Ophthalmologic Manifestations of Reactive Arthritis Medication

  • Author: Mounir Bashour, MD, CM, FRCS(C), PhD, FACS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 14, 2012
 

Medication Summary

Joint symptoms are best treated by NSAIDs.[3] High and sustained doses often have to be used. For acute arthritis, indomethacin is often effective. Any other NSAID can also be used. Phenylbutazone may work in patients refractive to other NSAIDs. One-month treatment at maximum dosage is needed before effectiveness can be fully evaluated.

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Nonsteroidal anti-inflammatory agents (NSAIDs)

Class Summary

Have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known but may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions, may exist.

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Indomethacin (Indochron, Indocin)

 

Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation; inhibits prostaglandin synthesis.

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Anti-inflammatory agents

Class Summary

Systemically interfere with events leading to inflammation.

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Sulfasalazine (Azulfidine)

 

Used as a second-line therapy for patients not controlled with NSAIDs alone. Mode of action of sulfasalazine (SSZ) or its metabolites, 5-aminosalicylic acid (5-ASA) and sulfapyridine (SP), still under investigation but may be related to its anti-inflammatory and/or immunomodulatory properties.

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Cytotoxic agents

Class Summary

Inhibit cell growth and proliferation. Used when the disease is aggressive and unremitting.

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Methotrexate (Folex PFS, Rheumatrex)

 

Antimetabolite used in the treatment of certain neoplastic diseases, severe psoriasis, and adult rheumatoid arthritis.

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Corticosteroids

Class Summary

For ocular therapy, topical or sub-Tenon injections of steroid have proven effective. Systemic steroids should only be used in cases of macular involvement and only for a short period of time.

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Prednisone (Deltasone)

 

For systemic therapy, should only be used in cases of macular involvement and only for a short period of time.

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Prednisolone acetate 1% (Pred Forte)

 

Mainly for acute iritis; best therapy is to treat aggressively early in the course of the disease. Gradually taper and discontinue based upon clinical response.

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Contributor Information and Disclosures
Author

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS  Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association, Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

John D Sheppard Jr, MD, MMSc  Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, American Uveitis Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

R Christopher Walton, MD  Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, Assistant Dean for Graduate Medical Education, University of Tennessee College of Medicine; Consulting Staff, Regional Medical Center, Memphis Veterans Affairs Medical Center, St Jude Children's Research Hospital

R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Garg AX, Pope JE, Thiessen-Philbrook H, Clark WF, Ouimet J. Arthritis risk after acute bacterial gastroenteritis. Rheumatology (Oxford). Feb 2008;47(2):200-4. [Medline].

  2. Kozeis N, Trachana M, Tyradellis S. Keratitis in reactive arthritis (Reiter syndrome) in childhood. Cornea. Aug 2011;30(8):924-5. [Medline].

  3. Rudwaleit M, Braun J, Sieper J. Treatment of reactive arthritis: a practical guide. BioDrugs. Jan 2000;13(1):21-8. [Medline].

  4. Amor B. Reiter's syndrome. Diagnosis and clinical features. Rheum Dis Clin North Am. Nov 1998;24(4):677-95, vii. [Medline].

  5. Banares A, Hernandez-Garcia C, Fernandez-Gutierrez B, Jover JA. Eye involvement in the spondyloarthropathies. Rheum Dis Clin North Am. Nov 1998;24(4):771-84, ix. [Medline].

  6. Kohnke SJ. Reactive arthritis. A clinical approach. Orthop Nurs. Jul-Aug 2004;23(4):274-80. [Medline].

  7. Lee DA, Barker SM, Su WP, Allen GL, Liesegang TJ, Ilstrup DM. The clinical diagnosis of Reiter's syndrome. Ophthalmic and nonophthalmic aspects. Ophthalmology. Mar 1986;93(3):350-6. [Medline].

  8. Mahoney BP. Rheumatologic disease and associated ocular manifestations. J Am Optom Assoc. Jun 1993;64(6):403-15. [Medline].

  9. Ostler HB. Oculogenital disease. Surv Ophthalmol. Jan-Feb 1976;20(4):233-46. [Medline].

 
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