What is included in the pharmacologic therapy for reactive arthritis (ReA)?

Updated: Dec 24, 2020
  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD  more...
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NSAIDs (eg, indomethacin and naproxen) are the foundation of therapy for ReA. [93] Etretinate/acitretin has been shown to decrease the required dosage of NSAIDs. [68] Sulfasalazine or methotrexate may be used for patients who do not experience relief with NSAIDs after 1 month or who have contraindications to NSAIDs. In addition, sulfasalazine-resistant ReA may be successfully treated with methotrexate. [94]

In a series of 22 pediatric ReA patients from the Republic of China, NSAIDs and sulfasalazine were the mainstays of treatment, with cyclophosphamide used in 14 patients and methotrexate and corticosteroids added in a few. [95] Most achieved full remission within 6 months.

Antibiotic treatment is indicated for cervicitis or urethritis but generally not for postdysenteric ReA. In Chlamydia-induced ReA, some data suggest that prolonged combination antibiotic therapy could be an effective treatment strategy. [39]

Case reports exist that demonstrate the effectiveness of anti−tumor necrosis factor (TNF) medications, [56, 96] such as etanercept and infliximab. [97, 66] No published data are available on the effectiveness of selective cyclooxygenase (COX)–2 inhibitors; however, a COX-2 inhibitor may be tried in patients who do not tolerate NSAIDs and in whom no preexisting contraindication to COX-2 use exists.

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