Acute onset of rash and oligoarthritis
Tx: Antibiotics, NSAIDs, and steroids
Antibiotic therapy for 3 months is indicated if a patient’s case of RS can be traced back to an infection. If a Chlamydia species is the offending organism, then doxycycline or tetracycline can be used7 (strength of recommendation [SOR]: B). If the infectious agent is unknown, then ciprofloxacin can offer broad-spectrum coverage8 (SOR: B).
Though few studies have evaluated the long-term effects of NSAID treatment on RS, a regular schedule of high doses for several weeks is appropriate for inflammation and pain management. It’s most effective when given early in the disease course5 (SOR: B).
Topical corticosteroids can be used on mucosal and skin lesions. For refractory disease, immunosuppressive agents such as sulfasalazine at 2000 mg/day9 (SOR: B) or a subcutaneous injection of etanercept at 25 mg twice weekly10 (SOR: B) offer relief.
Our patient’s treatment included an NSAID and corticosteroids
Because our patient’s syndrome involved a variety of systemic manifestations, we used several medications to cover all of his symptoms. We prescribed piroxicam 20 mg daily, clobetasol 0.05% ointment applied daily to legs and feet, triamcinolone 0.1% cream applied to scalp twice daily and genitals and armpits once daily, and acitretin 25 mg daily. We consulted Rheumatology to assess and treat his joint disease. We also consulted Ophthalmology to assess for potential ocular manifestations.
Though the patient did report a history of a sexually transmitted infection, it occurred long before his visit, and we were unable to identify an infectious agent. As a result, we did not start him on any antibiotics.
We instructed the patient to return in 2 weeks. Unfortunately, he was lost to follow-up. Patients with RS, though, typically make a full recovery from their symptoms. Some patients, however—10% to 20%—may go on to have a chronic, deforming arthritis.3
