Follow-up study of the effect of a three-month course of ciprofloxacin on the late prognosis of reactive arthritis

Methods

In a randomised, double blind, placebo controlled trial, between 1992 and 1996, 71 patients with acute reactive arthritis (ReA) triggered by a gastrointestinal or an urogenital infection were randomly assigned to receive ciprofloxacin or placebo twice daily for three months. There were no statistically significant differences in any variables during the 12-month follow-up. The aim of the present study was to evaluate the effect of ciprofloxacin on the late prognosis of ReA. We reviewed the long-term outcome in 56 (79%) of 71 patients 4-8 years after the acute phase of ReA. The patients suspected to have inflammatory back pain (IBP) were further evaluated using the MRI of the sacroiliac joints. Six of the 10 patients with chronic spondyloarthropathy (SpA) were assessed by Tc-labelled leucocyte scintigraphy to search for the association between gut inflammation and SpA.

Results

Two patients (7%) in the active treatment group and 10 patients (36%) in the placebo group had developed chronic disease. Ankylosing spondylitis (AS) was diagnosed in 3 patients (11%) in the placebo group. One patient (4%) in the active treatment group had psoriatic arthritis. None in the active, 4 (14%) in the placebo group were assessed as having undifferentiated spondylarthropathy (USpA, ESSG, Amor's criteria). Three of these USpA patients had sacroiliitis, 1 had chronic oligoarthritis and one male patient had chronic oligoarthritis and bilateral sacroiliitis. Two patients (7%) in the placebo group suffered from chronic enthesiopathy (achilles tendon). Seronegative rheumatoid arthritis was diagnosed in one female patient in the active treatment group. One patient (4%) in the placebo group had recurrent anterior uveitis. MRI indicated sacroiliitis in 3 out of 5 patients with suspected IBP (2 bilateral, 1 unilateral). Scintigraphy revealed mild (grade 1/4) bowel inflammation in only 2 patients out of 6 with chronic SpA.

Discussion

The result is somewhat surprising considering that antibiotics did not show any beneficial effect in the first phase of the study. In this follow-up the occurrence of chronic development or late sequelae was clearly more prominent in the placebo group.