Tumor necrosis factor (TNF)-alpha inhibitors
Mild elevations of TNF have been identified in the serum of ReA patients compared with controls.[72]Rihl M, Gu J, Baeten D, et al. Alpha beta but not gamma delta T cell clones in synovial fluids of patients with reactive arthritis show active transcription of tumour necrosis factor alpha and interferon gamma. Ann Rheum Dis. 2004;63:1673-1676.
http://www.ncbi.nlm.nih.gov/pubmed/15547094?tool=bestpractice.com
Observational data suggest clinical benefit among ReA patients receiving TNF-alpha inhibitors; prospective randomized controlled trials are required.[73]Flagg SD, Meador R, Hsia E, et al. Decreased pain and synovial inflammation after etanercept therapy in patients with reactive and undifferentiated arthritis: an open-label trial. Arthritis Rheum. 2005;53:613-617.
http://www.ncbi.nlm.nih.gov/pubmed/16082643?tool=bestpractice.com
[74]Oili KS, Niinisalo H, Korpilahde T, et al. Treatment of reactive arthritis with infliximab. Scand J Rheumatol. 2003;32:122-124.
http://www.ncbi.nlm.nih.gov/pubmed/12737333?tool=bestpractice.com
[75]Haibel H, Brandt J, Rudwaleit M, et al. Therapy of chronic enteral reactive arthritis with infliximab. Ann Rheum Dis. 2003;62:ABO380.[76]Meyer A, Chatelus E, Wendling D, et al. Safety and efficacy of anti-tumor necrosis factor α therapy in ten patients with recent-onset refractory reactive arthritis. Arthritis Rheum. 2011;63:1274-1280.
http://onlinelibrary.wiley.com/doi/10.1002/art.30272/full
http://www.ncbi.nlm.nih.gov/pubmed/21538314?tool=bestpractice.com
[77]Brinster A, Guillot X, Prati C, et al. Anti-TNF treatment of reactive arthritis. A monocentric experience. Joint Bone Spine. 2017 Mar;84(2):237-238.
https://www.doi.org/10.1016/j.jbspin.2016.02.022
http://www.ncbi.nlm.nih.gov/pubmed/27236263?tool=bestpractice.com
There is some evidence to suggest TNF-alpha inhibitors do not reactivate the infective trigger in patients with ReA.[59]Carlin E, Marzo-Ortega H, Flew S. British Association of Sexual Health and HIV national guideline on the management of sexually acquired reactive arthritis 2021. Int J STD AIDS. 2021 Oct;32(11):986-997.
http://www.ncbi.nlm.nih.gov/pubmed/34014782?tool=bestpractice.com
Antibiotics
Several prospective randomized controlled trials have indicated that antibiotic therapy may be of benefit in patients with postchlamydial ReA.[78]Lauhio A, Leirisalo-Repo M, Lahdevirta J, et al. Double-blind, placebo-controlled study of three-month treatment with lymecycline in reactive arthritis, with special reference to Chlamydia arthritis. Arthritis Rheum. 1991;34:6-14.
http://www.ncbi.nlm.nih.gov/pubmed/1670621?tool=bestpractice.com
[46]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;31:1973-1980.
http://www.ncbi.nlm.nih.gov/pubmed/15468362?tool=bestpractice.com
[79]Putschky N, Pott HG, Kuipers JG, et al. Comparing 10-day and 4-month doxycycline courses for treatment of Chlamydia trachomatis-reactive arthritis: A prospective, double-blind trial. Ann Rheum Dis. 2006;65:1521-1524.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1798345/?tool=pubmed
http://www.ncbi.nlm.nih.gov/pubmed/17038453?tool=bestpractice.com
[80]Carter JD, Espinoza LR, Inman RD, et al. Combination antibiotics as a treatment for chronic Chlamydia-induced reactive arthritis: a double-blind, placebo-controlled, prospective trial. Arthritis Rheum. 2010;62:1298-1307.
http://www.ncbi.nlm.nih.gov/pubmed/20155838?tool=bestpractice.com
However, a systematic review and meta-analysis found that antibiotic treatment had no significant effect on remission of ReA triggered by chlamydial infection.[81]Barber CE, Kim J, Inman RD, et al. Antibiotics for treatment of reactive arthritis: a systematic review and meta-analysis. J Rheumatol. 2013;40:916-928.
http://www.ncbi.nlm.nih.gov/pubmed/23588936?tool=bestpractice.com
Heterogeneity in trial results was reported and may have been attributable to differences in study design.[81]Barber CE, Kim J, Inman RD, et al. Antibiotics for treatment of reactive arthritis: a systematic review and meta-analysis. J Rheumatol. 2013;40:916-928.
http://www.ncbi.nlm.nih.gov/pubmed/23588936?tool=bestpractice.com
There is no data to suggest that long-term antibiotics have any therapeutic effect in the treatment of postenteric infection. Further high quality prospective RCTs are needed to confirm the role of antibiotic therapy in the management of postchlamydial ReA.