Reactive Arthritis Medication: Nonsteroidal Anti-inflammatory Drugs (NSAIDs), Corticosteroids, Keratolytic Agents, Antibiotics, Aminosalicylic Acid Derivatives, Vitamins, Fat-Soluble, Antineoplastic Agents, Antimalarials, Retinoid-like Agents, Tumor Necrosis Factor Blockers (original) (raw)

Medication Summary

The goals of pharmacotherapy for reactive arthritis (ReA) are to reduce morbidity, to prevent joint damage, and to alleviate extra-articular disease. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstays of therapy for joint symptoms. Other types of agents used to treat ReA or its extra-articular manifestations include corticosteroids, antibiotics, and various disease-modifying antirheumatic drugs (DMARDs).

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Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Class Summary

Several NSAIDs are available for relief of mild to moderate pain in ReA patients. They are similar with respect to effectiveness, though indomethacin may be more effective in the spondyloarthropathies. Cyclooxygenase (COX)-2–specific inhibitors can be used in patients at high risk for GI complications.

NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not fully known, but they may inhibit COX activity and prostaglandin synthesis. Other mechanisms, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions, may exist.

Aspirin and several NSAIDs are available for use in ReA patients and are comparably effective in treating symptoms.

Aspirin (Ascriptin, Bayer Aspirin, Bayer, Bufferin, Ecotrin Arthritis Strength)

Aspirin is a short-acting anti-inflammatory agent with rapid absorption in the proximal gastrointestinal (GI) tract. It is optimally effective only when stable serum levels of 150-250 µg/L are achieved after 3-5 days of treatment. Serum aspirin levels can be checked after 5-10 days of treatment. Maximal anti-inflammatory action is generally achieved within 2-4 weeks, with some further benefit occurring up to 3 months.

Ibuprofen (Motrin, Advil, NeoProfen, Addaprin)

Ibuprofen inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Indomethacin (Indocin)

Indomethacin is the NSAID of choice in ReA; however, other NSAIDs are often effective as well. It is rapidly absorbed; metabolism occurs in the liver via demethylation, deacetylation, and glucuronide conjugation. Indomethacin inhibits prostaglandin synthesis; it is also a potent COX inhibitor, and this action may decrease local production of arachidonic acid–derived chemotactic factors for eosinophils present in sebum.

Naproxen (Naprosyn, Aleve, Naprelan)

Naproxen is used for relief of mild-to-moderate pain and is available in both short-acting and long-acting forms. It inhibits inflammatory reactions and pain by decreasing the activity of COX, which is responsible for prostaglandin synthesis.

Diclofenac (Voltaren, Cataflam XR, Zipsor, Cambia)

Diclofenac inhibits prostaglandin synthesis by decreasing COX activity, which, in turn, decreases formation of prostaglandin precursors.

Ketoprofen

Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are indicated initially in small patients, elderly patients, and patients with renal or liver disease. Doses higher than 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient's response.

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Corticosteroids

Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body’s immune response to diverse stimuli. Topical corticosteroids are used for dermatologic manifestations of ReA, such as keratoderma blennorrhagicum and balanitis circinata (circinate balanitis). For ocular therapy, topical or subtenon injections of steroid have proven effective. Systemic steroids should only be used in cases of macular involvement and only for short periods.

Prednisone (Rayos)

Prednisone may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity the activity of polymorphonuclear leukocytes (PMNs).

Prednisolone acetate 1% (Pred Forte, Pred Mild, Omnipred)

Prednisolone acetate is used mainly for acute iritis. The best approach is to treat aggressively early in the course of the disease, then to gradually taper and discontinue the drug on the basis of the patient's clinical response.

Hydrocortisone valerate (CortAlo, TheraCort, U-Cort, Westcort)

Topical corticosteroids are adrenocorticosteroid derivatives suitable for application to skin or external mucous membranes; they have mineralocorticoid and glucocorticoid effects, resulting in a nonspecific anti-inflammatory activity.

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Keratolytic Agents

Class Summary

These agents cause cornified epithelium to swell, soften, macerate, and then desquamate.

Salicylic acid topical (Calicylic, Aliclen, Keralyt, Salkera, Salvax)

Topical salicylic acid, by dissolving intercellular cement substance, produces desquamation of the horny layer of the skin, without affecting the structure of viable epidermis.

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Antibiotics

Class Summary

Antibiotics may be used in ReA for antibacterial effects and for treatment of possible coexistent infection. Empiric antimicrobial therapy should cover all likely pathogens in the context of the clinical setting. Whenever feasible, antibiotic selection should be guided by blood culture sensitivity.

Tetracyclines are used to treat urethritis or cervicitis caused by chlamydial organisms. Some evidence shows that tetracycline treatment in chlamydia-induced ReA may reduce the duration, and perhaps the severity, of illness. Collagenase inhibitors have been used to treat early rheumatoid arthritis.

Erythromycin (EryPed 200, E.E.S. 400, Ery-Tab, PCE)

Erythromycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is indicated for treatment of infections caused by susceptible strains of microorganisms (eg, Mycoplasma pneumoniae and Staphylococcus, Streptococcus, and Chlamydia spp) and for prevention of corneal and conjunctival infections.

Erythromycin ophthalmic (Romycin, Ilotycin)

Erythromycin inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is indicated for the prevention of corneal and conjunctival infections.

Ciprofloxacin (Cipro, Cipro XR)

Ciprofloxacin is the drug of choice for obtaining improvement in clinical parameters (except joint involvement) in postenteric ReA. It is a bactericidal antibiotic that inhibits bacterial DNA synthesis and, consequently, growth by inhibiting DNA gyrase in susceptible organisms.

Tetracycline

Tetracycline is used to treat gram-positive and gram-negative infections, as well as mycoplasmal, chlamydial, and rickettsial infections. It inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunits.

Doxycycline (Adoxa, Doryx, Vibramycin)

Doxycycline is used to treat infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma organisms. It inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Minocycline (Minocin, Solodyn)

Minocycline is used to treat infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Chlamydia, Rickettsia, and Mycoplasma organisms. It inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Azithromycin (Zithromax, Zmax)

Azithromycin is used to treat mild-to-moderate microbial infections.

Cefdinir

Cefdinir is a third-generation cephalosporin indicated for treatment of susceptible infections.

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Aminosalicylic Acid Derivatives

Class Summary

Aminosalicylic acid derivatives are used to reduce inflammation when NSAIDs do not control arthritis or when inflammatory lesions of the intestinal mucosa are present.

Sulfasalazine (Azulfidine EN-tabs, Sulfazine, Sulfazine EC)

Sulfasalazine is used as a second-line therapy to treat ReA that is not controlled with NSAIDs alone. It is a conjugate of the salicylate 5-aminosalicylic acid (5-ASA) and the sulfonamide sulfapyridine (linked by an azo bond). Sulfasalazine is primarily excreted in the urine unchanged. Most of the 5-ASA remains in the colon and is not absorbed. Sulfasalazine acts locally to decrease the inflammatory response in the joints and systemically inhibits prostaglandin synthesis and folate metabolism.

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Vitamins, Fat-Soluble

Class Summary

Vitamins are essential for normal synthesis of DNA and metabolism of proteins, carbohydrates, and fats.

Calcipotriene (Dovonex, Calcetrene, Sorilux)

Calcipotriene is a synthetic vitamin D-3 analogue that regulates skin-cell production and development. It is available as a 0.005% cream, ointment, or solution.

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Antineoplastic Agents

Class Summary

Antineoplastic agents have immunosuppressive effects and inhibit cell growth and proliferation. They are used when the disease is aggressive and unremitting.

Azathioprine (Imuran, Azasan)

Azathioprine may be used alone or as a steroid-sparing agent. It antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. Azathioprine may decrease proliferation of immune cells, thereby reducing autoimmune activity. It is used more commonly for ReA and psoriasis. Thiopurine methyltransferase levels should be checked before azathioprine is used.

Methotrexate (Trexall, Rheumatrex)

Methotrexate is an antimetabolite that is indicated for the symptomatic control of severe ReA and severe, recalcitrant, disabling psoriasis. It is also used alone or in combination with other anticancer agents in the treatment of advanced mycosis fungoides and cancer of the head, neck, or lung, particularly those of the squamous-cell and small-cell types.

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Antimalarials

Class Summary

Derivatives of 4-aminoquinoline are active against a variety of autoimmune disorders. They must be used with caution because hydroxychloroquine is known to be capable of exacerbating psoriasis. Because hydroxychloroquine is used for the joint involvement and not the skin involvement, it should probably be given only in conjunction with rheumatologic evaluation.

Hydroxychloroquine (Plaquenil)

It is not clear how hydroxychloroquine works. It is known to interfere with TLR signaling, inhibit chemotaxis of eosinophils neutrophils, and impair complement-dependent antigen-antibody reactions. A 200-mg quantity of hydroxychloroquine sulfate is equivalent to 155 mg of hydroxychloroquine base and 250 mg of chloroquine phosphate.

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Retinoid-like Agents

Class Summary

Retinoids decrease the cohesiveness of abnormal hyperproliferative keratinocytes and may reduce the potential for malignant degeneration. They also modulate keratinocyte differentiation.

Isotretinoin (Absorica, Claravis, Myorisan, Zenatane)

Oral agent used to treat serious dermatologic conditions. It is a synthetic 13-cis isomer of the naturally occurring tretinoin (trans-retinoic acid), and both agents are structurally related to vitamin A. Isotretinoin alters the pattern of keratinization, reduces bacterial flora, and has an anti-inflammatory effect.

A US Food and Drug Administration (FDA)–mandated registry is now in place for all individuals prescribing, dispensing, or taking isotretinoin (see iPLEDGE). This registry aims to achieve further decreases in the risks of pregnancy and other unwanted and potentially dangerous adverse effects during a course of isotretinoin therapy.

Acitretin (Soriatane)

Acitretin is a retinoic acid analogue, similar to etretinate and isotretinoin. Etretinate is the main metabolite and has similar clinical effects. Acitretin's mechanism of action is unknown.

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Tumor Necrosis Factor Blockers

Class Summary

Anti–tumor necrosis factor (TNF)–α therapy may be considered in refractory cases of ReA.

Infliximab (Remicade)

Infliximab is a chimeric IgG1κ monoclonal antibody that binds specifically to the soluble and transmembrane forms of TNF-α and inhibits the binding of TNF-α to its receptors.

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  1. Cheeti A, Chakraborty RK, Ramphul K. Reactive Arthritis. 2024 Jan. [QxMD MEDLINE Link]. [Full Text].
  2. Bekaryssova D, Yessirkepov M, Bekarissova S. Reactive arthritis following COVID-19: clinical case presentation and literature review. Rheumatol Int. 2024 Jan. 44 (1):191-195. [QxMD MEDLINE Link].
  3. López-González MD, Peral-Garrido ML, Calabuig I, Tovar-Sugrañes E, Jovani V, Bernabeu P, et al. Case series of acute arthritis during COVID-19 admission. Ann Rheum Dis. 2020 May 29. [QxMD MEDLINE Link]. [Full Text].
  4. Bekaryssova D, Yessirkepov M, Zimba O, Gasparyan AY, Ahmed S. Reactive arthritis before and after the onset of the COVID-19 pandemic. Clin Rheumatol. 2022 Jun. 41 (6):1641-1652. [QxMD MEDLINE Link]. [Full Text].
  5. Reiter H. Ueber cine bisher unbekannte spirochaeten-infektion (spirochaetosis arthritica). Dtsche Med Wschr. 1916. 42:1535-6.
  6. Lu DW, Katz KA. Declining use of the eponym "Reiter's syndrome" in the medical literature, 1998-2003. J Am Acad Dermatol. 2005 Oct. 53(4):720-3. [QxMD MEDLINE Link].
  7. Panush RS, Wallace DJ, Dorff RE, Engleman EP. Retraction of the suggestion to use the term "Reiter's syndrome" sixty-five years later: the legacy of Reiter, a war criminal, should not be eponymic honor but rather condemnation. Arthritis Rheum. 2007 Feb. 56 (2):693-4. [QxMD MEDLINE Link]. [Full Text].
  8. Kataria RK, Brent LH. Spondyloarthropathies. Am Fam Physician. 2004 Jun 15. 69(12):2853-60. [QxMD MEDLINE Link].
  9. Kaarela K, Jäntti JK, Kotaniemi KM. Similarity between chronic reactive arthritis and ankylosing spondylitis.A 32-35-year follow-up study. Clin Exp Rheumatol. 2009 Mar-Apr. 27(2):325-8. [QxMD MEDLINE Link].
  10. Mahmood A, Ackerman AB. Reiter’s syndrome is psoriasis!. Dermatopathol Pract Concept. 2000. 6:337-339.
  11. Carter JD, Hudson AP. Recent advances and future directions in understanding and treating Chlamydia-induced reactive arthritis. Expert Rev Clin Immunol. 2017 Mar. 13 (3):197-206. [QxMD MEDLINE Link].
  12. Carter JD, Hudson AP. Reactive arthritis: clinical aspects and medical management. Rheum Dis Clin North Am. 2009 Feb. 35(1):21-44. [QxMD MEDLINE Link].
  13. Garg AX, Pope JE, Thiessen-Philbrook H, Clark WF, Ouimet J. Arthritis risk after acute bacterial gastroenteritis. Rheumatology (Oxford). 2008 Feb. 47(2):200-4. [QxMD MEDLINE Link]. [Full Text].
  14. Savolainen E, Kettunen A, Närvänen A, Kautiainen H, Kärkkäinen U, Luosujärvi R, et al. Prevalence of antibodies against Chlamydia trachomatis and incidence of C. trachomatis-induced reactive arthritis in an early arthritis series in Finland in 2000. Scand J Rheumatol. 2009. 38(5):353-6. [QxMD MEDLINE Link].
  15. Sun HS, Liu DX, Bai YY, Hu NW. Disease-association of different killer cell immunoglobulin-like receptors (KIR) and HLA-C gene combinations in reactive arthritis. Mod Rheumatol. 2018 Jul 23. 1-7. [QxMD MEDLINE Link].
  16. Singh AK, Misra R, Aggarwal A. Th-17 associated cytokines in patients with reactive arthritis/undifferentiated spondyloarthropathy. Clin Rheumatol. 2011 Jun. 30(6):771-6. [QxMD MEDLINE Link].
  17. Shen H, Goodall JC, Gaston JS. Frequency and phenotype of T helper 17 cells in peripheral blood and synovial fluid of patients with reactive arthritis. J Rheumatol. 2010 Oct. 37(10):2096-9. [QxMD MEDLINE Link].
  18. Eliçabe RJ, Cargnelutti E, Serer MI, Stege PW, Valdez SR, Toscano MA, et al. Lack of TNFR p55 results in heightened expression of IFN-? and IL-17 during the development of reactive arthritis. J Immunol. 2010 Oct 1. 185(7):4485-95. [QxMD MEDLINE Link].
  19. Pöllänen R, Sillat T, Pajarinen J, Levón J, Kaivosoja E, Konttinen YT. Microbial antigens mediate HLA-B27 diseases via TLRs. J Autoimmun. 2009 May-Jun. 32(3-4):172-7. [QxMD MEDLINE Link].
  20. Inman RD. Innate immunity of spondyloarthritis: the role of toll-like receptors. Adv Exp Med Biol. 2009. 649:300-9. [QxMD MEDLINE Link].
  21. Lauhio A, Leirisalo-Repo M, Lähdevirta J, Saikku P, Repo H. Double-blind, placebo-controlled study of three-month treatment with lymecycline in reactive arthritis, with special reference to Chlamydia arthritis. Arthritis Rheum. 1991 Jan. 34(1):6-14. [QxMD MEDLINE Link].
  22. Carter JD, Valeriano J, Vasey FB. Doxycycline versus doxycycline and rifampin in undifferentiated spondyloarthropathy, with special reference to chlamydia-induced arthritis. A prospective, randomized 9-month comparison. J Rheumatol. 2004 Oct. 31(10):1973-80. [QxMD MEDLINE Link].
  23. Alvarez-Navarro C, Cragnolini JJ, Dos Santos HG, Barnea E, Admon A, Morreale A, et al. Novel HLA-B27-restricted epitopes from Chlamydia trachomatis generated upon endogenous processing of bacterial proteins suggest a role of molecular mimicry in reactive arthritis. J Biol Chem. 2013 Sep 6. 288(36):25810-25. [QxMD MEDLINE Link]. [Full Text].
  24. Sahlberg AS, Granfors K, Penttinen MA. HLA-B27 and host-pathogen interaction. Adv Exp Med Biol. 2009. 649:235-44. [QxMD MEDLINE Link].
  25. Carter JD, Hudson AP. Recent advances and future directions in understanding and treating Chlamydia-induced reactive arthritis. Expert Rev Clin Immunol. 2016 Sep 20. 1-10. [QxMD MEDLINE Link].
  26. El Karoui K, Méchaï F, Ribadeau-Dumas F, Viard JP, Lecuit M, de Barbeyrac B, et al. Reactive arthritis associated with L2b lymphogranuloma venereum proctitis. Sex Transm Infect. 2009 Jun. 85(3):180-1. [QxMD MEDLINE Link].
  27. Foschi C, Banzola N, Gaspari V, D'Antuono A, Cevenini R, Marangoni A. A Case of Reactive Arthritis Associated With Lymphogranuloma Venereum Infection in a Woman. Sex Transm Dis. 2016 Sep. 43 (9):584-6. [QxMD MEDLINE Link].
  28. Dworkin MS, Shoemaker PC, Goldoft MJ, Kobayashi JM. Reactive arthritis and Reiter's syndrome following an outbreak of gastroenteritis caused by Salmonella enteritidis. Clin Infect Dis. 2001 Oct 1. 33(7):1010-4. [QxMD MEDLINE Link].
  29. Arnedo-Pena A, Beltrán-Fabregat J, Vila-Pastor B, Tirado-Balaguer MD, Herrero-Carot C, Bellido-Blasco JB, et al. Reactive arthritis and other musculoskeletal sequelae following an outbreak of Salmonella hadar in Castellon, Spain. J Rheumatol. 2010 Aug 1. 37(8):1735-42. [QxMD MEDLINE Link].
  30. Kroot EJ, Hazes JM, Colin EM, Dolhain RJ. Poncet's disease: reactive arthritis accompanying tuberculosis. Two case reports and a review of the literature. Rheumatology (Oxford). 2007 Mar. 46(3):484-9. [QxMD MEDLINE Link].
  31. Connor BA, Johnson EJ, Soave R. Reiter syndrome following protracted symptoms of Cyclospora infection. Emerg Infect Dis. 2001 May-Jun. 7(3):453-4. [QxMD MEDLINE Link]. [Full Text].
  32. Townes JM. Reactive arthritis after enteric infections in the United States: the problem of definition. Clin Infect Dis. 2010 Jan 15. 50(2):247-54. [QxMD MEDLINE Link].
  33. Mahdavi J, Motavallihaghi S, Ghasemikhah R. Evaluation of clinical and paraclinical findings in patients with reactive arthritis caused by giardiasis: A systematic review. Semin Arthritis Rheum. 2022 Sep 11. 57:152094. [QxMD MEDLINE Link].
  34. Zeidler H, Hudson AP. Quo vadis reactive arthritis?. Curr Opin Rheumatol. 2022 Jul 1. 34 (4):218-224. [QxMD MEDLINE Link].
  35. van Bemmel JM, Delgado V, Holman ER, Allaart CF, Huizinga TW, Bax JJ, et al. No increased risk of valvular heart disease in adult poststreptococcal reactive arthritis. Arthritis Rheum. 2009 Apr. 60(4):987-93. [QxMD MEDLINE Link].
  36. Kousa M, Saikku P, Richmond S, Lassus A. Frequent association of chlamydial infection with Reiter's syndrome. Sex Transm Dis. 1978 Apr-Jun. 5(2):57-61. [QxMD MEDLINE Link].
  37. Berlau J, Junker U, Groh A, Straube E. In situ hybridisation and direct fluorescence antibodies for the detection of Chlamydia trachomatis in synovial tissue from patients with reactive arthritis. J Clin Pathol. 1998 Nov. 51(11):803-6. [QxMD MEDLINE Link]. [Full Text].
  38. Carter JD, Hudson AP. The evolving story of Chlamydia-induced reactive arthritis. Curr Opin Rheumatol. 2010 Jul. 22(4):424-30. [QxMD MEDLINE Link].
  39. Siala M, Mahfoudh N, Fourati H, Gdoura R, Younes M, Kammoun A, et al. MHC class I and class II genes in Tunisian patients with reactive and undifferentiated arthritis. Clin Exp Rheumatol. 2009 Mar-Apr. 27(2):208-13. [QxMD MEDLINE Link].
  40. Horowitz S, Horowitz J, Taylor-Robinson D, Sukenik S, Apte RN, Bar-David J, et al. Ureaplasma urealyticum in Reiter's syndrome. J Rheumatol. 1994 May. 21 (5):877-82. [QxMD MEDLINE Link].
  41. Pavlica L, Drasković N, Kuljić-Kapulica N, Nikolić D. Isolation of Chlamydia trachomatis or Ureaplasma urealyticum from the synovial fluid of patients with Reiter's syndrome. Vojnosanit Pregl. 2003 Jan-Feb. 60 (1):5-10. [QxMD MEDLINE Link].
  42. Pope JE, Krizova A, Garg AX, Thiessen-Philbrook H, Ouimet JM. Campylobacter reactive arthritis: a systematic review. Semin Arthritis Rheum. 2007 Aug. 37(1):48-55. [QxMD MEDLINE Link]. [Full Text].
  43. Mortensen NP, Kuijf ML, Ang CW, Schiellerup P, Krogfelt KA, Jacobs BC, et al. Sialylation of Campylobacter jejuni lipo-oligosaccharides is associated with severe gastro-enteritis and reactive arthritis. Microbes Infect. 2009 Oct. 11(12):988-94. [QxMD MEDLINE Link].
  44. van der Helm-van Mil AH. Acute rheumatic fever and poststreptococcal reactive arthritis reconsidered. Curr Opin Rheumatol. 2010 Jul. 22(4):437-42. [QxMD MEDLINE Link].
  45. Sarakbi HA, Hammoudeh M, Kanjar I, Al-Emadi S, Mahdy S, Siam A. Poststreptococcal reactive arthritis and the association with tendonitis, tenosynovitis, and enthesitis. J Clin Rheumatol. 2010 Jan. 16(1):3-6. [QxMD MEDLINE Link].
  46. Kobayashi S, Ichikawa G. Reactive arthritis induced by tonsillitis: a type of 'focal infection'. Adv Otorhinolaryngol. 2011. 72:79-82. [QxMD MEDLINE Link].
  47. Garg S, Malaviya AN, Kapoor S, Rawat R, Agarwal D, Sharma A. Acute inflammatory ankle arthritis in northern India--Löfgren's syndrome or Poncet's disease?. J Assoc Physicians India. 2011 Feb. 59:87-90. [QxMD MEDLINE Link].
  48. Ideguchi H, Ohno S, Takase K, Tsukahara T, Kaneko T, Ishigatsubo Y. A case of Poncet's disease (tuberculous rheumatism). Rheumatol Int. 2009 Jul. 29(9):1097-9. [QxMD MEDLINE Link].
  49. Rueda JC, Crepy MF, Mantilla RD. Clinical features of Poncet's disease. From the description of 198 cases found in the literature. Clin Rheumatol. 2013 Jul. 32(7):929-35. [QxMD MEDLINE Link].
  50. Prati C, Bertolini E, Toussirot E, Wendling D. Reactive arthritis due to Clostridium difficile. Joint Bone Spine. 2010 Mar. 77(2):190-2. [QxMD MEDLINE Link].
  51. Durand CL, Miller PF. Severe Clostridium difficile colitis and reactive arthritis in a ten-year-old child. Pediatr Infect Dis J. 2009 Aug. 28(8):750-1. [QxMD MEDLINE Link].
  52. Taniguchi Y, Nishikawa H, Kimata T, Yoshinaga Y, Kobayashi S, Terada Y. Reactive Arthritis After Intravesical Bacillus Calmette-Guérin Therapy. J Clin Rheumatol. 2022 Mar 1. 28 (2):e583-e588. [QxMD MEDLINE Link]. [Full Text].
  53. Yoshimura H, Okano T, Inui K, Nakamura H. Ultrasonographic findings in a patient with reactive arthritis induced by intravesical BCG therapy for bladder cancer. J Med Ultrason (2001). 2018 Jul 10. [QxMD MEDLINE Link].
  54. Bernini L, Manzini CU, Giuggioli D, Sebastiani M, Ferri C. Reactive arthritis induced by intravesical BCG therapy for bladder cancer: our clinical experience and systematic review of the literature. Autoimmun Rev. 2013 Oct. 12(12):1150-9. [QxMD MEDLINE Link].
  55. Sahin N, Salli A, Enginar AU, Ugurlu H. Reactive arthritis following tetanus vaccination: a case report. Mod Rheumatol. 2009. 19(2):209-11. [QxMD MEDLINE Link].
  56. Aksu K, Keser G, Doganavsargil E. Reactive arthritis following tetanus and rabies vaccinations. Rheumatol Int. 2006 Dec. 27(2):209-10. [QxMD MEDLINE Link].
  57. Golstein MA, Fagnart O, Steinfeld SD. Reactive arthritis after COVID-19 vaccination: 17 cases. Rheumatology (Oxford). 2023 Nov 2. 62 (11):3706-3709. [QxMD MEDLINE Link].
  58. Kim PS, Klausmeier TL, Orr DP. Reactive arthritis: a review. J Adolesc Health. 2009 Apr. 44(4):309-15. [QxMD MEDLINE Link].
  59. Rihl M, Barthel C, Klos A, Schmidt RE, Tak PP, Zeidler H, et al. Identification of candidate genes for susceptibility to reactive arthritis. Rheumatol Int. 2009 Oct. 29(12):1519-22. [QxMD MEDLINE Link].
  60. Thielen AM, Barde C, Janer V, Borradori L, Saurat JH. Reiter syndrome triggered by adalimumab (Humira) and leflunomide (Arava) in a patient with ankylosing spondylarthropathy and Crohn disease. Br J Dermatol. 2007 Jan. 156(1):188-9. [QxMD MEDLINE Link].
  61. Braun J, Kingsley G, van der Heijde D, Sieper J. On the difficulties of establishing a consensus on the definition of and diagnostic investigations for reactive arthritis. Results and discussion of a questionnaire prepared for the 4th International Workshop on Reactive Arthritis, Berlin, Germany, July 3-6, 1999. J Rheumatol. 2000 Sep. 27(9):2185-92. [QxMD MEDLINE Link].
  62. Rohekar S, Pope J. Epidemiologic approaches to infection and immunity: the case of reactive arthritis. Curr Opin Rheumatol. 2009 Jul. 21(4):386-90. [QxMD MEDLINE Link].
  63. Carter JD, Espinoza LR, Inman RD, Sneed KB, Ricca LR, Vasey FB, et al. Combination antibiotics as a treatment for chronic Chlamydia-induced reactive arthritis: a double-blind, placebo-controlled, prospective trial. Arthritis Rheum. 2010 May. 62(5):1298-307. [QxMD MEDLINE Link]. [Full Text].
  64. Townes JM, Deodhar AA, Laine ES, Smith K, Krug HE, Barkhuizen A, et al. Reactive arthritis following culture-confirmed infections with bacterial enteric pathogens in Minnesota and Oregon: a population-based study. Ann Rheum Dis. 2008 Dec. 67(12):1689-96. [QxMD MEDLINE Link].
  65. Hajjaj-Hassouni N, Burgos-Vargas R. Ankylosing spondylitis and reactive arthritis in the developing world. Best Pract Res Clin Rheumatol. 2008 Aug. 22(4):709-23. [QxMD MEDLINE Link].
  66. Hanova P, Pavelka K, Holcatova I, Pikhart H. Incidence and prevalence of psoriatic arthritis, ankylosing spondylitis, and reactive arthritis in the first descriptive population-based study in the Czech Republic. Scand J Rheumatol. 2010 Aug. 39(4):310-7. [QxMD MEDLINE Link].
  67. Lahu A, Backa T, Ismaili J, Lahu V, Saiti V. Modes of presentation of reactive arthritis based on the affected joints. Med Arch. 2015 Feb. 69 (1):42-5. [QxMD MEDLINE Link].
  68. Wechalekar MD, Rischmueller M, Whittle S, Burnet S, Hill CL. Prolonged remission of chronic reactive arthritis treated with three infusions of infliximab. J Clin Rheumatol. 2010 Mar. 16(2):79-80. [QxMD MEDLINE Link].
  69. Amor B, Santos RS, Nahal R, Listrat V, Dougados M. Predictive factors for the longterm outcome of spondyloarthropathies. J Rheumatol. 1994 Oct. 21(10):1883-7. [QxMD MEDLINE Link].
  70. Wu IB, Schwartz RA. Reiter's syndrome: the classic triad and more. J Am Acad Dermatol. 2008 Jul. 59(1):113-21. [QxMD MEDLINE Link].
  71. Kanwar AJ, Mahajan R. Reactive arthritis in India: a dermatologists' perspective. J Cutan Med Surg. 2013 May-Jun. 17(3):180-8. [QxMD MEDLINE Link].
  72. Ngaruiya CM, Martin IB. A case of reactive arthritis: a great masquerader. Am J Emerg Med. 2013 Jan. 31(1):266.e5-7. [QxMD MEDLINE Link].
  73. Kober C, Richardson D, Bell C, Walker-Bone K. Acute seronegative polyarthritis associated with lymphogranuloma venereum infection in a patient with prevalent HIV infection. Int J STD AIDS. 2011 Jan. 22(1):59-60. [QxMD MEDLINE Link].
  74. Lin RY. Reiter's syndrome and human immunodeficiency virus infection. Dermatologica. 1988. 176(1):39-42. [QxMD MEDLINE Link].
  75. Romaní J, Puig L, Baselga E, De Moragas JM. Reiter's syndrome-like pattern in AIDS-associated psoriasiform dermatitis. Int J Dermatol. 1996 Jul. 35(7):484-8. [QxMD MEDLINE Link].
  76. Sieper J. Developments in the scientific and clinical understanding of the spondyloarthritides. Arthritis Res Ther. 2009. 11(1):208. [QxMD MEDLINE Link]. [Full Text].
  77. Mansour AM, Jaroudi MO, Medawar WA, Tabbarah ZA. Bilateral multifocal posterior pole lesions in Reiter syndrome. BMJ Case Rep. 2013 Apr 9. 2013:[QxMD MEDLINE Link].
  78. Kozeis N, Trachana M, Tyradellis S. Keratitis in reactive arthritis (Reiter syndrome) in childhood. Cornea. 2011 Aug. 30(8):924-5. [QxMD MEDLINE Link].
  79. Madge SN, James C, Selva D. Bilateral dacryoadenitis: a new addition to the spectrum of reactive arthritis?. Ophthal Plast Reconstr Surg. 2009 Mar-Apr. 25(2):152-3. [QxMD MEDLINE Link].
  80. Arora S, Arora G. Reiter's disease in a six-year-old girl. Indian J Dermatol Venereol Leprol. 2005 Jul-Aug. 71(4):285-6. [QxMD MEDLINE Link].
  81. Birnbaum J, Bartlett JG, Gelber AC. Clostridium difficile: an under-recognized cause of reactive arthritis?. Clin Rheumatol. 2008 Feb. 27(2):253-5. [QxMD MEDLINE Link].
  82. Satko SG, Iskandar SS, Appel RG. IgA nephropathy and Reiter's syndrome. Report of two cases and review of the literature. Nephron. 2000 Feb. 84(2):177-82. [QxMD MEDLINE Link].
  83. Manoj E, Ragunathan M. Disease flare of ankylosing spondylitis presenting as reactive arthritis with seropositivity: a case report. J Med Case Rep. 2012 Feb 14. 6(1):60. [QxMD MEDLINE Link]. [Full Text].
  84. da Silva Carneiro SC, Pirmez R, de Hollanda TR, Cuzzi T, Ramos-E-Silva M. Syphilis mimicking other dermatological diseases: reactive arthritis and mucha-habermann disease. Case Rep Dermatol. 2013 Jan. 5(1):15-20. [QxMD MEDLINE Link]. [Full Text].
  85. Kuipers JG, Sibilia J, Bas S, Gaston H, Granfors K, Vischer TL, et al. Reactive and undifferentiated arthritis in North Africa: use of PCR for detection of Chlamydia trachomatis. Clin Rheumatol. 2009 Jan. 28(1):11-6. [QxMD MEDLINE Link].
  86. [Guideline] Chlamydia and Gonorrhea: Screening. U.S. Preventive Services Task Force. Available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/chlamydia-and-gonorrhea-screening. September 14, 2021; Accessed: September 27, 2024.
  87. Kim SH, Chung SK, Bahk YW, Park YH, Lee SY, Sohn HS. Whole-body and pinhole bone scintigraphic manifestations of Reiter's syndrome: distribution patterns and early and characteristic signs. Eur J Nucl Med. 1999 Feb. 26(2):163-70. [QxMD MEDLINE Link].
  88. Taniguchi Y, Kumon Y, Nakayama S, Arii K, Ohnishi T, Ogawa Y, et al. F-18 FDG PET/CT provides the earliest findings of enthesitis in reactive arthritis. Clin Nucl Med. 2011 Feb. 36(2):121-3. [QxMD MEDLINE Link].
  89. Thomas KN, Jain N, Mohindra N, Misra D, Agarwal V, Gupta L. MRI and Sonography of the Knee in Acute Reactive Arthritis: An Observational Cohort Study. J Clin Rheumatol. 2022 Mar 1. 28 (2):e511-e516. [QxMD MEDLINE Link].
  90. Simonini G, Taddio A, Cimaz R. No evidence yet to change American Heart Association recommendations for poststreptococcal reactive arthritis: comment on the article by van Bemmel et al. Arthritis Rheum. 2009 Nov. 60(11):3516-8; author reply 3518-9. [QxMD MEDLINE Link].
  91. Pathak H, Marshall T. Post-streptococcal reactive arthritis: where are we now. BMJ Case Rep. 2016 Aug 12. 2016:174-82. [QxMD MEDLINE Link]. [Full Text].
  92. Siala M, Gdoura R, Younes M, Fourati H, Cheour I, Meddeb N, et al. Detection and frequency of Chlamydia trachomatis DNA in synovial samples from Tunisian patients with reactive arthritis and undifferentiated oligoarthritis. FEMS Immunol Med Microbiol. 2009 Mar. 55(2):178-86. [QxMD MEDLINE Link].
  93. Rihl M, Kuipers JG. [Reactive arthritis: from pathogenesis to novel strategies]. Z Rheumatol. 2010 Dec. 69(10):864-70. [QxMD MEDLINE Link].
  94. Scott C, Brand A, Natha M. Reactive arthritis responding to antiretroviral therapy in an HIV-1-infected individual. Int J STD AIDS. 2012 May. 23(5):373-4. [QxMD MEDLINE Link].
  95. Bentaleb I, Abdelghani KB, Rostom S, Amine B, Laatar A, Bahiri R. Reactive Arthritis: Update. Curr Clin Microbiol Rep. 2020 Sep 26. 32 (8):1-9. [QxMD MEDLINE Link]. [Full Text].
  96. Nanke Y, Yago T, Kobashigawa T, Kotake S. Efficacy of methotrexate in the treatment of a HLA-B27-positive Japanease patient with reactive arthritis. Nihon Rinsho Meneki Gakkai Kaishi. 2010. 33(5):283-5. [QxMD MEDLINE Link].
  97. Li CW, Ma JJ, Yin J, Liu L, Hu J. [Reiter's syndrome in children: a clinical analysis of 22 cases]. Zhonghua Er Ke Za Zhi. 2010 Mar. 48(3):212-5. [QxMD MEDLINE Link].
  98. Schafranski MD. Infliximab for reactive arthritis secondary to Chlamydia trachomatis infection. Rheumatol Int. 2010 Mar. 30(5):679-80. [QxMD MEDLINE Link].
  99. Courcoul A, Muis Pistor O, Tebib JG, Coury F. Early treatment of reactive arthritis with etanercept and 2 years follow-up. Joint Bone Spine. 2016 Jun 3. [QxMD MEDLINE Link].
  100. Gill H, Majithia V. Successful use of infliximab in the treatment of Reiter's syndrome: a case report and discussion. Clin Rheumatol. 2008 Jan. 27(1):121-3. [QxMD MEDLINE Link].
  101. Kiss S, Letko E, Qamruddin S, Baltatzis S, Foster CS. Long-term progression, prognosis, and treatment of patients with recurrent ocular manifestations of Reiter's syndrome. Ophthalmology. 2003 Sep. 110(9):1764-9. [QxMD MEDLINE Link].
  102. Maugars Y, Mathis C, Vilon P, Prost A. Corticosteroid injection of the sacroiliac joint in patients with seronegative spondylarthropathy. Arthritis Rheum. 1992 May. 35(5):564-8. [QxMD MEDLINE Link].
  103. Kvien TK, Gaston JS, Bardin T, Butrimiene I, Dijkmans BA, Leirisalo-Repo M, et al. Three month treatment of reactive arthritis with azithromycin: a EULAR double blind, placebo controlled study. Ann Rheum Dis. 2004 Sep. 63(9):1113-9. [QxMD MEDLINE Link]. [Full Text].
  104. Carter JD et al. Combination Antibiotics as a Treatment for Chronic Chlamydia-Induced Reactive Arthritis. Philadelphia PA. (abstract 1152).: ACR/ARHP Annual Scientific Meeting; October 19, 2009.
  105. Yli-Kerttula T, Luukkainen R, Yli-Kerttula U, Möttönen T, Hakola M, Korpela M, et al. Effect of a three month course of ciprofloxacin on the late prognosis of reactive arthritis. Ann Rheum Dis. 2003 Sep. 62(9):880-4. [QxMD MEDLINE Link]. [Full Text].
  106. Barber CE, Kim J, Inman RD, Esdaile JM, James MT. Antibiotics for treatment of reactive arthritis: a systematic review and metaanalysis. J Rheumatol. 2013 Jun. 40(6):916-28. [QxMD MEDLINE Link].
  107. Clegg DO, Reda DJ, Weisman MH, Cush JJ, Vasey FB, Schumacher HR Jr, et al. Comparison of sulfasalazine and placebo in the treatment of reactive arthritis (Reiter's syndrome). A Department of Veterans Affairs Cooperative Study. Arthritis Rheum. 1996 Dec. 39(12):2021-7. [QxMD MEDLINE Link].
  108. Calin A. A placebo controlled, crossover study of azathioprine in Reiter's syndrome. Ann Rheum Dis. 1986 Aug. 45(8):653-5. [QxMD MEDLINE Link]. [Full Text].
  109. Bravo G, Zazueta B, Lavalle C. An acute remission of Reiter's syndrome in male patients treated with bromocriptine. J Rheumatol. 1992 May. 19(5):747-50. [QxMD MEDLINE Link].
  110. Abdelmoula LC, Yahia CB, Testouri N, Tekaya R, Ben M'barek R, Chaabouni L, et al. [Treatment of reactive arthritis with infliximab]. Tunis Med. 2008 Dec. 86(12):1095-7. [QxMD MEDLINE Link].
  111. Meyer A, Chatelus E, Wendling D, Berthelot JM, Dernis E, Houvenagel E, et al. Safety and efficacy of anti-tumor necrosis factor a therapy in ten patients with recent-onset refractory reactive arthritis. Arthritis Rheum. 2011 May. 63(5):1274-80. [QxMD MEDLINE Link].
  112. Tanaka T, Kuwahara Y, Shima Y, Hirano T, Kawai M, Ogawa M, et al. Successful treatment of reactive arthritis with a humanized anti-interleukin-6 receptor antibody, tocilizumab. Arthritis Rheum. 2009 Dec 15. 61(12):1762-4. [QxMD MEDLINE Link].
  113. Padhan P, Maikap D. Secukinumab therapy in reactive arthritis: Report of two cases. Mod Rheumatol Case Rep. 2022 Jan 7. 6 (1):22-24. [QxMD MEDLINE Link]. [Full Text].

Author

Carlos J Lozada, MD Director of Rheumatology Fellowship Training Program, Professor of Clinical Medicine, Department of Medicine, Division of Rheumatology and Immunology, University of Miami, Leonard M Miller School of Medicine

Carlos J Lozada, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology

Disclosure: Received honoraria from Pfizer for consulting; Received grant/research funds from AbbVie for other; Received honoraria from Heel for consulting.

Coauthor(s)

Maria F Carpintero, MD Assistant Professor of Clinical Medicine, Division Rheumatology/Immunology, University of Miami, Leonard M Miller School of Medicine

Maria F Carpintero, MD is a member of the following medical societies: American College of Physicians, American College of Rheumatology

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS Assistant Professor of Ophthalmology, McGill University; Clinical Assistant Professor of Ophthalmology, Sherbrooke University; Medical Director, Cornea Laser and Lasik MD

Mounir Bashour, MD, CM, FRCS(C), PhD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American College of International Physicians, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Mechanical Engineers, American Society of Ophthalmic Plastic and Reconstructive Surgery, Biomedical Engineering Society, Canadian Medical Association,Canadian Ophthalmological Society, Contact Lens Association of Ophthalmologists, International College of Surgeons US Section, Ontario Medical Association, Quebec Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Igor Boyarsky, DO Emergency Room Physician, Kaiser Permanente Southern California

Igor Boyarsky, DO is a member of the following medical societies: American Academy of Anti-Aging Medicine, American Academy of Emergency Medicine, American College of Emergency Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Bo Burns, DO, FACEP, FAAEM Assistant Professor, Associate Residency Director, Medical Clerkship Director, Department of Emergency Medicine, University of Oklahoma School of Community Medicine; Attending Physician, Department of Emergency Medicine

Bo Burns, DO, FACEP, FAAEM, is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Gino A Farina, MD, FACEP, FAAEM Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Elliot Goldberg, MD Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine

Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology

Disclosure: Nothing to disclose.

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Lawrence K Jung, MD Chief, Division of Pediatric Rheumatology, Children's National Medical Center

Lawrence K Jung, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Rheumatology, Clinical Immunology Society, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Barry L Myones, MD Associate Professor, Departments of Pediatrics and Immunology, Pediatric Rheumatology Section, Baylor College of Medicine; Director of Research, Pediatric Rheumatology Center, Texas Children's Hospital

Barry L Myones, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American College of Rheumatology, American Heart Association, American Society for Microbiology, Clinical Immunology Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Lluís Puig, MD, PhD Program Director, Assistant Professor, Department of Dermatology, Hospital De La Santa Creu I Sant Pau, Universitat Autónoma De Barcelona

Lluís Puig, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, European Academy of Dermatology and Venereology, and International Society of Dermatopathology

Disclosure: Nothing to disclose.

Jorge Romaní, MD Assistant Professor, Department of Dermatology, Hospital De Palamós Faculty of Medicine, Spain

Disclosure: Nothing to disclose.

Hampton Roy Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Nima Sarani, MD Resident Physician, Department of Emergency Medicine, Oklahoma University College of Medicine

Nima Sarani, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians, and Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Thomas Scoggins, MD Consulting Staff, Department of Emergency Medicine, Blount Memorial Hospital

Thomas Scoggins, MD is a member of the following medical societies: American College of Emergency Physicians and Flying Physicians Association

Disclosure: Nothing to disclose.

John D Sheppard Jr, MD, MMSc Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, American Uveitis Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

David D Sherry, MD Director, Clinical Rheumatology, Attending Physician, Pain Management, The Children's Hospital of Philadelphia; Professor of Pediatrics, University of Pennsylvania School of Medicine

David D Sherry, MD is a member of the following medical societies: American College of Rheumatology and American Pain Society

Disclosure: Nothing to disclose.

Dana A Stearns, MD Assistant Director of Undergraduate Education, Department of Emergency Medicine, Massachusetts General Hospital; Assistant Professor of Surgery, Harvard Medical School

Dana A Stearns, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Akaluck Thatayatikom, MD Associate Professor and Chief, Department of Pediatrics, Division of Pediatric Allergy, Immunology, and Rheumatology, University of Kentucky College of Medicine

Akaluck Thatayatikom, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Rheumatology, Childhood Arthritis and Rheumatology Research Alliance, and Clinical Immunology Society

Disclosure: Nothing to disclose.

Robin Travers, MD Assistant Professor of Medicine (Dermatology), Dartmouth University School of Medicine; Staff Dermatologist, New England Baptist Hospital; Private Practice, SkinCare Physicians

Robin Travers, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Informatics Association, Massachusetts Medical Society, Medical Dermatology Society, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

R Christopher Walton, MD Professor, Director of Uveitis and Ocular Inflammatory Disease Service, Department of Ophthalmology, University of Tennessee College of Medicine

R Christopher Walton, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Healthcare Executives, American Uveitis Society, Association for Research in Vision and Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.