Reactive arthritis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

• Reactive arthritis is generally seen with preceeding GI or GU infections. Antibiotics may be given if there is an ongoing infection, but generally patients of reactive arthritis are not advised antibiotic therapy. Recent studies have shown that antibiotic therapy does not alter the course of disease and their role is not completely established.
• Pharmacologic medical therapies for reactive arthritis include symptomatic control:
  • 1.1 NSAIDs such as the COX-2 inhibitors

    • Preferred regimen (1): Naproxen 500 mg PO q8-12h daily.
    • Preferred regimen (2): Diclofenac 50 mg PO q8h daily.
    • Preferred regimen (3): Indomethacin 50 mg PO q6-8h daily.

    Note(1):NSAIDs are usually given for a duration of two weeks.

    Note(2):NSAIDs are contraindicated in patients with GI bleeding, heart disease and renal disease.

• • 2.1 Steroid therapy Patients with inadequate response to NSAID are given intra-articular steroids initially and in case of no response are given systemic systemic steroids .

    • Preferred regimen (1): Triamcinolone acetonide 40 mg given as intra-articular injection.
    • Preferred regimen (2): Methylprednisolone acetate 20-60 mg as intra-articular injection.

    Note(1):Intra-articular injections are given every 1- 5 weeks depending upon response.

    Note(2):Most common side effects of intra-articular steroids include osteonecrosis and acute synovitis.

    • Alternative regimen (1): Patients unresponsive to NSAIDs and intra-articular steroids are advised systemic glucocorticoids such as prednisone 20 mg PO q24 daily.

    Note(1):Glucocorticoids should be started with the minimum dose and gradually increased if desired effect is not achieved.

• • 3.1 Steroid therapyPatients unresponsive to above therapy are advised DMARDs.

    • Preferred regimen (1): Sulfasalazine 500 mg PO q24 daily, if unresponsive dose can be increased to 1000-3000 mg BID daily.
    • Preferred regimen (2): Methotrexate 15 to 25 mg PO one day weekly.

    Note(1):The duration of therapy with DMARDs is four months for sulfasalazine.

    Note(2):For methotrexate the duration of therapy is three months.

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