Leirisalo-Repo M
Department of Medicine, Helsinki University Central Hospital, Finland.
Rheum Dis Clin North Am. 1998 Nov;24(4):737-51, viii. doi: 10.1016/s0889-857x(05)70039-9.
Prognosis in the majority of patients with acute reactive arthritis is usually good, with most patients recovering in a few months. In about 15% to 30% of such patients, the disease progresses, and spondyloarthropathy and even ankylosing spondylitis develop in the following 10 to 20 years. A recurrent attack of reactive arthritis is common in patients with chlamydia-triggered arthritis, but it is rare in patients who have had enteroarthritis. In patients with chronic spondyloarthropathy without evidence of preceding infection, the disease can progress slowly into ankylosing spondylitis. When reactive chlamydia arthritis is indicated, a prolonged course of antibiotics is needed. For other forms of reactive arthritis, solid evidence in favor of antibiotic therapy is still lacking. Presence of hip pain, decreased mobility of thoracic cervical or thoracic spine, heel pain, inflammatory gut lesions, high erythrocyte sedimentation rate, positive family history, and presence of human leukocyte antigen B27 are indicators for chronicity. Sulfasalazine might be of use in chronic arthritis and ankylosing spondylitis, especially if the patient has peripheral arthritis.
大多数急性反应性关节炎患者的预后通常良好，大多数患者在几个月内康复。在约15%至30%的此类患者中，疾病会进展，在接下来的10至20年内会发展为脊柱关节病甚至强直性脊柱炎。衣原体引发的关节炎患者中反应性关节炎复发很常见，但肠道关节炎患者中则很少见。在无先前感染证据的慢性脊柱关节病患者中，疾病可缓慢发展为强直性脊柱炎。当确诊为反应性衣原体关节炎时，需要延长抗生素疗程。对于其他形式的反应性关节炎，仍缺乏支持抗生素治疗的确凿证据。髋部疼痛、胸颈椎或胸椎活动度降低、足跟疼痛、炎症性肠道病变、红细胞沉降率升高、阳性家族史以及人类白细胞抗原B27阳性是慢性病程的指标。柳氮磺胺吡啶可能对慢性关节炎和强直性脊柱炎有用，特别是当患者有外周关节炎时。
