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Effect of a three month course of ciprofloxacin on the late prognosis of reactive arthritis

Abstract

Background: The value of antibiotics in the treatment of reactive arthritis (ReA) is still controversial.

Objectives: To analyse the long term outcome of patients with ReA, treated with a three month course of ciprofloxacin or placebo.

Methods: Patients who had had ReA and had participated in a double blind, placebo controlled trial on the effectiveness of ciprofloxacin 4–7 years earlier were invited to a clinical examination. Of the 71 patients who were included in the original study, 53 agreed to visit the clinic for an examination. Twenty six of 53 patients had originally received ciprofloxacin and 27 had belonged to the placebo group. Of these, 20 in the ciprofloxacin and 25 in the placebo group were HLA-B27 positive.

Results: 11/27 (41%) patients in the original placebo group had now developed chronic rheumatic disease, as compared with only 2/26 (8%) patients originally treated with ciprofloxacin (p=0.006). Two patients who originally had received placebo, none in the ciprofloxacin group had developed ankylosing spondylitis, and three patients in the original placebo group, none in the ciprofloxacin group had recurrent anterior uveitis. The same tendency was seen when several different measures were analysed. Of the patients with chronic spondyloarthropathy, 10 in the placebo and none in the ciprofloxacin group were HLA-B27 positive.

Conclusion: Analysis 4–7 years after the initial ReA suggests that a three month course of antibiotics in the acute phase may have a beneficial effect on the long term prognosis.

  • reactive arthritis
  • spondyloarthropathy
  • HLA-B27
  • ciprofloxacin
  • AS, ankylosing spondylitis
  • CRP, C reactive protein
  • ESR, erythrocyte sedimentation rate
  • IBD, inflammatory bowel disease
  • IBP, inflammatory back pain
  • IQR, interquartile range
  • ReA, reactive arthritis
  • SpA, spondyloarthropathy

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