Which is a first-line therapy for reactive arthritis?

• A. Antibiotics
• B. NSAIDs
• C. Methotrexate
• D. TNF inhibitors

Answer: (B)

Reactive arthritis is driven by inflammation of the joints after an infection, so the initial goal is to reduce inflammation and relieve pain quickly. Nonsteroidal anti-inflammatory drugs do this by blocking cyclooxygenase and lowering prostaglandin production, which decreases joint swelling, stiffness, and tenderness and helps people return to normal activities.

Antibiotics aren’t used to treat the arthritis itself, since the inflammation is a reactive process rather than an active infection in the joints. They may be indicated if there is an ongoing underlying infection that needs to be eradicated (for example, persistent genitourinary infection), but that’s separate from first-line relief of joint symptoms.

If NSAIDs aren’t enough to control symptoms, clinicians may turn to intra-articular or short course systemic steroids, and for longer-standing or more severe disease, disease-modifying agents like methotrexate or sulfasalazine, with TNF inhibitors reserved for refractory cases.