Reactive Arthritis Medication
- Author: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD more...
The goals of pharmacotherapy for reactive arthritis (ReA) are to reduce morbidity, to prevent joint damage, and to alleviate extra-articular disease. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstays of therapy for joint symptoms. Other types of agents used to treat ReA or its extra-articular manifestations include corticosteroids, antibiotics, and various disease-modifying antirheumatic drugs (DMARDs).
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Several NSAIDs are available for relief of mild to moderate pain in ReA patients. They are similar with respect to effectiveness, though indomethacin may be more effective in the spondyloarthropathies. Cyclooxygenase (COX)-2–specific inhibitors can be used in patients at high risk for GI complications.
NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not fully known, but they may inhibit COX 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.
Aspirin and several NSAIDs are available for use in ReA patients and are comparably effective in treating symptoms.
Aspirin is a short-acting anti-inflammatory agent with rapid absorption in the proximal gastrointestinal (GI) tract. It is optimally effective only when stable serum levels of 150-250 µg/L are achieved after 3-5 days of treatment. Serum aspirin levels can be checked after 5-10 days of treatment. Maximal anti-inflammatory action is generally achieved within 2-4 weeks, with some further benefit occurring up to 3 months.
Ibuprofen inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Indomethacin is the NSAID of choice in ReA; however, other NSAIDs are often effective as well. It is rapidly absorbed; metabolism occurs in the liver via demethylation, deacetylation, and glucuronide conjugation. Indomethacin inhibits prostaglandin synthesis; it is also a potent COX inhibitor, and this action may decrease local production of arachidonic acid–derived chemotactic factors for eosinophils present in sebum.
Naproxen is used for relief of mild-to-moderate pain and is available in both short-acting and long-acting forms. It inhibits inflammatory reactions and pain by decreasing the activity of COX, which is responsible for prostaglandin synthesis.
Diclofenac inhibits prostaglandin synthesis by decreasing COX activity, which, in turn, decreases formation of prostaglandin precursors.
Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are indicated initially in small patients, elderly patients, and patients with renal or liver disease. Doses higher than 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient's response.
Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body’s immune response to diverse stimuli. Topical corticosteroids are used for dermatologic manifestations of ReA, such as keratoderma blennorrhagicum and balanitis circinata (circinate balanitis). For ocular therapy, topical or subtenon injections of steroid have proven effective. Systemic steroids should only be used in cases of macular involvement and only for short periods.
Prednisone may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity the activity of polymorphonuclear leukocytes (PMNs).
Prednisolone acetate is used mainly for acute iritis. The best approach is to treat aggressively early in the course of the disease, then to gradually taper and discontinue the drug on the basis of the patient's clinical response.
Topical corticosteroids are adrenocorticosteroid derivatives suitable for application to skin or external mucous membranes; they have mineralocorticoid and glucocorticoid effects, resulting in a nonspecific anti-inflammatory activity.
These agents cause cornified epithelium to swell, soften, macerate, and then desquamate.
Topical salicylic acid, by dissolving intercellular cement substance, produces desquamation of the horny layer of the skin, without affecting the structure of viable epidermis.
Antibiotics may be used in ReA for antibacterial effects and for treatment of possible coexistent infection. Empiric antimicrobial therapy should cover all likely pathogens in the context of the clinical setting. Whenever feasible, antibiotic selection should be guided by blood culture sensitivity.
Tetracyclines are used to treat urethritis or cervicitis caused by chlamydial organisms. Some evidence shows that tetracycline treatment in chlamydia-induced ReA may reduce the duration, and perhaps the severity, of illness. Collagenase inhibitors have been used to treat early rheumatoid arthritis.
Erythromycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is indicated for treatment of infections caused by susceptible strains of microorganisms (eg, Mycoplasma pneumoniae and Staphylococcus, Streptococcus, and Chlamydia spp) and for prevention of corneal and conjunctival infections.
Erythromycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is indicated for the prevention of corneal and conjunctival infections.
Ciprofloxacin is the drug of choice for obtaining improvement in clinical parameters (except joint involvement) in postenteric ReA. It is a bactericidal antibiotic that inhibits bacterial DNA synthesis and, consequently, growth by inhibiting DNA gyrase in susceptible organisms.
Tetracycline is used to treat gram-positive and gram-negative infections, as well as mycoplasmal, chlamydial, and rickettsial infections. It inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunits.
Doxycycline is used to treat infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma organisms. It inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.
Minocycline is used to treat infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma organisms. It inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.
Azithromycin is used to treat mild-to-moderate microbial infections.
Cefdinir is a third-generation cephalosporin indicated for treatment of susceptible infections.
Aminosalicylic Acid Derivatives
Aminosalicylic acid derivatives are used to reduce inflammation when NSAIDs do not control arthritis or when inflammatory lesions of the intestinal mucosa are present.
Sulfasalazine is used as a second-line therapy to treat ReA that is not controlled with NSAIDs alone. It is a conjugate of the salicylate 5-aminosalicylic acid (5-ASA) and the sulfonamide sulfapyridine (linked by an azo bond). Sulfasalazine is primarily excreted in the urine unchanged. Most of the 5-ASA remains in the colon and is not absorbed. Sulfasalazine acts locally to decrease the inflammatory response in the joints and systemically inhibits prostaglandin synthesis and folate metabolism.
Vitamins are essential for normal synthesis of DNA and metabolism of proteins, carbohydrates, and fats.
Calcipotriene is a synthetic vitamin D-3 analogue that regulates skin-cell production and development. It is available as a 0.005% cream, ointment, or solution.
Antineoplastic agents have immunosuppressive effects and inhibit cell growth and proliferation. They are used when the disease is aggressive and unremitting.
Azathioprine may be used alone or as a steroid-sparing agent. It antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. Azathioprine may decrease proliferation of immune cells, thereby reducing autoimmune activity. It is used more commonly for ReA and psoriasis. Thiopurine methyltransferase levels should be checked before azathioprine is used.
Methotrexate is an antimetabolite that is indicated for the symptomatic control of severe ReA and severe, recalcitrant, disabling psoriasis. It is also used alone or in combination with other anticancer agents in the treatment of advanced mycosis fungoides and cancer of the head, neck, or lung, particularly those of the squamous-cell and small-cell types.
Derivatives of 4-aminoquinoline are active against a variety of autoimmune disorders. They must be used with caution because hydroxychloroquine is known to be capable of exacerbating psoriasis. Because hydroxychloroquine is used for the joint involvement and not the skin involvement, it should probably be given only in conjunction with rheumatologic evaluation.
It is not clear how hydroxychloroquine works. It is known to interfere with TLR signaling, inhibit chemotaxis of eosinophils neutrophils, and impair complement-dependent antigen-antibody reactions. A 200-mg quantity of hydroxychloroquine sulfate is equivalent to 155 mg of hydroxychloroquine base and 250 mg of chloroquine phosphate.
Retinoids decrease the cohesiveness of abnormal hyperproliferative keratinocytes and may reduce the potential for malignant degeneration. They also modulate keratinocyte differentiation.
Oral agent used to treat serious dermatologic conditions. It is a synthetic 13-cis isomer of the naturally occurring tretinoin (trans-retinoic acid), and both agents are structurally related to vitamin A. Isotretinoin alters the pattern of keratinization, reduces bacterial flora, and has an anti-inflammatory effect.
A US Food and Drug Administration (FDA)–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin (see iPLEDGE). This registry aims to achieve further decreases in the risks of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.
Acitretin is a retinoic acid analogue, similar to etretinate and isotretinoin. Etretinate is the main metabolite and has similar clinical effects. Acitretin's mechanism of action is unknown.
Tumor Necrosis Factor Blockers
Anti–tumor necrosis factor (TNF)–α therapy may be considered in refractory cases of ReA.
Infliximab is a chimeric IgG1κ monoclonal antibody that binds specifically to the soluble and transmembrane forms of TNF-α and inhibits the binding of TNF-α to its receptors.
Lu DW, Katz KA. Declining use of the eponym "Reiter's syndrome" in the medical literature, 1998-2003. J Am Acad Dermatol. 2005 Oct. 53(4):720-3. [Medline].
Kataria RK, Brent LH. Spondyloarthropathies. Am Fam Physician. 2004 Jun 15. 69(12):2853-60. [Medline].
Kaarela K, Jäntti JK, Kotaniemi KM. Similarity between chronic reactive arthritis and ankylosing spondylitis.A 32-35-year follow-up study. Clin Exp Rheumatol. 2009 Mar-Apr. 27(2):325-8. [Medline].
Mahmood A, Ackerman AB. Reiter’s syndrome is psoriasis!. Dermatopathol Pract Concept. 2000. 6:337-339.
Braun J, Laitko S, Treharne J, Eggens U, Wu P, Distler A, et al. Chlamydia pneumoniae--a new causative agent of reactive arthritis and undifferentiated oligoarthritis. Ann Rheum Dis. 1994 Feb. 53(2):100-5. [Medline]. [Full Text].
Carter JD, Hudson AP. Reactive arthritis: clinical aspects and medical management. Rheum Dis Clin North Am. 2009 Feb. 35(1):21-44. [Medline].
Savolainen E, Kettunen A, Närvänen A, Kautiainen H, Kärkkäinen U, Luosujärvi R, et al. Prevalence of antibodies against Chlamydia trachomatis and incidence of C. trachomatis-induced reactive arthritis in an early arthritis series in Finland in 2000. Scand J Rheumatol. 2009. 38(5):353-6. [Medline].
Singh AK, Misra R, Aggarwal A. Th-17 associated cytokines in patients with reactive arthritis/undifferentiated spondyloarthropathy. Clin Rheumatol. 2011 Jun. 30(6):771-6. [Medline].
Shen H, Goodall JC, Gaston JS. Frequency and phenotype of T helper 17 cells in peripheral blood and synovial fluid of patients with reactive arthritis. J Rheumatol. 2010 Oct. 37(10):2096-9. [Medline].
Eliçabe RJ, Cargnelutti E, Serer MI, Stege PW, Valdez SR, Toscano MA, et al. Lack of TNFR p55 results in heightened expression of IFN-? and IL-17 during the development of reactive arthritis. J Immunol. 2010 Oct 1. 185(7):4485-95. [Medline].
Pöllänen R, Sillat T, Pajarinen J, Levón J, Kaivosoja E, Konttinen YT. Microbial antigens mediate HLA-B27 diseases via TLRs. J Autoimmun. 2009 May-Jun. 32(3-4):172-7. [Medline].
Inman RD. Innate immunity of spondyloarthritis: the role of toll-like receptors. Adv Exp Med Biol. 2009. 649:300-9. [Medline].
Lauhio A, Leirisalo-Repo M, Lähdevirta J, Saikku P, Repo H. Double-blind, placebo-controlled study of three-month treatment with lymecycline in reactive arthritis, with special reference to Chlamydia arthritis. Arthritis Rheum. 1991 Jan. 34(1):6-14. [Medline].
Carter JD, Valeriano J, Vasey FB. Doxycycline versus doxycycline and rifampin in undifferentiated spondyloarthropathy, with special reference to chlamydia-induced arthritis. A prospective, randomized 9-month comparison. J Rheumatol. 2004 Oct. 31(10):1973-80. [Medline].
Alvarez-Navarro C, Cragnolini JJ, Dos Santos HG, Barnea E, Admon A, Morreale A, et al. Novel HLA-B27-restricted epitopes from Chlamydia trachomatis generated upon endogenous processing of bacterial proteins suggest a role of molecular mimicry in reactive arthritis. J Biol Chem. 2013 Sep 6. 288(36):25810-25. [Medline]. [Full Text].
Sahlberg AS, Granfors K, Penttinen MA. HLA-B27 and host-pathogen interaction. Adv Exp Med Biol. 2009. 649:235-44. [Medline].
El Karoui K, Méchaï F, Ribadeau-Dumas F, Viard JP, Lecuit M, de Barbeyrac B, et al. Reactive arthritis associated with L2b lymphogranuloma venereum proctitis. Sex Transm Infect. 2009 Jun. 85(3):180-1. [Medline].
Dworkin MS, Shoemaker PC, Goldoft MJ, Kobayashi JM. Reactive arthritis and Reiter's syndrome following an outbreak of gastroenteritis caused by Salmonella enteritidis. Clin Infect Dis. 2001 Oct 1. 33(7):1010-4. [Medline].
Arnedo-Pena A, Beltrán-Fabregat J, Vila-Pastor B, Tirado-Balaguer MD, Herrero-Carot C, Bellido-Blasco JB, et al. Reactive arthritis and other musculoskeletal sequelae following an outbreak of Salmonella hadar in Castellon, Spain. J Rheumatol. 2010 Aug 1. 37(8):1735-42. [Medline].
Kroot EJ, Hazes JM, Colin EM, Dolhain RJ. Poncet's disease: reactive arthritis accompanying tuberculosis. Two case reports and a review of the literature. Rheumatology (Oxford). 2007 Mar. 46(3):484-9. [Medline].
Townes JM. Reactive arthritis after enteric infections in the United States: the problem of definition. Clin Infect Dis. 2010 Jan 15. 50(2):247-54. [Medline].
van Bemmel JM, Delgado V, Holman ER, Allaart CF, Huizinga TW, Bax JJ, et al. No increased risk of valvular heart disease in adult poststreptococcal reactive arthritis. Arthritis Rheum. 2009 Apr. 60(4):987-93. [Medline].
Kousa M, Saikku P, Richmond S, Lassus A. Frequent association of chlamydial infection with Reiter's syndrome. Sex Transm Dis. 1978 Apr-Jun. 5(2):57-61. [Medline].
Berlau J, Junker U, Groh A, Straube E. In situ hybridisation and direct fluorescence antibodies for the detection of Chlamydia trachomatis in synovial tissue from patients with reactive arthritis. J Clin Pathol. 1998 Nov. 51(11):803-6. [Medline]. [Full Text].
Carter JD, Hudson AP. The evolving story of Chlamydia-induced reactive arthritis. Curr Opin Rheumatol. 2010 Jul. 22(4):424-30. [Medline].
Siala M, Mahfoudh N, Fourati H, Gdoura R, Younes M, Kammoun A, et al. MHC class I and class II genes in Tunisian patients with reactive and undifferentiated arthritis. Clin Exp Rheumatol. 2009 Mar-Apr. 27(2):208-13. [Medline].
Mortensen NP, Kuijf ML, Ang CW, Schiellerup P, Krogfelt KA, Jacobs BC, et al. Sialylation of Campylobacter jejuni lipo-oligosaccharides is associated with severe gastro-enteritis and reactive arthritis. Microbes Infect. 2009 Oct. 11(12):988-94. [Medline].
van der Helm-van Mil AH. Acute rheumatic fever and poststreptococcal reactive arthritis reconsidered. Curr Opin Rheumatol. 2010 Jul. 22(4):437-42. [Medline].
Sarakbi HA, Hammoudeh M, Kanjar I, Al-Emadi S, Mahdy S, Siam A. Poststreptococcal reactive arthritis and the association with tendonitis, tenosynovitis, and enthesitis. J Clin Rheumatol. 2010 Jan. 16(1):3-6. [Medline].
Kobayashi S, Ichikawa G. Reactive arthritis induced by tonsillitis: a type of 'focal infection'. Adv Otorhinolaryngol. 2011. 72:79-82. [Medline].
Garg S, Malaviya AN, Kapoor S, Rawat R, Agarwal D, Sharma A. Acute inflammatory ankle arthritis in northern India--Löfgren's syndrome or Poncet's disease?. J Assoc Physicians India. 2011 Feb. 59:87-90. [Medline].
Ideguchi H, Ohno S, Takase K, Tsukahara T, Kaneko T, Ishigatsubo Y. A case of Poncet's disease (tuberculous rheumatism). Rheumatol Int. 2009 Jul. 29(9):1097-9. [Medline].
Rueda JC, Crepy MF, Mantilla RD. Clinical features of Poncet's disease. From the description of 198 cases found in the literature. Clin Rheumatol. 2013 Jul. 32(7):929-35. [Medline].
Prati C, Bertolini E, Toussirot E, Wendling D. Reactive arthritis due to Clostridium difficile. Joint Bone Spine. 2010 Mar. 77(2):190-2. [Medline].
Durand CL, Miller PF. Severe Clostridium difficile colitis and reactive arthritis in a ten-year-old child. Pediatr Infect Dis J. 2009 Aug. 28(8):750-1. [Medline].
Okamoto K, Hamano T, Kawaguchi T. [Reiter's syndrome following intravesical instillation of Bacillus Calmette-Guerin]. Hinyokika Kiyo. 2010 Feb. 56(2):111-3. [Medline].
Murata H, Adachi Y, Ebitsuka T, Chino Y, Takahashi R, Hayashi T, et al. Reiter's syndrome following intravesical bacille biliE de Calmette-GuErin treatment for superficial bladder carcinoma: report of six cases. Mod Rheumatol. 2004. 14(1):82-6. [Medline].
Macía Villa C, Sifuentes Giraldo W, Boteanu A, González Lanza M, Bachiller Corral J. Reactive arthritis after the intravesical instillation of BCG. Reumatol Clin. 2012 Sep-Oct. 8(5):284-6. [Medline].
Tektonidou MG. Reiter's syndrome during intravesical BCG therapy for bladder carcinoma. Clin Rheumatol. 2007 Aug. 26(8):1368-9. [Medline].
Bernini L, Manzini CU, Giuggioli D, Sebastiani M, Ferri C. Reactive arthritis induced by intravesical BCG therapy for bladder cancer: our clinical experience and systematic review of the literature. Autoimmun Rev. 2013 Oct. 12(12):1150-9. [Medline].
Sahin N, Salli A, Enginar AU, Ugurlu H. Reactive arthritis following tetanus vaccination: a case report. Mod Rheumatol. 2009. 19(2):209-11. [Medline].
Aksu K, Keser G, Doganavsargil E. Reactive arthritis following tetanus and rabies vaccinations. Rheumatol Int. 2006 Dec. 27(2):209-10. [Medline].
Kim PS, Klausmeier TL, Orr DP. Reactive arthritis: a review. J Adolesc Health. 2009 Apr. 44(4):309-15. [Medline].
Rihl M, Barthel C, Klos A, Schmidt RE, Tak PP, Zeidler H, et al. Identification of candidate genes for susceptibility to reactive arthritis. Rheumatol Int. 2009 Oct. 29(12):1519-22. [Medline].
Thielen AM, Barde C, Janer V, Borradori L, Saurat JH. Reiter syndrome triggered by adalimumab (Humira) and leflunomide (Arava) in a patient with ankylosing spondylarthropathy and Crohn disease. Br J Dermatol. 2007 Jan. 156(1):188-9. [Medline].
Braun J, Kingsley G, van der Heijde D, Sieper J. On the difficulties of establishing a consensus on the definition of and diagnostic investigations for reactive arthritis. Results and discussion of a questionnaire prepared for the 4th International Workshop on Reactive Arthritis, Berlin, Germany, July 3-6, 1999. J Rheumatol. 2000 Sep. 27(9):2185-92. [Medline].
Rohekar S, Pope J. Epidemiologic approaches to infection and immunity: the case of reactive arthritis. Curr Opin Rheumatol. 2009 Jul. 21(4):386-90. [Medline].
Carter JD, Espinoza LR, Inman RD, Sneed KB, Ricca LR, Vasey FB, et al. Combination antibiotics as a treatment for chronic Chlamydia-induced reactive arthritis: a double-blind, placebo-controlled, prospective trial. Arthritis Rheum. 2010 May. 62(5):1298-307. [Medline]. [Full Text].
Townes JM, Deodhar AA, Laine ES, Smith K, Krug HE, Barkhuizen A, et al. Reactive arthritis following culture-confirmed infections with bacterial enteric pathogens in Minnesota and Oregon: a population-based study. Ann Rheum Dis. 2008 Dec. 67(12):1689-96. [Medline].
Hajjaj-Hassouni N, Burgos-Vargas R. Ankylosing spondylitis and reactive arthritis in the developing world. Best Pract Res Clin Rheumatol. 2008 Aug. 22(4):709-23. [Medline].
Hanova P, Pavelka K, Holcatova I, Pikhart H. Incidence and prevalence of psoriatic arthritis, ankylosing spondylitis, and reactive arthritis in the first descriptive population-based study in the Czech Republic. Scand J Rheumatol. 2010 Aug. 39(4):310-7. [Medline].
Lahu A, Backa T, Ismaili J, Lahu V, Saiti V. Modes of presentation of reactive arthritis based on the affected joints. Med Arch. 2015 Feb. 69 (1):42-5. [Medline].
Wechalekar MD, Rischmueller M, Whittle S, Burnet S, Hill CL. Prolonged remission of chronic reactive arthritis treated with three infusions of infliximab. J Clin Rheumatol. 2010 Mar. 16(2):79-80. [Medline].
Amor B, Santos RS, Nahal R, Listrat V, Dougados M. Predictive factors for the longterm outcome of spondyloarthropathies. J Rheumatol. 1994 Oct. 21(10):1883-7. [Medline].
Wu IB, Schwartz RA. Reiter's syndrome: the classic triad and more. J Am Acad Dermatol. 2008 Jul. 59(1):113-21. [Medline].
Kanwar AJ, Mahajan R. Reactive arthritis in India: a dermatologists' perspective. J Cutan Med Surg. 2013 May-Jun. 17(3):180-8. [Medline].
Ngaruiya CM, Martin IB. A case of reactive arthritis: a great masquerader. Am J Emerg Med. 2013 Jan. 31(1):266.e5-7. [Medline].
Kober C, Richardson D, Bell C, Walker-Bone K. Acute seronegative polyarthritis associated with lymphogranuloma venereum infection in a patient with prevalent HIV infection. Int J STD AIDS. 2011 Jan. 22(1):59-60. [Medline].
Lin RY. Reiter's syndrome and human immunodeficiency virus infection. Dermatologica. 1988. 176(1):39-42. [Medline].
Romaní J, Puig L, Baselga E, De Moragas JM. Reiter's syndrome-like pattern in AIDS-associated psoriasiform dermatitis. Int J Dermatol. 1996 Jul. 35(7):484-8. [Medline].
Mansour AM, Jaroudi MO, Medawar WA, Tabbarah ZA. Bilateral multifocal posterior pole lesions in Reiter syndrome. BMJ Case Rep. 2013 Apr 9. 2013:[Medline].
Kozeis N, Trachana M, Tyradellis S. Keratitis in reactive arthritis (Reiter syndrome) in childhood. Cornea. 2011 Aug. 30(8):924-5. [Medline].
Madge SN, James C, Selva D. Bilateral dacryoadenitis: a new addition to the spectrum of reactive arthritis?. Ophthal Plast Reconstr Surg. 2009 Mar-Apr. 25(2):152-3. [Medline].
Arora S, Arora G. Reiter's disease in a six-year-old girl. Indian J Dermatol Venereol Leprol. 2005 Jul-Aug. 71(4):285-6. [Medline].
Birnbaum J, Bartlett JG, Gelber AC. Clostridium difficile: an under-recognized cause of reactive arthritis?. Clin Rheumatol. 2008 Feb. 27(2):253-5. [Medline].
Satko SG, Iskandar SS, Appel RG. IgA nephropathy and Reiter's syndrome. Report of two cases and review of the literature. Nephron. 2000 Feb. 84(2):177-82. [Medline].
da Silva Carneiro SC, Pirmez R, de Hollanda TR, Cuzzi T, Ramos-E-Silva M. Syphilis mimicking other dermatological diseases: reactive arthritis and mucha-habermann disease. Case Rep Dermatol. 2013 Jan. 5(1):15-20. [Medline]. [Full Text].
Kuipers JG, Sibilia J, Bas S, Gaston H, Granfors K, Vischer TL, et al. Reactive and undifferentiated arthritis in North Africa: use of PCR for detection of Chlamydia trachomatis. Clin Rheumatol. 2009 Jan. 28(1):11-6. [Medline].
[Guideline] LeFevre ML, U.S. Preventive Services Task Force. Screening for Chlamydia and gonorrhea: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014 Dec 16. 161 (12):902-10. [Medline].
Shimamoto Y, Sugiyama H, Hirohata S. Reiter's syndrome associated with HLA-B51. Intern Med. 2000 Feb. 39(2):182-4. [Medline].
Kim SH, Chung SK, Bahk YW, Park YH, Lee SY, Sohn HS. Whole-body and pinhole bone scintigraphic manifestations of Reiter's syndrome: distribution patterns and early and characteristic signs. Eur J Nucl Med. 1999 Feb. 26(2):163-70. [Medline].
Taniguchi Y, Kumon Y, Nakayama S, Arii K, Ohnishi T, Ogawa Y, et al. F-18 FDG PET/CT provides the earliest findings of enthesitis in reactive arthritis. Clin Nucl Med. 2011 Feb. 36(2):121-3. [Medline].
Simonini G, Taddio A, Cimaz R. No evidence yet to change American Heart Association recommendations for poststreptococcal reactive arthritis: comment on the article by van Bemmel et al. Arthritis Rheum. 2009 Nov. 60(11):3516-8; author reply 3518-9. [Medline].
Moorthy LN, Gaur S, Peterson MG, Landa YF, Tandon M, Lehman TJ. Poststreptococcal reactive arthritis in children: a retrospective study. Clin Pediatr (Phila). 2009 Mar. 48(2):174-82. [Medline].
Siala M, Gdoura R, Younes M, Fourati H, Cheour I, Meddeb N, et al. Detection and frequency of Chlamydia trachomatis DNA in synovial samples from Tunisian patients with reactive arthritis and undifferentiated oligoarthritis. FEMS Immunol Med Microbiol. 2009 Mar. 55(2):178-86. [Medline].
Rihl M, Kuipers JG. [Reactive arthritis: from pathogenesis to novel strategies]. Z Rheumatol. 2010 Dec. 69(10):864-70. [Medline].
Scott C, Brand A, Natha M. Reactive arthritis responding to antiretroviral therapy in an HIV-1-infected individual. Int J STD AIDS. 2012 May. 23(5):373-4. [Medline].
Rudwaleit M, Braun J, Sieper J. Treatment of reactive arthritis: a practical guide. BioDrugs. 2000 Jan. 13(1):21-8. [Medline].
Nanke Y, Yago T, Kobashigawa T, Kotake S. Efficacy of methotrexate in the treatment of a HLA-B27-positive Japanease patient with reactive arthritis. Nihon Rinsho Meneki Gakkai Kaishi. 2010. 33(5):283-5. [Medline].
Li CW, Ma JJ, Yin J, Liu L, Hu J. [Reiter's syndrome in children: a clinical analysis of 22 cases]. Zhonghua Er Ke Za Zhi. 2010 Mar. 48(3):212-5. [Medline].
Schafranski MD. Infliximab for reactive arthritis secondary to Chlamydia trachomatis infection. Rheumatol Int. 2010 Mar. 30(5):679-80. [Medline].
Gill H, Majithia V. Successful use of infliximab in the treatment of Reiter's syndrome: a case report and discussion. Clin Rheumatol. 2008 Jan. 27(1):121-3. [Medline].
Kiss S, Letko E, Qamruddin S, Baltatzis S, Foster CS. Long-term progression, prognosis, and treatment of patients with recurrent ocular manifestations of Reiter's syndrome. Ophthalmology. 2003 Sep. 110(9):1764-9. [Medline].
Maugars Y, Mathis C, Vilon P, Prost A. Corticosteroid injection of the sacroiliac joint in patients with seronegative spondylarthropathy. Arthritis Rheum. 1992 May. 35(5):564-8. [Medline].
Kvien TK, Gaston JS, Bardin T, Butrimiene I, Dijkmans BA, Leirisalo-Repo M, et al. Three month treatment of reactive arthritis with azithromycin: a EULAR double blind, placebo controlled study. Ann Rheum Dis. 2004 Sep. 63(9):1113-9. [Medline]. [Full Text].
Carter JD et al. Combination Antibiotics as a Treatment for Chronic Chlamydia-Induced Reactive Arthritis. Philadelphia PA. (abstract 1152).: ACR/ARHP Annual Scientific Meeting; October 19, 2009.
Yli-Kerttula T, Luukkainen R, Yli-Kerttula U, Möttönen T, Hakola M, Korpela M, et al. Effect of a three month course of ciprofloxacin on the late prognosis of reactive arthritis. Ann Rheum Dis. 2003 Sep. 62(9):880-4. [Medline]. [Full Text].
Barber CE, Kim J, Inman RD, Esdaile JM, James MT. Antibiotics for treatment of reactive arthritis: a systematic review and metaanalysis. J Rheumatol. 2013 Jun. 40(6):916-28. [Medline].
Clegg DO, Reda DJ, Weisman MH, Cush JJ, Vasey FB, Schumacher HR Jr, et al. Comparison of sulfasalazine and placebo in the treatment of reactive arthritis (Reiter's syndrome). A Department of Veterans Affairs Cooperative Study. Arthritis Rheum. 1996 Dec. 39(12):2021-7. [Medline].
Bravo G, Zazueta B, Lavalle C. An acute remission of Reiter's syndrome in male patients treated with bromocriptine. J Rheumatol. 1992 May. 19(5):747-50. [Medline].
Abdelmoula LC, Yahia CB, Testouri N, Tekaya R, Ben M'barek R, Chaabouni L, et al. [Treatment of reactive arthritis with infliximab]. Tunis Med. 2008 Dec. 86(12):1095-7. [Medline].
Meyer A, Chatelus E, Wendling D, Berthelot JM, Dernis E, Houvenagel E, et al. Safety and efficacy of anti-tumor necrosis factor a therapy in ten patients with recent-onset refractory reactive arthritis. Arthritis Rheum. 2011 May. 63(5):1274-80. [Medline].
Reiter H. Ueber cine bisher unbekannte spirochaeten-infektion (spirochaetosis arthritica). Dtsche Med Wschr. 1916. 42:1535-6.
Tanaka T, Kuwahara Y, Shima Y, Hirano T, Kawai M, Ogawa M, et al. Successful treatment of reactive arthritis with a humanized anti-interleukin-6 receptor antibody, tocilizumab. Arthritis Rheum. 2009 Dec 15. 61(12):1762-4. [Medline].
Kuuliala A, Julkunen H, Paimela L, Peltomaa R, Kautiainen H, Repo H, et al. Double-blind, randomized, placebo-controlled study of three-month treatment with the combination of ofloxacin and roxithromycin in recent-onset reactive arthritis. Rheumatol Int. 2013 Nov. 33 (11):2723-9. [Medline].