How is Reiter’s Syndrome treated?
Symptomatic treatment with high doses of a nonsteroidal anti-inflammatory drug (NSAID) and steroid injections into affected joints can be helpful (Barth & Segal, 1999). NSAIDs can reduce joint inflammation and are commonly used to treat patients with reactive arthritis. Some traditional NSAIDs, such as aspirin and ibuprofen, are available without a prescription, but others that are more effective for reactive arthritis, such as indomethacin and tolmetin, must be prescribed by a doctor. Less is known about whether a new class of NSAIDs, called COX-2 inhibitors, is effective for reactive arthritis, but they may reduce the risk of gastrointestinal complications associated with traditional NSAIDs (National Institutes of Health, 2004). For people with severe joint inflammation, injections of corticosteroids directly into the affected joint may reduce inflammation. Doctors usually prescribe these injections only after trying unsuccessfully to control arthritis with NSAIDs.
A small percentage of patients with reactive arthritis have severe symptoms that cannot be controlled with any of the above treatments. For these people, medicine that suppresses the immune system, such as sulfasalazine or methotrexate, may be effective (Clegg, et al., 1996; Creemers et al., 1994; National Institutes of Health, 2004).
Topical corticosteroids, which come in a cream or lotion, can be applied directly on the skin lesions associated with reactive arthritis. Topical corticosteroids reduce inflammation and promote healing (National Institutes of Health, 2004).
Antibiotics to eliminate the bacterial infection that triggered the reactive arthritis may be prescribed. The specific antibiotic prescribed depends on the type of bacterial infection present. It is important to follow instructions about how much medicine to take and for how long; otherwise the infection may persist. Typically, an antibiotic is taken for 7 to 10 days or longer (National Institutes of Health, 2004). Currently, however, there is no evidence to suggest that antibiotic treatment is beneficial once reactive arthritis has occurred (Hill Gaston & Lillicrap, 2003).
Several relatively new treatments that suppress tumor necrosis factor (TNF), a protein involved in the body’s inflammatory response, may be effective for reactive arthritis and other spondyloarthropathies. They include etanercept and infliximab. These treatments were first used to treat rheumatoid arthritis (National Institutes of Health, 2004).
Exercise, when introduced gradually, may help improve joint function. In particular, strengthening and range-of-motion exercises will maintain or improve joint function. Strengthening exercises builds up the muscles around the joint to better support it. Muscle-tightening exercises that do not move any joints can be done even when a person has inflammation and pain. Range-of-motion exercises improve movement and flexibility and reduce stiffness in the affected joint. For patients with spine pain or inflammation, exercises to stretch and extend the back can be particularly helpful in preventing long-term disability. Aquatic exercise also may be helpful. Before beginning an exercise program, patients should talk to a health professional who can recommend appropriate exercises (National Institutes of Health, 2004).
What Is the Prognosis for People Who Have Reiter’s Syndrome or Reactive Arthritis?
Most people with reactive arthritis recover fully from the initial flare of symptoms and are able to return to regular activities 2 to 6 months after the first symptoms appear. In some cases, the symptoms of arthritis may last up to 12 months, although these symptoms are usually very mild and do not interfere with daily activities. Approximately 20% of people with reactive arthritis will have chronic (long-term) arthritis, which usually is mild. Studies show that between 15 and 50% of patients will develop symptoms again sometime after the initial flare has disappeared (Yu et al., 2001; National Institutes of Health, 2004). Back pain and arthritis are the symptoms that most commonly reappear. Up to one-third of affected individuals will have chronic, severe arthritis that is difficult to control with treatment and may cause joint deformity (Kataria & Brent, 2004; Leirisalo-Repo et al., 1997; National Institutes of Health, 2004; Yu et al., 2001). One study found that two-thirds of individuals who developed reactive arthritis after a Salmonella infection continued to have symptoms at five years of follow-up (Thomson et al., 1995). Symptoms were severe enough to force a change in work for four of 18 individuals and another four had objective damage to joints radiographically.
Overall, a relapsing course appears less common in enteric-infection-related disease than in Chlamydia-associated reactive arthritis (of genitourinary origin). HLA-B27 contributes to the development of chronic disease and therefore, the prognosis is less favorable in those who are HLA-positive (Hill Gaston & Lillicrap, 2003; Leirisalo-Repo et al., 1997).