Which specialist consultations are beneficial to patients with reactive arthritis (ReA)?

Updated: Dec 24, 2020
  • Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Appropriate consultations should be obtained as necessary.

A rheumatologist may be consulted to discuss appropriate additional tests and medications for symptomatic relief and to ensure follow-up treatment. In particular, the consulting rheumatologist may be extremely helpful in suggesting an appropriate oral NSAID or immunosuppressive agent to augment topical and periocular corticosteroid therapy.

Consultation with a urologist may be necessary if particularly prominent genitourinary manifestations develop.

An ophthalmologist may be consulted to confirm the diagnosis and to treat the ophthalmologic manifestations of ReA.

Consultation with a dermatologist is often helpful. For example, dermatologic involvement may occur with several uveitic syndromes; an accurate description of these lesions may help establish the diagnosis in some cases.

Consultation with and treatment by a dentist, an oral surgeon, or a periodontist may be useful for patients with aphthous ulcers.

An internal medicine consultation should be sought when prolonged systemic corticosteroid therapy is anticipated, especially in patients with concomitant diabetes or hypertension.

An infectious disease consultation may be sought when empiric antibiotic therapy is being considered or when the patient has manifestations of coincident AIDS-defining illnesses.

In cases of poststreptococcal ReA, a cardiology consultation is necessary because serial echocardiography and long-term antibiotic therapy may be of benefit to the patient. It should be kept in mind that patients with ReA symptoms who have evidence of preceding streptococcal infection are likely meet the Jones criteria for acute rheumatic fever. Many cardiologists elect to place these patients on long-term penicillin treatment. [88, 89]

It should be noted that current data show no increased risk of valvular heart disease in adult poststreptococcal ReA. On the basis of these findings, routine long-term antibiotic prophylaxis is not recommended in adult poststreptococcal ReA. [36, 54, 44, 43] The above recommendation is valid in pediatric patients with ReA.

Physical and occupational therapists may be consulted for assistance with maintenance of function and gait.


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