Ibero-American consensus on reactive arthritis: definition, diagnosis, and management

Reactive arthritis (ReA) is characterized by substantial clinical heterogeneity and lacks universally accepted diagnostic criteria. The scarce evidence-based treatment guidelines highlight the urgent need for regionally relevant consensus recommendations.

To develop recommendations based on evidence and clinical experience to establish definitions, accurate diagnosis, and therapeutic management of patients with ReA.

A methodological team and a multidisciplinary group of experts were established. MEDLINE, LILACS, Cochrane, and gray literature from conferences (EULAR, ACR, PANLAR, SAR) were analyzed in a systematic literature review (PRISMA). Based on the PICO format and GRADE methodology, treatment recommendations were made. For the development of definitions, a Delphi process was performed until consensus was reached. Consensus for recommendations required at least 70% agreement.

A total of 13 overarching principles and 54 recommendations were formulated, arranged into concepts, definitions, and treatment guidelines. Seventeen specific recommendations regarding the diagnostic process were included. A therapeutic approach was established using an algorithm based on whether the involvement was peripheral, predominantly axial, or entheseal. Treatment was also specified according to extra-musculoskeletal manifestations.

For the first time, this agreement allows for the establishment of uniform therapeutic algorithms and classification criteria across the region. The document represents an essential tool for standardizing healthcare and raising the level of care for patients with ReA. Keypoints • Establishes the first regional consensus providing standardized definitions, diagnostic criteria, and uniform therapeutic algorithms for ReA. • Employs a Delphi process, GRADE methodology, and a rigorous systematic review to develop 54 recommendations and 13 overarching principles. • Despite the limited evidence available for ReA, several treatment recommendations achieved moderate certainty of evidence and strong recommendations, with high expert agreement, including the use of csDMARDs after failure of NSAIDs and/or corticosteroids (100%) and sulfasalazine as the preferred csDMARD (91%).