Answer for the : Azithromycin + Indomethacin Reactive arthr | Daily Medical Info 4 Medics

Answer for the : Azithromycin + Indomethacin

Reactive arthritis (formerly known as Reiter syndrome) is a spondyloarthritis, which classically manifests as arthritis, urethritis, and conjunctivitis. Uveitis, fever, and other constitutional symptoms are also common features, as are acute pustular skin lesions known as keratoderma blennorrhagica.

However, in more than 50% of affected patients, extra-articular manifestations are absent. Joint involvement, typically oligoarticular and asymmetric, may involve the spine (most frequently the sacroiliac joints).

Causative pathogens include Chlamydia trachomatis and enteric bacteria, such as Salmonella, Shigella, Yersinia, Campylobacter, and Clostridioides difficile. Treatment involves eradicating the pathogen if there is evidence of ongoing infection, but in many cases, the precipitating infection has resolved before arthritis develops. In this patient, azithromycin treats the active chlamydial infection.

Nonsteroidal antiinflammatory drug (NSAID) therapy is the first choice for control of arthritis, and it is not uncommon for more than one NSAID to be tried in an attempt to find an effective agent.
Systemic or intra-articular glucocorticoids are indicated if NSAIDs are ineffective. Average disease duration is 3 to 6 months.
In the up to 20% of patients with reactive arthritis who have arthritis that persists beyond several months, disease-modifying antirheumatic drugs, such as methotrexate, can be considered.

Prolonged antibiotic treatment (with rifampin plus azithromycin or doxycycline) may benefit patients who have refractory, Chlamydia-induced reactive arthritis, particularly if there is evidence for persistence of bacteria in an attenuated form.
However, testing for such persistent infection by polymerase chain reaction of synovial tissue is not generally available.

Source: NEJM
Last reviewed Sep 2019. Last modified Jul 2019.