Reactive arthritis medical therapy

Reactive arthritis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Reactive arthritis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Reactive arthritis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Reactive arthritis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Reactive arthritis medical therapy
CDC on Reactive arthritis medical therapy
Reactive arthritis medical therapy in the news
Blogs onReactive arthritis medical therapy
Directions to Hospitals Treating Reactive arthritis
Risk calculators and risk factors forReactive arthritis medical therapy

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 do not require antibiotic therapy. Recent studies have shown that antibiotic therapy does not alter the course of disease and their role in reactive arthritis is not completely established.
• Arthritis (mono or oligoarthritis) is most common initial symptom and therefore primary medical therapy is aimed at alleviating arthritis.
• Pharmacologic medical therapies for reactive arthritis include symptomatic control starting initially with NSAIDs.
• As the disease progresses or in case of no response, further management includes intra-articular and systemic steroids, DMARDs and finally TNF inhibitors.
  • 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 NSAIDs and steroids 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.

  • 4.1 Tumor necrosis factor (TNF) inhibitorsPatients unresponsive to above therapy are advised TNF inhibitors.

    • Preferred regimen (1): Etanercept 50 mg/week given as subcutaneous injection.
    • Preferred regimen (2): Infliximab 3 to 5 mg/kg administered intravenously on weeks zero, two, and six and then every eight weeks.

    Note(1):The duration of treatment is 3 months.

    Note(2):If the patients does not respond to one TNF another TNF agent may be given

    Note(3):Treatment is discontinued when patient goes into remission for at least three months.

• For treatment of ocular symptoms such as conjunctivitis, please click here
• For treatment of urethritis please click here
• Skin and mucous membrane lesions are generally self limited and therefore do not require further intervention.

References

Template:WikiDoc Sources