Decreased pain and synovial inflammation after etanercept therapy in patients with reactive and undifferentiated arthritis: An open-label trial

Reactive arthritis: defined etiologies, emerging pathophysiology, and unresolved treatment

ReA is unique in that it is one of the few disease states of which there is a known trigger. This insight into disease initiation has led to great advances in the pathophysiology. Despite this detailed knowledge, the proper treatment remains elusive. In the years to come it is possible that the specific treatment will be dictated by the triggering microbe.

Reactive arthritis

Reactive arthritis (ReA) has been recognized as a clinical disease entity for nearly 100 years. The prevalence is estimated to be 30-40/100,000 adults. The HLA-B27-associated form is part of the spondyloarthritis concept. According to the current hypothesis the arthritis follows a primary extra-articular infection and is characterized by the presence of bacterial antigen and/or of viable but non-culturable bacteria persisting within the joint. Pathogenesis involves the modification of host cells by pathogen-associated molecular patterns (PAMPs, e.g. lipopolysaccharide), bacterial effector proteins, the adaptive immune system, and the genetic background. Up to 30% of patients develop chronic symptoms, and therapeutic options for these patients are still limited. Data for recommendations to apply conventional disease-modifying anti-rheumatic drugs (DMARDs) are rare; however, sulfasalazine seems to be effective, and first reports on agents that block tumour necrosis factor (TNF) are promising. Combination therapy of several antibiotics might open the window to curing the disease; however, controlled clinical studies are needed.

Therapie der sekundären Arthropathien

Arthralgia is one of the most common complaints in Western society. The classification of joint diseases with respect to genesis is crucial for the determination of adequate treatment. For inflammatory arthropathies, treatment options have expanded significantly over the last decade. This review summarizes the current treatment of psoriatic arthritis and Reiter's disease, both belonging to the spectrum of seronegative spondyloarthropathies. Regardless of our increasing knowledge of chondrogenesis, the treatment of osteoarthritis is still more or less symptomatic. Premature age of onset and the atypical joint distribution of osteoarthritis should bring metabolic diseases, for example hemochromatosis, into consideration.