Ciprofloxacin treatment does not influence course or relapse rate of reactive arthritis and anterior uveitis

Wakefield, Denis; McCluskey, Peter; Verma, Manju; Aziz, Karim Elias; Gatus, Barrie J.; Carr, Gregory

doi:10.1002/1529-0131(199909)42:9<1894::aid-anr14>3.0.co;2-v

Cited by 61 publications

(22 citation statements)

References 13 publications

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“…Therapy for uveitis consists of topical corticosteroids, mydriatics, and cycloplegics (144). In patients with ReA and acute anterior uveitis, long-term treatment (12 months) with ciprofloxacin made no significant difference to the severity or natural history of disease (215).…”

Section: Nonpharmacologic Approachmentioning

confidence: 86%

HLA-B27-Associated Reactive Arthritis: Pathogenetic and Clinical Considerations

2004

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Current evidence supports the concept that reactive arthritis (ReA) is an immune-mediated synovitis resulting from slow bacterial infections and showing intra-articular persistence of viable, nonculturable bacteria and/or immunogenetic bacterial antigens synthesized by metabolically active bacteria residing in the joint and/or elsewhere in the body. The mechanisms that lead to the development of ReA are complex and basically involve an interaction between an arthritogenic agent and a predisposed host. The way in which a host accommodates to invasive facultative intracellular bacteria is the key to the development of ReA. The details of the molecular pathways that explain the articular and extra-articular manifestations of the disease are still under investigation. Several studies have been done to gain a better understanding of the pathogenesis of ReA; these constitute the basis for a more rational therapeutic approach to this disease

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Section: Nonpharmacologic Approachmentioning

confidence: 86%

HLA-B27-Associated Reactive Arthritis: Pathogenetic and Clinical Considerations

2004

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“…In this randomized, placebo-controlled trial, no difference was seen in the subgroup of patients with disease duration of less than 3 months [67,68]. Treatment of reactive arthritis with ciprofloxacin during 12 months in another randomized, placebo-controlled clinical trial made no difference to the natural history or severity of this disease.…”

Section: Treatmentmentioning

confidence: 77%

Clinical aspects, outcome assessment, and management of ankylosing spondylitis and postenteric reactive arthritis

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D²

2000

Current Opinion in Rheumatology

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The cause of ankylosing spondylitis remains unclear. Proof that this disorder is an autoimmune disease attributable to crossreactivity between bacteria and HLA-B27 is still lacking. Differences in endogenous peptide presentation by HLA-B27 subtypes might be relevant in the etiopathogenesis. Fractures of the osteoporotic spine contribute to morbidity. Spinal cord injury may occur. MR imaging enables identifying sacroiliitis earlier than plain radiography. Sweet syndrome has now been described in patients with ankylosing spondylitis and Crohn disease. Progress has been made in the assessment of ankylosing spondylitis. There are now core sets for different settings and validated instruments for functioning and disease activity that will enable demonstrating efficacy of new therapeutic interventions. The debate continues on classification of postinfectious and reactive arthritis. Bacterial antigens may be found in the inflamed joints; occasionally 16S ribosomal RNA is also demonstrated. Antibiotics seem not to be effective in postenteric reactive arthritis. More than 25 years have now elapsed since the association between ankylosing spondylitis and HLA-B27 was first described in 1973. The cause of this disease is still unknown, but a lot of progress has been made regarding the molecular structure of HLA-B27, the spectrum of disease, the clinical and radiographic assessment of ankylosing spondylitis, and its treatment. Recent advances in research on ankylosing spondylitis are reviewed here.

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“…However, in cases that are severe, relapsing and recalcitrant to conventional treatment, the published peer-reviewed evidence is very clear that continuing to rely solely upon topical or oral steroids chronically, even at low dosages, is strongly associated with the formation of glaucoma and cataract [12,26], and further is associated with poorer outcomes. Although it has been suggested that sulfa antibiotics [2] taken chronically may reduce the frequency of relapses in patients with ankylosing spondylitis, a randomized controlled clinical trial failed to show benefit of a 12-month treatment with oral ciprofloxacin in the recurrent form of this disease [25]. Anti-tumor necrosis factor agents [20] have been reported in small case series studies to produce remission in some patients with this form of uveitis; a randomized controlled trial [8], however, showed that etanercept had no better effect than placebo in controlling the relapses of uveitis.…”

Section: Discussionmentioning

confidence: 99%