DEAR DR. DONOHUE: My right knee and the fingers on my right hand suddenly swelled and became painful. My family doctor didn’t know what I had and sent me to an arthritis specialist. He asked if I had been sick in the past month. I had. I had diarrhea for about one week. After a series of tests, he said I had reactive arthritis. Reactive to what? Can you throw some light on this? – P.Z.

ANSWER: Reactive arthritis is joint swelling with severe joint pain that is a “reaction” to a previous infection. The infection is often an intestinal infection usually producing diarrhea. Or it might be an infection of the urethra, the bladder’s emptying tube. It causes painful urination. Germs involved in this infection include the common diarrhea-producing germs – salmonella, Shigella and Campylobacter. The urethral infection is most often due to the chlamydia germ.

Anywhere from one week to a month after the initial infection, joint symptoms set in. The knee, ankle, foot, toes, wrist and fingers are the usual targets. The fingers take on the appearance of stuffed sausages.

The eyes can also become inflamed, and an eye doctor should be consulted if that happens.

A rash might break out on the palms and soles.

Anti-inflammatory drugs like Indocin can often control joint swelling and pain. If symptoms are resistant to those drugs, the sulfa drug sulfasalazine is beneficial. If the eye is a target, cortisone drops can quell the inflammation.

On the down side, joint symptoms can last for a considerable time in about a third of patients. Peculiarly and unexplainably, heel pain can be a consequence of this condition. A few patients have to put up with recurring joint swelling and pain.

DEAR DR. DONOHUE: For more than 35 years I have had rheumatoid arthritis. I have had finger joints replaced and am actually doing quite well. I still work, and I get around with a minimum of discomfort.

However, on my last doctor visit, he said my spleen was enlarged. He ordered a blood count, which showed that my white blood cell count was low. He called this Felty’s syndrome. What’s the significance of this? I don’t feel any different than I did before knowing I had it. – D.K.

ANSWER: Felty’s syndrome is the triple misfortune of longstanding rheumatoid arthritis, spleen enlargement and a drop in the white blood count. It’s an unusual condition that happens only to 1 percent of people with rheumatoid arthritis. That fact doesn’t bring much joy to the 1 percent who develop it.

Since white blood cells are one of the body’s main defenses against infection, a drop in their numbers leaves people vulnerable to repeated infections. This hasn’t happened to you, and that’s a good sign.

Treatment depends on how low the white blood cell count has fallen and on how many infections have struck the patient. Spleen removal is a way of boosting the white blood cell count. An enlarged spleen gobbles them. Methotrexate, a drug often used for rheumatoid arthritis without Felty’s, can have a beneficial effect on Felty’s too. Granulocyte colony-stimulating factor is another treatment. Granulocyte is a synonym for white blood cells.

Without having any infections, you might not need any treatment – at least, now.

DEAR DR. DONOHUE: I use talcum powder to dust my body. I hear that it should not be used in the vaginal area. Why not? I have asked many people, but no one can tell me the reason. – J.F.

ANSWER: Talc, a composite of magnesium, silicon and oxygen, is an ingredient of talcum powder. When cells taken from cancers of the ovary and uterus are examined, some of them contain talc. As a safety measure, therefore, women should not use talcum powder in the genital region.

DEAR DR. DONOHUE: Does Parkinson’s disease ever go into remission? My grandpa has it. – R.T.

ANSWER: I have never read that it does and have never heard anyone say it does. There are many effective medicines for Parkinson’s. Is your grandfather taking one?

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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