Alexander Swetha Ann, Kim Eunjung, Mandhadi Ranadeep
Internal Medicine, University of Connecticut, Farmington, USA.
Rheumatology, University of Connecticut, Farmington, USA.
Cureus. 2021 Feb 25;13(2):e13555. doi: 10.7759/cureus.13555.
The aim of this paper is to review and discuss the background, common manifestations, differential diagnosis, and current treatment practices of reactive arthritis. The focus will be on the choice of therapy in patients with poor prognostic factors. A PubMed search was performed in March 2020 on reactive arthritis and revealed 137 articles. Fourteen case reports and four large-scale studies that are pertinent for discussion in terms of treatment of reactive arthritis over the past five years are reported along with poor prognostic markers. The first choice of therapy regardless of the number of poor prognostic markers is non-steroidal anti-inflammatory drugs (NSAIDs). The second choice of therapy appeared to be glucocorticoids in the oral as well as intra-articular forms. No correlation was detected between the need for systemic steroids and the number of poor prognostic factors present. The third choice of therapy appears to be disease-modifying anti-rheumatic drugs (DMARDs) (such as sulfasalazine) and their increasing use can be demonstrated over time. Novel therapies such as adalimumab have also been shown to be used and this shows a strong correlation with an increased number of poor prognostic factors. Reporting of these case reports and review of literature contribute to knowing more about reactive arthritis and help keep us up to date with newer therapies available when patients do not respond to conventional therapy. It was notable that the increased number of poor prognostic factors and non-responders have shown increased use of tumor necrosis factor inhibitors (TNFI) such as adalimumab.
本文旨在回顾和讨论反应性关节炎的背景、常见表现、鉴别诊断及当前的治疗方法。重点将放在具有不良预后因素患者的治疗选择上。2020年3月在PubMed上检索了反应性关节炎相关内容，共检索到137篇文章。本文报告了过去五年中与反应性关节炎治疗相关的14例病例报告和4项大型研究，以及不良预后指标。无论不良预后指标数量多少，治疗的首选药物都是非甾体抗炎药（NSAIDs）。治疗的第二选择似乎是口服和关节腔内注射的糖皮质激素。未发现全身使用糖皮质激素的必要性与存在的不良预后因素数量之间存在相关性。治疗的第三选择似乎是改善病情抗风湿药（DMARDs）（如柳氮磺胺吡啶），并且随着时间的推移其使用量不断增加。诸如阿达木单抗等新型疗法也已被证明有应用，且这与不良预后因素数量增加密切相关。这些病例报告的发表及文献综述有助于我们更多地了解反应性关节炎，并帮助我们在患者对传统治疗无反应时及时了解可用的新疗法。值得注意的是，不良预后因素数量增加以及无反应者增多的情况下，肿瘤坏死因子抑制剂（TNFI）如阿达木单抗的使用量有所增加。
