Are antibiotics of any use in reactive arthritis?

Abstract

In the pathogenesis of reactive arthritis, infection through the mucosal route and genetic susceptibility (HLA‐B27) are the most important contributing factors. With regard to non‐specific urethritis, most probably caused by Chlamydia trachomatis infection, the use of early antimicrobial therapy has been shown to be effective in preventing arthritic recurrences. When the arthritis has been initiated, short‐term conventional antimicrobial therapy seems unable to modify the course of the ongoing disease. In patients with acute reactive arthritis, a prolonged (3‐month) treatment with tetracycline shortens the duration of arthritis when triggered by Chlamydia trachomatis, while such treatment has not proved effective in enteroarthritis. In patients with chronic reactive enteroarthritis, a prolonged course of quinolones, such as ciprofloxacin, might be of benefit. Sulfasalazine, which has an effect in the acute exacerbations of ankylosing spondylitis, is probably also effective in chronic reactive arthritis. An antimicrobial effect can be one of the mechanisms by which sulfasalazine exerts its therapeutic effect. Follow‐up studies are necessary to assess the influence of antibiotic therapy on the late prognosis of patients with reactive arthritis.

Persistence ofYersinia antigens in peripheral blood cells from patients withYersinia enterocolitica O:3 infection with or without reactive arthritis

“…The possibility that living microbes persist in other, unknown, locations in patients with ReA has provided a basis for the antibiotic therapies tested recently in many studies (26). We did not find any viable Yersinia in carefully examined cultures of blood and synovial fluid samples in this study, which is consistent with earlier results (7,8), but this does not rule out the possibility that the Yersinia may live in another location.…”

Effects of Levofloxacin and Doxycycline on Interleukin-6 Production of <i>Chlamydia trachomatis</i>-Infected Human Synovial Fibroblasts

“…Several attempts have been made to assess the effects of antibiotics on recurrence of articular symptoms in ReA [17][18][19][20] . When lymecycline was given for 3 months, the disease duration was shortened to 15 weeks in 505 patients, in comparison with 39 weeks in the placebo group [18] .…”

Comparison of the Polymerase Chain Reaction and Culture for the Detection of Feline Chlamydia psittaci in Untreated and Doxycycline‐Treated Experimentally Infected Cats

“…Persistent chlamydiae detected in the synovium of humans suffering from Reiter's syndrome and reactive arthritis have been shown to have an altered state that is somewhat resistant to antimicrobial therapy. 28,37 Delaying therapy possibly may favor establishment of this altered chlamydial state. However, recurring cases have usually involved large numbers of cats and poor compliance; often not all cats are treated and the owner has failed to administer all doses.…”