society of Internal Medicine, 1998, 87: 1388-1394.
- Guan Xuntian, Huang Ruxun, Deng Wenying, et al. Dictionary of Medical Syndromes [M]. Guangzhou: Science Popularization Press, Guangzhou Branch, 1980: 362-363.
- Schumacher HR. Reactive arthritis [J]. Rheum Dis Clin North Am, 1998, 24: 261-273.
- Jansen TL, Janssen M, de Jong AJ, et al. Poststreptococcal reactive arthritis: a clinical and serological description, revealing its distinction from acute rheumatic fever [J]. J Intern Med, 1999, 245: 261-267.
- Aviles RJ, Ramakrishna C, Mohr DN, et al. Poststreptococcal reactive arthritis in adults: a case series [J]. Mayo Clin Proc, 2000, 75: 144-147.
- Flagg SD, Meador R, Hsia E, et al. Decreased pain and synovial inflammation after etanercept therapy in patients with reactive and undifferentiated arthritis: An open-label trial [J]. Arthritis Rheum, 2005, 53: 613-617.
- Wen Chengping, Wang Meijiao, Sun Jing, et al. Meta-analysis of Yishen Juanbi Wan for the treatment of ankylosing spondylitis [J]. Chinese Archives of Traditional Chinese Medicine, 2012, 30(5): 947-949.
- Xu Fengquan, Feng Xinghua. Aconite seed poisoning and its safe use [J]. Adverse Drug Reactions Journal, 2008, 10(12): 426-428.
- Lu Zhongqiu, Hu Guoxin. Current status of research on acute aconitine poisoning, diagnosis, and treatment [J]. Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care, 2005, 12(3): 119-121.