Toivanen A
Department of Medicine, Turku University, Finland.
Drugs. 2001;61(3):343-51. doi: 10.2165/00003495-200161030-00003.
Reactive arthritis (ReA) is definitely caused by an infection. Several observations suggest that the triggering microbe may persist in the tissues of the patient for a prolonged time. The obvious conclusion is to consider antibacterial treatment. In two instances antibacterial agents are of definite value: in the primary and secondary prevention of rheumatic fever and for early eradication of Borrelia burgdorferi in order to prevent development of the arthritis associated with Lyme disease. Altogether, clinical and experimental data exist to indicate that if antibacterial treatment of ReA can be started very early during the pathogenetic process, the disease can be prevented or the prognosis improved. In fully developed ReA, the value of antibacterial agents is less certain. All available evidence indicates that short term antibacterial treatment has no effect on the prognosis and final outcome of ReA, and the results with long term administration of antibacterials are also overall poor. In some instances sulfasalazine appears useful, rather as a result of its antirheumatic effect or influence on an underlying inflammatory bowel disease than its action as an antibacterial agent. Tetracyclines have also been found to have an effect on ReA, but again, this is probably due to their anti-inflammatory action rather than any antibacterial effect.
反应性关节炎（ReA）肯定是由感染引起的。多项观察结果表明，引发感染的微生物可能会在患者组织中持续较长时间。显而易见的结论是考虑进行抗菌治疗。在两种情况下抗菌药物具有明确的价值：用于风湿热的一级和二级预防，以及早期根除伯氏疏螺旋体以预防莱姆病相关关节炎的发生。总体而言，临床和实验数据表明，如果在发病过程中非常早期就开始对ReA进行抗菌治疗，疾病可以得到预防或预后得到改善。在病情完全发展的ReA中，抗菌药物的价值不太确定。所有现有证据表明，短期抗菌治疗对ReA的预后和最终结局没有影响，长期使用抗菌药物的结果总体也不佳。在某些情况下，柳氮磺胺吡啶似乎有用，这更可能是由于其抗风湿作用或对潜在炎症性肠病的影响，而非其抗菌作用。四环素也被发现对ReA有作用，但同样，这可能是由于它们的抗炎作用而非任何抗菌作用。
