Abstract
Objective Reactive arthritis (ReA) is a spondyloarthritis triggered by a bacterial infection. In cases where nonsteroidal anti-inflammatory drugs and conventional synthetic disease-modifying antirheumatic drugs have failed, biologics such as tumor necrosis factor inhibitors (TNFi) have been used. However, limited evidence exists of the efficacy and safety of these drugs in ReA. We report on Icelandic patients with ReA who have been treated with TNFi, their characteristics, outcomes, and safety.
Methods We conducted an observational cohort study using the Icelandic nationwide database of biologic therapy (ICEBIO) supplemented with a retrospective study of electronic health record data. Drug efficacy was assessed using disease activity scores and standardized questionnaires within ICEBIO; safety was assessed using ICEBIO and electronic health record data.
Results Thirty-eight patients with ReA were registered in the database. Eight were given TNFi within one year of symptom onset. At six and 18 months, there was a significant reduction in C-reactive protein (CRP), tender and swollen joints, Visual Analog Scale for pain and fatigue, Disease Activity Score 28-joint count CRP (DAS28CRP), Clinical Disease Activity Index (CDAI), and Health Assessment Questionnaire (HAQ) scores. Seventy-one to 90% of patients were considered treatment responders. Two patients were able to stop biologics due to remission. During the 303 patient years (mean 8, range 1–15) biologics were given, six hospital admissions for infections were noted.
Conclusion TNFi are safe and effective in ReA, but treatment tends to be prolonged. Further clinical trials are urgently needed in ReA.