What is the recommended steroid dose for acute Reiter syndrome?

From the Research

For acute Reiter syndrome (reactive arthritis), oral prednisone at 20-40 mg daily for 1-2 weeks with a gradual taper over 2-4 weeks is typically recommended. This moderate-dose steroid regimen helps rapidly control the acute inflammatory symptoms including joint pain, swelling, and associated enthesitis. The treatment should be used as a bridge therapy while addressing the underlying trigger (often genitourinary or gastrointestinal infection) and initiating longer-term management with NSAIDs. Patients should be monitored for steroid side effects including elevated blood glucose, mood changes, and sleep disturbances. Intra-articular steroid injections (typically methylprednisolone acetate 40-80 mg or triamcinolone acetonide 20-40 mg) may be considered for persistent monoarthritis. Steroids work by suppressing the abnormal immune response that occurs following the triggering infection, reducing production of pro-inflammatory cytokines and inhibiting leukocyte migration to affected tissues. For patients with more severe or persistent symptoms, disease-modifying antirheumatic drugs may be needed as steroid-sparing agents 1.

Some key points to consider when treating acute Reiter syndrome include:

• The importance of addressing the underlying trigger, such as a genitourinary or gastrointestinal infection
• The use of NSAIDs for longer-term management of symptoms
• The potential need for disease-modifying antirheumatic drugs in patients with more severe or persistent symptoms
• The importance of monitoring for steroid side effects, such as elevated blood glucose and mood changes
• The potential use of intra-articular steroid injections for persistent monoarthritis.

It's worth noting that the evidence for the treatment of acute Reiter syndrome is largely based on case reports and small studies, and more research is needed to determine the optimal treatment approach 2, 3, 4, 5. However, based on the available evidence, oral prednisone at 20-40 mg daily for 1-2 weeks with a gradual taper over 2-4 weeks is a reasonable treatment approach.