The Bottom Line: There has been a randomized controlled trial of combination antibiotics in chlamydia-induced reactive arthritis, which reported a positive result. Also, there are several uncontrolled reports of anti-TNF agents being used successfully in refractory reactive arthritis.
Summary: Presently, inclusion and exclusion criteria are not well defined, and clinicians are often left to treat reactive arthritis on the basis of clinical experience. Current evidence supports the notion that reactive arthritis is a variant of septic arthritis in which the pathogen cannot be cultured. This would direct future research efforts toward therapies targeted at eradication of the intra-articular pathogens. But prior to such initiatives, more reliable detection of these pathogens in the joints needs to be developed. Defined guidelines need to be elucidated that balance both the risk and cost of these agents in patients with reactive arthritis. Hopefully, the use of these biologic agents will be curtailed with the development of directed antibiotic therapy or, perhaps, the discovery of effective vaccines for arthritogenic pathogens.