Reactive Arthritis: Treatment Challenges and Future Perspectives

Abstract

Purpose of the Review

Reactive arthritis is synovitis related to an infection away from the joint. The evolution is variable, frequently self-limited, but with the possible evolution to a prolonged form, generating functional incapacity and sequelae.

Recent Findings

New microbiological families have been incriminated and pathophysiological links have been clarified, highlighting the role of the mucous membranes (gut in particular), specific cell populations, and the production of pro-inflammatory cytokines. First-line pharmacological treatment is based on NSAIDs. In case of failure, synthetic and more recently biological DMARDs are indicated. Only open data are available for biological DMARDs but suggest good efficacy and safety.

Summary

Reactive arthritis has not disappeared. The diagnosis must be mentioned by the clinic and history to allow the rapid introduction of an appropriate treatment.

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Correspondence to Daniel Wendling.

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Conflict of Interest

Daniel Wendling: Occasional interventions (speaking fees, advisory board): AbbVie, BMS, MSD, Pfizer, Roche Chugai, Amgen, Nordic Pharma, UCB, Novartis, Janssen, Celgene, Hospira, Lilly, Sandoz, Grunenthal. Indirect interests: Abbvie, Pfizer, Roche Chugai, MSD, UCB, Mylan, Fresenius Kabi.

C Prati: Novartis, Lily and Pfizer

M Chouk: none

F Verhoeven: Novartis, MSD, Celgene, Amgen and BMS

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Wendling, D., Prati, C., Chouk, M. et al. Reactive Arthritis: Treatment Challenges and Future Perspectives. Curr Rheumatol Rep 22, 29 (2020). https://doi.org/10.1007/s11926-020-00904-9

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Keywords

  • Reactive arthritis
  • Spondyloarthritis
  • Interleukin-23
  • Interleukin-17
  • Treatment
  • Anti-TNF agents
  • Biodrugs