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Migliorini F, Bell A, Vaishya R, Eschweiler J, Hildebrand F, Maffulli N. Reactive arthritis following COVID-19 current evidence, diagnosis, and management strategies. J Orthop Surg Res 2023; 18:205. [PMID: 36922870 PMCID: PMC10017067 DOI: 10.1186/s13018-023-03651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/25/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Immune-mediated conditions associated to Corona Virus Disease-19 (COVID-19) have been reported, including vasculitis, antiphospholipid antibody syndrome, myositis, and lupus. Emerging studies have reported the potential occurrence of reactive arthritis in patients previously infected with COVID-19. This systematic review summarised the current evidence on the occurrence of reactive arthritis in patients previously infected by COVID-19. METHODS This study was conducted according to the 2020 PRISMA guidelines. All the clinical investigations describing the occurrence of reactive arthritis following COVID-19 were accessed. In September 2022, the following databases were accessed: PubMed, Web of Science, Google Scholar, Embase. The generalities of the study were extracted: author, year and journal of publication, country of the main author, study design, sample size, mean age, number of women, main results of the study. The following data on COVID-19 severity and management were retrieved: type of treatment, hospitalization regimes (inpatient or outpatient), admission to the intensive care unit, need of mechanical ventilation, pharmacological management. The following data on reactive arthritis were collected: time elapsed between COVID-19 infection to the onset of reactive arthritis symptoms (days), pharmacological management, type of arthritis (mono- or bilateral, mono- or polyarticular), extra-articular manifestations, presence of tenosynovitis or enthesitis, synovial examination at microscopic polarised light, imaging (radiography, magnetic resonance, sonography), clinical examination, laboratory findings. RESULTS Data from 27 case reports (54 patients) were retrieved, with a mean age of 49.8 ± 14.5 years. 54% (29 of 54 patients) were women. The mean time span between COVID-19 infection and the occurrence of reactive arthritis symptoms was 22.3 ± 10.7 days. Between studies diagnosis and management of reactive arthritis were heterogeneous. Symptoms resolved within few days in all studies considered. At last follow-up, all patients were minimally symptomatic or asymptomatic, and no additional therapy or attentions were required by any patient. CONCLUSION Poor evidence suggests that COVID-19 could target the musculoskeletal system causing reactive arthritis at its post infectious stage. COVID-19 can act as a causative agent or as a trigger for development of reactive arthritis even without presence of antibodies of rheumatological disorders. Treating physicians should have a high index of suspicion while treating post infectious COVID-19 patient with arthralgia. LEVEL OF EVIDENCE Level IV, systematic review.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany. .,Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany.
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals Institutes of Orthopaedics, New Delhi, India
| | - Jörg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, ST4 7QB, England.,Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, E1 4DG, England
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Carlin E, Marzo-Ortega H, Flew S. British Association of Sexual Health and HIV national guideline on the management of sexually acquired reactive arthritis 2021. Int J STD AIDS 2021; 32:986-997. [PMID: 34014782 DOI: 10.1177/09564624211020266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
These guidelines update the 2008 UK guideline for the management of sexually acquired reactive arthritis. The guideline is aimed at those over the age of 16 years, presenting to healthcare professionals working in sexual health services. The recommendations are primarily aimed at services offering level 3 care in sexually transmitted infection management within the United Kingdom. However, the principles will apply to those presenting to level 1 and 2 services, and appropriate local referral pathways will need to be developed.
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Affiliation(s)
- Elizabeth Carlin
- Integrated Sexual Health Service, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, UK.,Integrated Sexual Health Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds Institute of Rheumatic and Musculoskeletal Medicine, 246751University of Leeds, Leeds, UK
| | - Sarah Flew
- Integrated Sexual Health Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Catan L, Boariu M, Amaricai E, Popa D, Puenea G, Drăgoi M, Stratul Ș, Drăgoi RG. Predicting functional disability in patients with spondyloarthritis using a CRP-based algorithm: A 3-year prospective study. Exp Ther Med 2020; 21:89. [PMID: 33363600 DOI: 10.3892/etm.2020.9521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/10/2020] [Indexed: 01/22/2023] Open
Abstract
This prospective study explored the link between values of C-reactive protein (CRP) in patients with SpA (ankylosing spondylitis, psoriatic arthritis, reactive arthritis, or arthritis-related inflammatory bowel disease) and functional disability in order to derive an algorithm that may predict functional disability based on disease activity. Patients diagnosed with Spa were classified into five groups based on the type of therapy and they were followed up for 3 years. Group 1: Symptomatic medication alone; Group 2: Disease-modifying antirheumatic drugs (DMARDs); Group 3: DMARDs and 30 rehabilitation sessions twice a year; Group 4: Group 3 therapy and biologic anti-tumor necrosis factor-alpha (anti-TNF-α) drugs; and Group 5: Group 4 therapy and, in addition, a daily home-adapted kinesiotherapy program. CRP, modified Health Assessment Questionnaire (mHAQ-S), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and T-score of the patients were recorded. Correlation and multivariate regression analyses were conducted using demographic data, CRP, and mHAQ-S scores to derive the CRP-mHAQ-S correlation algorithm. Statistical analysis included the chi-square, Mann-Whitney, and multiple regression tests and repeated measures analysis of variance. A total of 144 patients were enrolled, all of whom completed the study. The best predictive model (P<0.001) provided the algorithm mHAQ-S36=17.14+0.12xCRP0-0.24xCRP12-0.15xCRP36 (CRP0, CRP12, and CRP36 correspond to CRP levels at baseline, 12, and 36 months, respectively, and mHAQ-S36 to mHAQ-S score at 36 months). This derived algorithm based on objective CRP assessment may have implications in the prediction of functional disability evolution in patients with SpA.
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Affiliation(s)
- Liliana Catan
- Department of Balneology, Medical Rehabilitation and Rheumatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marius Boariu
- Department of Endodontics, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Elena Amaricai
- Department of Balneology, Medical Rehabilitation and Rheumatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Daniel Popa
- Department of Balneology, Medical Rehabilitation and Rheumatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania.,Rehabilitation and Rheumatology Department, City University and Emergency Hospital, 300020 Timisoara, Romania
| | - George Puenea
- Department of Balneology, Medical Rehabilitation and Rheumatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mihai Drăgoi
- Department of Balneology, Medical Rehabilitation and Rheumatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania.,Rehabilitation and Rheumatology Department, City University and Emergency Hospital, 300020 Timisoara, Romania
| | - Ștefan Stratul
- Department of Periodontology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Răzvan Gabriel Drăgoi
- Department of Balneology, Medical Rehabilitation and Rheumatology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania.,Rehabilitation and Rheumatology Department, City University and Emergency Hospital, 300020 Timisoara, Romania
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Honda K, Iwanaga N, Izumi Y, Tsuji Y, Kawahara C, Michitsuji T, Higashi S, Kawakami A, Migita K. Reactive Arthritis Caused by Yersinia enterocolitica Enteritis. Intern Med 2017; 56:1239-1242. [PMID: 28502944 PMCID: PMC5491824 DOI: 10.2169/internalmedicine.56.7888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
We report a case of reactive arthritis (ReA) triggered by Yersinia enterocolitica enteritis. A 24-year-old Japanese man developed polyarthritis in the lower limbs. Two weeks prior to these symptoms, he noted diarrhea, right lower abdominal pain and a fever. Y. enterocolitica was not isolated from a stool culture; however, he was diagnosed with ReA based on the colonoscopic findings of a high anti-Y. enterocolitica antibody titer and HLA-B27 antigen positivity. Following treatment with methotrexate and steroids, his arthritis improved. This is the first reported Japanese case of ReA in the English literature after a gastrointestinal infection caused by Y. enterocolitica.
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Affiliation(s)
- Kazuya Honda
- Department of Rheumatology and General Internal Medicine, Nagasaki Medical Center, Japan
| | - Nozomi Iwanaga
- Department of Rheumatology and General Internal Medicine, Nagasaki Medical Center, Japan
| | - Yasumori Izumi
- Department of Rheumatology and General Internal Medicine, Nagasaki Medical Center, Japan
| | - Yoshika Tsuji
- Department of Rheumatology and General Internal Medicine, Nagasaki Medical Center, Japan
| | - Chieko Kawahara
- Department of Rheumatology and General Internal Medicine, Nagasaki Medical Center, Japan
| | - Toru Michitsuji
- Department of Rheumatology and General Internal Medicine, Nagasaki Medical Center, Japan
| | | | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Kiyoshi Migita
- Department of Rheumatology and General Internal Medicine, Nagasaki Medical Center, Japan
- Department of Rheumatology, Fukushima Medical University School of Medicine, Japan
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Generali E, Ceribelli A, Massarotti M, Cantarini L, Selmi C. Seronegative reactive spondyloarthritis and the skin. Clin Dermatol 2015; 33:531-7. [DOI: 10.1016/j.clindermatol.2015.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Palazzi C, D’Angelo S, Gilio M, Leccese P, Padula A, Olivieri I. Pharmacological therapy of spondyloarthritis. Expert Opin Pharmacother 2015; 16:1495-504. [DOI: 10.1517/14656566.2015.1052744] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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7
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Carlin EM, Ziza JM, Keat A, Janier M. 2014 European Guideline on the management of sexually acquired reactive arthritis. Int J STD AIDS 2014; 25:901-12. [DOI: 10.1177/0956462414540617] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- EM Carlin
- Sherwood Forest Hospitals NHS Foundation Trust & Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - JM Ziza
- Groupe Hospitalier Diaconesses Croix-Saint Simon, Paris, France
| | - A Keat
- Northwick Park & St Mark’s NHS Trust, London, UK
| | - M Janier
- STD Clinic Hôpital Saint-Louis AP-HP, Paris, France
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Kilic G, Kilic E, Akgul O, Ozgocmen S. Is iontophoresis really an effective modality for the treatment of dactylitis? Int J Rheum Dis 2014; 17:226-8. [DOI: 10.1111/1756-185x.12092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Gamze Kilic
- Division of Rheumatology; Department of Physical Medicine and Rehabilitation; Faculty of Medicine; Erciyes University; Gevher Nesibe Hospital; Kayseri Turkey
| | - Erkan Kilic
- Division of Rheumatology; Department of Physical Medicine and Rehabilitation; Faculty of Medicine; Erciyes University; Gevher Nesibe Hospital; Kayseri Turkey
| | - Ozgur Akgul
- Division of Rheumatology; Department of Physical Medicine and Rehabilitation; Faculty of Medicine; Erciyes University; Gevher Nesibe Hospital; Kayseri Turkey
| | - Salih Ozgocmen
- Division of Rheumatology; Department of Physical Medicine and Rehabilitation; Faculty of Medicine; Erciyes University; Gevher Nesibe Hospital; Kayseri Turkey
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Rizzo A, Domenico MD, Carratelli CR, Paolillo R. The role of Chlamydia and Chlamydophila infections in reactive arthritis. Intern Med 2012; 51:113-7. [PMID: 22214635 DOI: 10.2169/internalmedicine.51.6228] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Chlamydia trachomatis and Chlamydophila pneumoniae are human pathogens; the former being the etiologic agent for trachoma as well as a prevalent sexually transmitted bacterium, while C. pneumoniae is a respiratory pathogen responsible for community-acquired pneumonia. Patients with reactive arthritis show evidence of present or past Chlamydial infection. Chlamydia spp., has been strongly implicated as a triggering factor for reactive arthritis. We describe the simultaneous occurrence of C. pneumoniae and C. trachomatis infections in a subject with reactive arthritis. We suggest treatment for a patient with Chlamydia-associated arthritis to define a means by which persistent organisms can be induced to return to the active developmental cycle, thereby making them more accessible to antibiotic activity.
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Affiliation(s)
- Antonietta Rizzo
- Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology, Faculty of Medicine and Surgery-Second University of Naples, Italy.
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10
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Nanke Y, Yago T, Kobashigawa T, Kotake S. Efficacy of methotrexate in the treatment of a HLA-B27-positive Japanease patient with reactive arthritis. NIHON RINSHO MEN'EKI GAKKAI KAISHI = JAPANESE JOURNAL OF CLINICAL IMMUNOLOGY 2010; 33:283-5. [PMID: 21048390 DOI: 10.2177/jsci.33.283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of reactive arthritis in a 21-year-old man who was successfully treated with methotrexate. In July 2008, the patient experienced arthritis in the left knee 3 days after being diagnosed as having urethritis by the urology clinic. The patient was treated with loxoprofen sodium and fosfomycin calcium at an orthopedic clinic. Antibiotics induced clinical improvement of urethritis, although arthritis became worse. Even after sulphasalazine and corticosteroid were started, polyarthritis remained persistent. Finally, methtrexate was added ; thereafter, polyarthritis and elevated CRP were resolved. HLA-B270502 was positive. Methotrexate could be one of the choices for sulphasalazine-resistant reactive arthritis.
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Affiliation(s)
- Yuki Nanke
- Institute of Rheumatology, Tokyo Women's Medical University, Japan
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Tanaka T, Kuwahara Y, Shima Y, Hirano T, Kawai M, Ogawa M, Arimitsu J, Hagihara K, Narazaki M, Ogata A, Kawase I, Kishimoto T. Successful treatment of reactive arthritis with a humanized anti-interleukin-6 receptor antibody, tocilizumab. ACTA ACUST UNITED AC 2010; 61:1762-4. [PMID: 19950316 DOI: 10.1002/art.24899] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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12
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Davis JC, Mease PJ. Insights Into the Pathology and Treatment of Spondyloarthritis: From the Bench to the Clinic. Semin Arthritis Rheum 2008; 38:83-100. [DOI: 10.1016/j.semarthrit.2007.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 10/11/2007] [Accepted: 10/29/2007] [Indexed: 12/18/2022]
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13
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Kim SK, An JY, Park MS, Kim BJ. A Case Report of Reiter's Syndrome with Progressive Myelopathy. J Clin Neurol 2007; 3:215-8. [PMID: 19513137 PMCID: PMC2686942 DOI: 10.3988/jcn.2007.3.4.215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 09/26/2007] [Indexed: 01/31/2023] Open
Abstract
Reiter's syndrome belongs to the family of spondyloarthropathies that usually present with a triad of arthritis, urethritis, and uveitis. The diagnostic criteria include clinical, radiological, and genetic findings, and the response to treatment. Nervous system involvement in Reiter's syndrome is extremely rare. We report here on a 36-year-old man who initially presented with progressive cervical myelopathy and was diagnosed as Reiter's syndrome 2 years later. The myelopathy was stable after treatment with methotrexate and sulfasalazine. This case suggests that Reiter's syndrome can present as progressive myelopathy and should be considered in the differential diagnosis of treatable myelopathies.
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Affiliation(s)
- Soo Kyoung Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sreenivasan PK, Gaffar A. Antibacterials as anti-inflammatory agents: dual action agents for oral health. Antonie van Leeuwenhoek 2007; 93:227-39. [PMID: 17851778 DOI: 10.1007/s10482-007-9197-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Accepted: 08/09/2007] [Indexed: 01/29/2023]
Abstract
BACKGROUND Inflammatory processes with a range of specialized cells and biochemical mediators form a complex network of inter-related signal transducing pathways that relay information to preserve normal functions. Advances in molecular analyses of the information relay pathways for their constituents and principal ligands along with mechanisms utilized by the host for microbial recognition have stimulated interest in therapeutic agents with dual functionalities i.e. antibacterial and anti-inflammatory effects. AIM This review examines clinically tested agents for oral health applications with both antimicrobial and anti-inflammatory effects to include antibiotics, antimicrobials and phenolics. RESULTS Bis-phenols such as triclosan, representing a unique dual functional therapeutic for routine oral hygiene, with its demonstrated clinical effects on inhibiting the dental plaque biofilm, reducing inflammation (gingivitis) and subsequent periodontitis is described. Cyclines, comprising another class of approved anti-inflammatory agents used at the patient level for oral health is discussed. Dual active agents in current clinical practice for systemic conditions are highlighted to summarize the clinical validity of dual function agents as an emerging therapeutic strategy. CONCLUSIONS Clinical studies demonstrate therapeutic benefits of agents with dual functionality with their effects on microorganisms and the concomitant host inflammatory response. Advances in microbial pathogenesis and resultant inflammation will facilitate progress in this emerging area poised to be a significant milestone for dental therapeutics.
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Affiliation(s)
- Prem K Sreenivasan
- Colgate-Palmolive Company, 909 River Road, Piscataway, NJ 08855-1343, USA
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Palazzi C, Padula A, Montaruli M, Pennese E, Olivieri I. Pharmacological management of undifferentiated spondyloarthropathies. Expert Opin Investig Drugs 2006; 15:39-46. [PMID: 16370932 DOI: 10.1517/13543784.15.1.39] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Among undifferentiated spondyloarthropathies (uSpA) are included incomplete forms or early phases of definite seronegative spondyloarthritides and cases of spondyloarthritides that remain undifferentiated. The treatment of all spondyloarthritides is more conditioned by the disease localisation, number of involved districts and severity of inflammation rather than by the subtype of the spondyloarthritides itself. Specific studies focused on the pharmacological approach to uSpA are scarce. As a consequence, many drugs are used on the basis of the experiences that have been gained in the treatment of other spondyloarthritides. At present, non-steroidal anti-inflammatory drugs/COX-2 inhibitors and disease-modifying antirheumatic drugs are the main therapeutic agents for the involvement of peripheral joints in uSpA. In those cases in which severe symptoms persist despite these treatments or when there is a severe axial involvement, antitumour necrosis factor agents represent an effective choice. In these patients, antitumour necrosis factor treatment raises the important possibility of blocking a shift from uSpA to differentiated severe forms of spondyloarthritides such as ankylosing spondylitis. Local administration of corticosteroids is useful when a small number of joints are involved, as is also the case for the extra-articular localisations of soft tissues.
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Affiliation(s)
- Carlo Palazzi
- Division of Rheumatology, Villa Pini Clinic, Chieti, Italy.
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Pavlica L, Nikolic D, Magic Z, Brajuskovic G, Strelic N, Milicic B, Jovelic A. Successful Treatment of Postvenereal Reactive Arthritis With Synovectomy and 3 Months’ Azithromycin. J Clin Rheumatol 2005; 11:257-63. [PMID: 16357772 DOI: 10.1097/01.rhu.0000182153.18181.81] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The effects of antibiotic therapy on the course of postvenereal reactive arthritis have not yet been elucidated. OBJECTIVE The objective of this study was to observe the clinical course and outcome of synovectomy and 3 months of azithromycin therapy in patients with reactive arthritis and previously diagnosed triggering bacteria. METHODS We performed an open, prospective study on 20 (14 male/6 female) patients with postvenereal reactive knee arthritis, aged 36.7 +/- 14.8 years, and with 16.5 +/- 20.4 months' duration of the disease. Detection of bacteria triggers was done by polymerase chain reaction, isolation and identification, and electron microscopy. Synovectomy was performed in all patients at entry into the study. Azithromycin was given at a dose of 500 mg per day for 5 days, and then 500 mg twice a week, during a 3-month period. Patients without remission were treated with combined antibiotic therapy using a macrolide, quinolone, and tetracycline for the next 4 months. Outcome evaluations of therapeutic efficacy and azithromycin safety were done after 1 and 3 months and 2 years of follow up. RESULTS Remission, defined by the absence of joint swelling and tenderness, and extraarticular signs, was reached after 3 months in 15 of 20 (75.0%) patients (P = 0.025). Of 5 patients with persistent knee arthritis, remission was achieved with combined antibiotic therapy in 4. Visual analog scale scores (P < 0.01), the number of patients (P = 0.002), and the number of samples (P = 0.01) with a positive finding of bacteria or their DNA were significantly lower after 3 months of therapy. During the azithromycin therapy, there were no significant adverse effects. CONCLUSIONS These patients with reactive arthritis did extremely well on the regimen described. In our study group, the number of patients and the number of samples with positive findings of bacteria or their DNA were lower after the antibiotic treatment combined with surgery, although not all bacteria were eradicated. Adverse effects of prolonged azithromycin administration were insignificant. This open treatment approach is recommended but does need a study with controls.
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Affiliation(s)
- Ljiljana Pavlica
- Department of Rheumatology and Clinical Immunology, Military Medical Academy, Belgrade, Serbia and Montenegro.
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