This reactive arthritis is an
- Immune mediated syndrome
- Characterised by a triad of arthritis urethritis and conjunctivitis
- Post an infection (a couple of days to weeks prior to presentation) usually the gastrointestinal infection (caused by Salmonella, Shigella, Campylobacter, Yersinia or Chlamydia etc) or genitourinary (Chlamydia Trachomatis, Neisseria Gonorrhoea, Mycoplasma Hominis, and Ureaplasma Urealyticum etc)
- Where the response to infection causes an aberrant autoimmune response by triggering autoantibodies to self-antigens following molecular mimicry.
A majority of these patients may be HLA b-27 positive; however, it is not used to diagnose the cases.
There may be a positive F/H/O ankylosing spondylitis or psoriasis.
Found very commonly in HIV patients, the patient presenting with new onset disease should be screened for HIV. Such patients may also have psoriasiform lesions on body.
Predominantly affects males.
Arthritis is characterised by asymmetrical involvement of weight bearing joints with night agg and morning stiffness. Chronic course may present as monoarthritis, heel pains or Achillies tendinitis.
Eye symptoms involve conjunctivitis or iritis with injection of ciliary vessels around cornea. Uveitis involves acute pain, photophobia, visual impairment, scleral injection, and hypopyon
Urethritis is characterised by dysuria, or a mucoid thread discharge just before urination. Occasionally haematuria may be there, prostatitis.
Skin may be involved with- mucosal ulcers, keratoderma blennorrhagica, circinate balanitis and erythema nodosum. There may plaque like lesions with hyperkeratosis, associated with severe nail dystrophy and subungual hyperkeratosis, nail pits.
Cardiac- carditis, aortic, conduction and valvular abnormalities
Geographic tongue
Sacroiliitis.
There may be systemic disturbances like fever, weight loss etc.
After understanding the diagnostic sphere let us now understand the closeness of this symptom constellation with SARSAPARILLA.
- Rheumatism after gonorrhoea
(Compare medicines for
Other medicines for above rubric include MEDORRHINUM, PULSATILLA, THUJA, CLEMATIS etc.
Rheumatism after diarrhoea– CIMICIFUGA, DULCAMARA, IODUM, KALI BICHROMICUM.
The above highlighted rubrics become the backbone of remedy selection in reactive arthritis.
These medicines may not cover the complete constellation but may be indicated remedies depending on presentation.)
(Since causation and past history is very important in this disease diagnosis other medicines to also consider are MEDORRHINUM, SEPIA and MERC SOL which come very close to SARSAPARILLA.)
- Urine- Severe pain before and while passing urine, pain in kidneys. Urine dribbles or passed in thin stream
- Crust sediment and shreddy urine
- Eruptions in groins and on genitals with offensive smell
- Eczema, crusta lactae or boils.
- Rhagades on fingers
- Itching pimply eruptions on body.
- Violent burning and agglutination of eyes in morning on awakening. Dimness of vision as if a gauze spread over eyes. Burning and stinging in eye with sensation of sand.
A prominent involvement of joints, genitourinary and skin along with eye symptoms makes this remedy a pathological simile of reactive arthritis.
NB: this similarity is found only while studying the medicine from a pathological point of view. The confirmation can only be done by applying this knowledge in such a clinical condition in a patient.
This kind of approach is especially helpful when:
- The patient is not able to give refined symptoms and sensations
- One is not able to find any characteristic symptom or
- The attendants are not able to give one,
- There is time constraint or
- The physician has not seen the patient but has received a diagnosis from attendants.
The results in such prescriptions would nonetheless depend on the accuracy of diagnosis and its pathological similarity to chosen medicine.
(This post is for the practitioners of Homoeopathy and not for patients for diagnosis and treatment of the said entity.)
References:
Boericke materia medica
Clark dictionary of materia medica
Phatak repertory
French diagnostic index
Harrison’s principles of internal medicine
Davidson’s Principles and practice of Medicine
Aude Sapere
Shivangi Jain
BHMS, MD, PGDMLE, PGDHHM
drshivangijain79@gmail.com
https://drshivangihomoeopathy.com/