Background/Purpose: Although bacterial infections are a common precipitant, it is unclear whether antibiotic treatment is effective for reactive arthritis. The purpose of this study was to conduct a systematic review and meta-analysis of randomized controlled trials to examine the efficacy and safety of antibiotic treatments for reactive arthritis. 

Methods: Medline, Embase, Pubmed, Cochrane CENTRAL Register of Controlled trials were searched up to November 2011 using MeSH terms and keywords pertaining to two major themes: reactive arthritis and antibiotic therapy.Randomized controlled trials of antibiotic use for reactive arthritis reporting on: remission, joint counts, pain or patient global scores were included. Two reviewers independently extracted information on the definition of reactive arthritis, features of study quality, type of treatment and outcomes. Pooled relative risks for binary outcomes (failure to achieve remission and adverse events) and pooled mean differences for continuous variables (joint counts, pain and patient global scores) were computed. Potential sources of heterogeneity were investigated using stratified analyses and meta-regression.

Results:

Twelve trials were eligible for inclusion and 10 provided adequate data for meta-analysis. The pooled relative risk of failure to achieve remission from a random effects model showed no significant benefit of antibiotic treatment (seven trials, 375 participants RR 0.74, 95% CI 0.49-1.10); however, substantial heterogeneity was observed (I²=76.3%, p<0.0001). The treatment effect did not significantly differ by the type of organism triggering the reactive arthritis (Chlamydia versus other), use of combination versus mono-therapy, or risk of bias. However, when only blinded trials were pooled, the treatment effect was attenuated and heterogeneity decreased significantly (RR 0.87, 95% CI 0.70-1.10, I²=32.8%, p=0.19). No significant effects of antibiotic treatment were observed on swollen joint counts (six trials, 375 participants weighted mean difference 0.21, 95% CI 1.16, 0.75, I²= 82.9%, p<0.0001) tender joint counts (five trials, 326 participants, standardized mean difference 0.10, 95% CI -0.58, 0.78, I² 86.9%, p<0.0001), pain (three trials, 220 participants, standardized mean difference 0.16, 95% CI -0.15, 0.46, I² 12.6%, p= 0.381), or patient global scores (four trials, 284 participants, standardized mean difference 0.15, 95% CI -0.08, 0.39, I² 0.0%, p= 0.499); however, antibiotics were associated with a 97% increase in gastrointestinal adverse events.

Conclusion: Trials of antibiotic treatment for reactive arthritis have produced heterogeneous results which may be related to differences in study quality.  The current evidence base does not support the use of antibiotics in routine clinical practice for the management of reactive arthritis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-systematic-review-and-meta-analysis-of-antibiotic-treatment-for-reactive-arthritis/