PROGNOSIS, COURSE OF DISEASE, AND TREATMENT OF THE SPONDYLOARTHROPATHIES

Prognosis in the majority of patients with acute reactive arthritis is usually good, with most patients recovering in a few months. In about 15% to 30% of such patients, the disease progresses, and spondyloarth ropathy and even ankylosing spondylitis develop in the following 10 to 20 years. A recurrent attack of reactive arthritis is common in patie nts with chlamydia-triggered arthritis, but it is rare in patients who have had enteroarthritis, In patients with chronic spondyloarthropath y without evidence of preceding infection, the disease can progress sl owly into ankylosing spondylitis. When reactive chlamydia arthritis is indicated, a prolonged course of antibiotics is needed. For other for ms of reactive arthritis, solid evidence in favor of antibiotic therap y is still lacking. Presence of hip pain, decreased mobility of thorac ic cervical or thoracic spine, heel pain, inflammatory gut lesions, hi gh erythrocyte sedimentation rate, positive family history and presenc e of human leukocyte antigen B27 are indicators for chronicity. Sulfas alazine might be of use in chronic arthritis and ankylosing spondyliti s, especially if the patient has peripheral arthritis.