Aktueller Stand der medikamentösen Therapie der Spondarthritiden und reaktiven Arthritiden

Spondyloarthritis is a systemic inflammatory rheumatic disease involving the spine, which additionally can include the sacroiliac joint, peripheral joints, enthesis, and extraarticular manifestations. The purpose of this overview is to summarize update knowledge of drug treatment of spondyloarthritides and reactive arthritides. The choice of treatment for any given patient is determined by clinical presentation, rather than precise diagnosis. The cornerstone of the axial involvement is use of nonsteroidal antiinflammatory drugs (NSAID). Failure of NSAIDs to relieve pain is an indication for intraarticular glucocorticoid therapy. In refractory disease, pulse therapy using methylprednisolone i.v. may control acute flares. With regard to disease-modifying antirheumatics, only sulfasalazine has proved effective for control of peripheral joint disease of ankylosing spondylitis and reactive arthritis, but this compound may not alter the course of the axial disease and enthesitis. Treatment of enthesitis consists of NSAIDs, physical therapy, and orthoses. If the disease is refractory to this regimen, local steroid injections should be tried. Low-dosage antiinflammatory radiotherapy is reserved for patients with persistent enthesitis despite physiotherapy and appropriate drug treatment. Treatment with sulfasalazine is recommended after the therapeutic options mentioned above have failed. In controlled studies no effect favouring the prolonged use of antibiotics for reactive arthritis has been found. The lack of efficacy of the antibiotics in this situation may be due to the altered metabolic statis of the organisms at issue.