Reactive arthritis carries a favourable prognosis in many patients, with complete resolution of clinical manifestations possible within months. The central treatment question is whether — and when — to escalate beyond initial therapy, given the real risk of overtreatment in those who will self-resolve.
For patients who develop chronic peripheral arthritis, or whose acute arthritis does not respond adequately to initial therapy, a conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) is indicated. This protocol focuses on the csDMARD with the most established evidence base in reactive arthritis — and on the structured observation period that should precede its initiation.
In patients who develop chronic arthritis or with acute arthritis resistant to therapy with NSAIDs and GCs, treatment with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) is usually indicated.
Sulphasalazine (SSZ) is the most extensively studied csDMARD in ReA.
Given the good prognosis of ReA, with a complete resolution of clinical manifestations in up to 6 months, a careful period of observation of 3–6 months before starting a DMARD is often recommended, to avoid potential overtreatment of patients with a self-limiting disease.
It should be underlined that SSZ was effective only in patients with peripheral arthritis, without any significant effect on axial disease.
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