Treatment of Reactive Arthritis

Journal/Book: Z Rheumatol 1998; 57 Suppl. 1: 22 (V 91). 1998;

Abstract: Department of Rheumatology University Hospital Lund Infection with gram-negative bacteria via mucosal route and genetic susceptibility of the host both contribute to the development of reactive arthritis (ReA). Dissemination and persistence of bacterial antigens in the synovium has been increasingly observed in ReA patients. In addition to general treatment modalities (NSAID local injections physiotherapy with the evidence of antigen persistence the question as to the role of chemotherapy in the treatment of ReA is relevant. In patients with previous Reiter's syndrome conventional 2 week course of tetracyclines is effective in preventing a recurrent uroarthritis while early treatment of gastroenteritis with antibiotics has not been shown to prevent the development of ReA triggered by preceding gastroenteritis (enteroarthritis). After the onset of arthritis short-term antibiotics do not modify the the course of acute ReA. The role of prolonged course of antibiotics in the treatment of established ReA is still controversial. We showed previously that a 3-month course of tetracycline shortened the duration of acute chlamydia arthritis but had no effect on enteroarthritis. However other controlled studies of long-term antibiotics on ReA (mostly chronic diseases) have not favoured the use of antibiotics. Sulphasalazine for acute or chronic ReA tends to hasten the recovery but has no major impact on the outcome. Experience with other DMARDs is so far limited. In conclusion. Patients with acute ReA are treated with NSAID and physiotherapy. Local corticosteroid injections are also of help. Patients (and partners) with Chlamydia trachomatis infection have to be treated according to normal guidelines. As to ReA best evidence for the use of antibiotics is in the case of chlamydia infection where prompt treatment of infection can prevent ReA. le

Zurück | Weiter