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Successful Treatment of Postvenereal Reactive Arthritis With Synovectomy and 3 Months’ Azithromycin

Pavlica, Ljiljana MD, PhD*; Nikolic, Dragan MD, PhD†; Magic, Zvonko MD, PhD‡; Brajuskovic, Goran PhD§; Strelic, Natasa MSc‡; Milicic, Biljana MD, MSc¶; Jovelic, Aleksandra MD, MSc*

JCR: Journal of Clinical Rheumatology: October 2005 - Volume 11 - Issue 5 - pp 257-263
Original Article

Background: The effects of antibiotic therapy on the course of postvenereal reactive arthritis have not yet been elucidated.

Objective: The objective of this study was to observe the clinical course and outcome of synovectomy and 3 months of azithromycin therapy in patients with reactive arthritis and previously diagnosed triggering bacteria.

Methods: We performed an open, prospective study on 20 (14 male/6 female) patients with postvenereal reactive knee arthritis, aged 36.7 ± 14.8 years, and with 16.5 ± 20.4 months’ duration of the disease. Detection of bacteria triggers was done by polymerase chain reaction, isolation and identification, and electron microscopy. Synovectomy was performed in all patients at entry into the study. Azithromycin was given at a dose of 500 mg per day for 5 days, and then 500 mg twice a week, during a 3-month period. Patients without remission were treated with combined antibiotic therapy using a macrolide, quinolone, and tetracycline for the next 4 months. Outcome evaluations of therapeutic efficacy and azithromycin safety were done after 1 and 3 months and 2 years of follow up.

Results: Remission, defined by the absence of joint swelling and tenderness, and extraarticular signs, was reached after 3 months in 15 of 20 (75.0%) patients (P = 0.025). Of 5 patients with persistent knee arthritis, remission was achieved with combined antibiotic therapy in 4. Visual analog scale scores (P < 0.01), the number of patients (P = 0.002), and the number of samples (P = 0.01) with a positive finding of bacteria or their DNA were significantly lower after 3 months of therapy. During the azithromycin therapy, there were no significant adverse effects.

Conclusions: These patients with reactive arthritis did extremely well on the regimen described. In our study group, the number of patients and the number of samples with positive findings of bacteria or their DNA were lower after the antibiotic treatment combined with surgery, although not all bacteria were eradicated. Adverse effects of prolonged azithromycin administration were insignificant. This open treatment approach is recommended but does need a study with controls.

This open study of 20 patients suggests that arthroscopic synovectomy and 3 months of antibiotics should be considered for therapy of reactive arthritis associated with venereal disease.

From the Departments of *Rheumatology and Clinical Immunology and †Trauma and Orthopedic Surgery, the ‡Institute for Medical Research, the §Institute of Pathology and Forensic Medicine, Military Medical Academy, and the ¶Institute of Anesthesiology, Clinical Centre of Serbia, Belgrade, Serbia and Montenegro.

Reprints: Ljiljana Pavlica, MD, PhD, Department of Rheumatology and Clinical Immunology, Military Medical Academy, Crnotravska 17 11000 Belgrade, Serbia and Montenegro. E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.