Reactive Arthritis Treatment When NSAIDs Are Insufficient or Disease Is Highly Active

Reactive arthritis can present across a wide spectrum — from localised mono- or oligoarticular joint swelling to widespread polyarthritis, and may include bursitis, enthesopathy, tenosynovitis, or severe extra-articular manifestations. When initial anti-inflammatory therapy does not adequately control symptoms, or when disease activity is high, a more targeted pharmacological approach is indicated.

Clinical Situation

The treatment decision in this protocol is shaped by the distribution of joint involvement (localised versus polyarticular), the level of disease activity, the nature of extra-articular manifestations, and whether prior symptomatic treatment has achieved adequate disease control.

Treatment Approach

Management is based on glucocorticoid therapy, with the specific route of administration selected according to whether disease involvement is focal or widespread and the degree of active inflammation.

The complete protocol — including the full selection criteria, sequencing, and regimen — is available below.

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References

Treatment with glucocorticoids (GCs) should be considered in the case of inadequate response to NSAIDs or persistent active disease for more than 4 weeks.
In the case of mono or oligoarticular involvement, bursitis, enthesopathy, tenosynovitis or other local manifestations of the disease, GC infiltration assures a good symptomatic response.
In the case of polyarthritis, high active disease, inadequate response to NSAIDs and to intraarticular glucocorticoids, or severe extra-articular manifestations, systemic GCs should be considered.

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