Reactive arthritis does not always remain confined to peripheral joints. In a subset of patients, particularly those who are HLA-B27 positive, the condition extends to the axial skeleton — manifesting as sacroiliitis or, less commonly, cervical and thoracic spine disease. This presentation requires a distinct clinical approach.
Axial involvement — sacroiliitis or spinal inflammation — is a recognised and common manifestation of reactive arthritis, most frequently observed in HLA-B27-positive patients. Cervical and thoracic spine disease can also occur, though less often than sacroiliac joint disease.
For patients in whom conventional therapy has not achieved adequate axial disease control, a targeted biologic strategy — specifically directed at TNF-α — may be considered. Eligibility criteria, agent selection, and the full clinical decision framework are detailed in the structured protocol.
Complete regimen, selection criteria, and monitoring details are in the full protocol below ↓