A retrospective case series of 12 patients with chronic reactive arthritis with emphasis on treatment outcome with biologics

Abstract

Background: Patients with reactive arthritis frequently present to dermatologists. However, there is paucity of information regarding its clinical aspects and management in dermatological literature.

Objective: To review the clinical features and management of patients with chronic reactive arthritis admitted to the dermatology department of a teaching hospital.

Methods: This was a retrospective analysis of patients with reactive arthritis admitted to the Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India from January 2016 to February 2018.

Results: There were 12 males (disease duration 9-180 months). Biologics were used in 9 (75%) patients on 16 different occasions, the most frequent being infliximab (n = 10 times), followed by adalimumab (n = 3), etanercept, secukinumab and itolizumab (n = 1 each), in combination with other systemic agents. Response rate with treatment regimens including biologics (69% responders, 31% partial responders) was statistically significantly better than those without biologics (27% responders, 46% partial responders, 27% nonresponders; P = 0.036), using a composite measure assessing improvement in skin and joint symptoms. Biologics were discontinued on 50% of the occasions, after a median of 3.5 months (range 1.5-7.5 months) because of satisfactory response (n = 4), therapeutic fatigue (n = 3) or adverse event (n = 1). After biologic discontinuation, the response was sustained for a median of 5 months (range 3-6 months) before disease exacerbation. The number of treatment switches increased with the follow-up duration (median three switches per patient, range 1-8). The median follow-up duration was 10.5 months (range 4-76 months).

Conclusion: Biologics produce rapid improvement in skin and joint symptoms in chronic reactive arthritis, but the response is not long-lasting. Patients with chronic reactive arthritis have a waxing and waning course despite regular treatment.

Limitations: The limitations are retrospective design, small sample size and lack of a validated outcome measure.

Keywords: Biologics; dermatological manifestations; reactive arthritis; treatment outcome.