Approaches to Differentiated Antibacterial Therapy of Reactive Arthritis

The dissertation is devoted to the study of the possibilities of differentiated antibacterial therapy in different clinical forms of reactive arthritis. The work summarizes data on the etiology and pathogenesis of the disease, the criteria for its diagnosis, and presents a review of the use of antibacterial agents. A comparative randomized study of the effectiveness of doxycycline, macrolides, and ciprofloxacin was conducted on clinical material in patients with urogenital, enterogenic, and mixed forms of reactive arthritis. The influence of the agents on the dynamics of articular syndrome and manifestations of focal infection, the frequency of detection of causative agents, as well as the frequency and duration of achieved improvements were analyzed. On the basis of the obtained results, approaches to the differentiated choice of an antibacterial agent depending on the form of the disease were formulated, which is of importance for the individualization of treatment and the prediction of its effect, including in reactive arthritis of unspecified etiology.

Relevance of the Study

Joint diseases rank among the most common chronic diseases in society. The medical and social significance of chronic arthritis is determined by the steady increase in their occurrence, the tendency toward chronicity and steadily progressive course with a sharp decrease in the quality of life of patients and high medical and social costs to society (V. A. Nasonova, O. M. Folomeeva, 2001). Joint diseases occupy one of the leading places among the causes of disability in the population aged 16-72 years and are the main cause of disability in persons over 65 years of age (87, 111).

Among chronic inflammatory joint diseases, one of the most common is reactive arthritis (5, 12). Patients with reactive arthritis account for about 10% of patients in rheumatological hospitals, and in the chronic form of the disease a significant loss of functional capacity of the joints and the development of severe complications may occur, leading to disability in 42% of patients (48).

The increased interest in reactive arthritis is associated not only with its high prevalence, but also with the established etiology of the disease and the emerging opportunities for antibacterial influence on the course of the disease.

Despite the fact that the association of reactive arthritis with microbial pathogens is considered established and antibacterial therapy included in the program is mandatory in the treatment of the disease, studies concerning the effectiveness of antibacterial agents in reactive arthritis are few in number, have been carried out on limited clinical material, are non-randomized in nature, and their results are ambiguous, without studying the comparative effectiveness of various antibacterial agents.

To date, not only the comparative effectiveness of various antibacterial agents has not been precisely established, but also the frequency and duration of achieved remissions.

Thus, it appears advisable to continue research on studying the effectiveness of antibacterial therapy in reactive arthritis.

Aim of the Study: to investigate the possibilities of differentiated antibacterial therapy in different forms of reactive arthritis.

Objectives of the Study:

1. To conduct a comparative study of the effect of doxycycline, macrolides, and ciprofloxacin on the clinical signs of articular syndrome, manifestations of focal infection, the frequency of achievement, and the duration of improvements in the general population of patients with reactive arthritis.

2. To evaluate the effect of the antibacterial agents studied on the dynamics of manifestations of focal infection and the clinical signs of articular syndrome in enterogenic, urogenital, and mixed forms of reactive arthritis.

3. To establish the effectiveness of doxycycline, macrolides, and ciprofloxacin in enterogenic, urogenital, and mixed forms of reactive arthritis.

4. To develop approaches to differentiated therapy of reactive arthritis depending on its form.

Scientific Novelty

For the first time under the conditions of a randomized study, a comparative investigation of the effectiveness of doxycycline, macrolides, and ciprofloxacin in different forms of reactive arthritis has been carried out.

For the first time, the dynamics of the course of articular syndrome, the frequency and duration of improvements in urogenital, enterogenic, and mixed reactive arthritis have been studied using different antibacterial agents.

For the first time, the relationship between the effectiveness of antibacterial therapy and the clinical form of reactive arthritis has been established.

Practical Significance

The division of patients with reactive arthritis on the basis of clinical signs into urogenital, enterogenic, and mixed forms of reactive arthritis will promote the individualization and optimization of treatment and will help to select the most effective agent for a particular patient.

The data obtained on the different effectiveness of antibacterial agents in different clinical forms will allow treatment to be carried out in reactive arthritis of unspecified etiology.

The results of the study will help to predict the effect of antibacterial agents in different forms of reactive arthritis.