PT - JOURNAL ARTICLE AU - Claire E. Barber AU - Joseph Kim AU - Robert D. Inman AU - John M. Esdaile AU - Matthew T. James TI - Antibiotics for Treatment of Reactive Arthritis: A Systematic Review and Metaanalysis AID - 10.3899/jrheum.121192 DP - 2013 Apr 15 TA - The Journal of Rheumatology PG - jrheum.121192 4099 - http://www.jrheum.org/content/early/2013/04/10/jrheum.121192.short 4100 - http://www.jrheum.org/content/early/2013/04/10/jrheum.121192.full AB - Objective To examine the efficacy and safety of antibiotic treatments for reactive arthritis (ReA). Methods We did a systematic review and metaanalysis of randomized controlled trials of antibiotics for treatment of ReA. We searched electronic databases and conference proceedings up to November 2011. Included trials reported on remission, joint counts, and pain or patient global scores in any language. Results Twelve trials were eligible for inclusion and 10 provided data for metaanalysis. The pooled relative risk of failure to achieve remission from a random effects model showed no significant benefit of antibiotic treatment on remission (7 trials, 375 participants, RR 0.74, 95% CI 0.49–1.10); however, substantial heterogeneity was observed (I2 = 76.3%, p < 0.0001). The treatment effect did not differ significantly by the type of organism triggering the ReA (chlamydia, 4 trials, RR 0.80, 95% CI 0.63–1.03, vs other microorganisms, 5 trials, RR 0.72, 95% CI 0.29–1.79, metaregression p = 0.477) or use of combination antibiotics (monotherapy, 6 trials, RR 0.70, 95% CI 0.39–1.26, vs combination therapy, 1 trial, RR 0.79, 95% CI 0.63–0.99, metaregression p = 0.466). When unblinded trials were excluded, the treatment effect was attenuated and heterogeneity decreased (RR 0.87, 95% CI 0.70–1.10, I2 = 32.8%, p = 0.19). No significant effects of antibiotic treatment were observed on joint counts, pain, or patient global scores; however, antibiotics were associated with a 97% increase in gastrointestinal adverse events. Conclusion Trials of antibiotic treatment for ReA have produced heterogeneous results that may be related to differences in study design. The efficacy of antibiotics is uncertain.