19th January 2024

Management 

The main aim of treatment is directed towards symptomatic relief and prevention or slowing down of progressive joint damage. In the acute phase, rest is recommended, but physiotherapy can be used in later stages for symptomatic management.

Pharmacological management

• NSAIDS: NSAIDs are often used first line to treat symptomatic axial and peripheral arthritis, and can improve functional status if used early in the disease process.
• Corticosteroids: In patients unresponsive to NSAIDs, corticosteroids can be trialled. Steroids have been shown to be beneficial in improving symptoms in peripheral joints, but their efficacy in the management of axial disease is limited. Patients with monoarticular or oligoarticular joint involvement may be offered intra-articular steroid injections in acute flares, but if multiple joints are affected or if there are cardiac or ocular manifestations, systemic corticosteroids may be required. Topical corticosteroids can be used to treat skin disease associated with reactive arthritis, i.e. circinate balanitis and keratoderma blennorrhagicum.
• Conventional DMARDs: DMARDs such as Sulfasalazine can be used in patients who do not respond sufficiently to NSAIDs and demonstrate progressive joint damage and functional impairment
• Antibiotics: NICE guidelines recommend treating the initial infection if a causative organism is found, but to not offer long-term treatment to manage the arthritic symptoms following the infection.