What are the recommended first-line treatments for managing reactive arthritis in adults?

First-line treatments for managing reactive arthritis in adults include:

• Use of non-steroidal anti-inflammatory drugs (NSAIDs) at the lowest effective dose to manage symptoms and pain, with consideration of clinical assessment and monitoring for risk factors such as gastrointestinal, cardiovascular, and renal issues.
• Local corticosteroid injections may be considered for peripheral arthritis as monotherapy or adjunctive therapy, and short courses of oral corticosteroids can be used cautiously to manage symptoms.
• Standard disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate, leflunomide, or sulfasalazine are used particularly when peripheral arthritis is present, especially if there is psoriatic skin involvement or structural damage.
• Long-term antibiotic therapy is not recommended solely for managing reactive arthritis after the initial infection has been treated.

These treatments are typically initiated and overseen in secondary care, with ongoing prescribing and monitoring potentially shared with primary care.

Non-pharmacological management including referral to specialist physiotherapy for individualized exercise programs is also important.

Specialist advice should be sought for persistent or recurrent flares, or if biological DMARDs are being considered.

References: NICE NG65, NICE CKS