Leirisalo-Repo M
Second Department of Medicine, Helsinki University Central Hospital, Finland.
APMIS. 1993 Aug;101(8):575-81. doi: 10.1111/j.1699-0463.1993.tb00149.x.
In the pathogenesis of reactive arthritis, infection through the mucosal route and genetic susceptibility (HLA-B27) are the most important contributing factors. With regard to non-specific urethritis, most probably caused by Chlamydia trachomatis infection, the use of early antimicrobial therapy has been shown to be effective in preventing arthritic recurrences. When the arthritis has been initiated, short-term conventional antimicrobial therapy seems unable to modify the course of the ongoing disease. In patients with acute reactive arthritis, a prolonged (3-month) treatment with tetracycline shortens the duration of arthritis when triggered by Chlamydia trachomatis, while such treatment has not proved effective in enteroarthritis. In patients with chronic reactive enteroarthritis, a prolonged course of quinolones, such as ciprofloxacin, might be of benefit. Sulfasalazine, which has an effect in the acute exacerbations of ankylosing spondylitis, is probably also effective in chronic reactive arthritis. An antimicrobial effect can be one of the mechanisms by which sulfasalazine exerts its therapeutic effect. Follow-up studies are necessary to assess the influence of antibiotic therapy on the late prognosis of patients with reactive arthritis.
在反应性关节炎的发病机制中，经黏膜途径感染和遗传易感性（HLA - B27）是最重要的促成因素。关于最有可能由沙眼衣原体感染引起的非特异性尿道炎，早期使用抗菌疗法已被证明可有效预防关节炎复发。当关节炎已经发作时，短期常规抗菌疗法似乎无法改变正在进展的疾病进程。在急性反应性关节炎患者中，由沙眼衣原体引发的关节炎，使用四环素进行为期3个月的延长治疗可缩短关节炎持续时间，而这种治疗在肠道关节炎中尚未证明有效。在慢性反应性肠道关节炎患者中，使用环丙沙星等喹诺酮类药物进行延长疗程治疗可能有益。柳氮磺胺吡啶对强直性脊柱炎的急性加重有效，可能对慢性反应性关节炎也有效。抗菌作用可能是柳氮磺胺吡啶发挥治疗作用的机制之一。有必要进行随访研究以评估抗生素治疗对反应性关节炎患者远期预后的影响。
