# When the Infection Clears but Inflammation Persists: A Case of Chlamydia-Associated Reactive Arthritis Requiring Disease-Modifying Antirheumatic Drug (DMARD) Therapy

## TL;DR

A young man with persistent reactive arthritis caused by Chlamydia required escalating treatments, including DMARDs, to manage his symptoms.

## Contribution

This case highlights the need for escalated care in persistent Chlamydia-associated reactive arthritis.

## Key findings

- Initial treatment with antibiotics and steroids provided partial relief but did not prevent relapse.
- Methotrexate and later a biologic DMARD were required to manage persistent symptoms.
- HLA-B27 positivity and elevated inflammatory markers were consistent with reactive arthritis.

## Abstract

Reactive arthritis (ReA) can be a persistent and debilitating form of arthritis that is a consequence of a gastrointestinal or genitourinary infection. Although most cases self-resolve, a small subset of cases may persist and require an escalation of care to manage their symptoms. We present a case of recurrent ReA induced by Chlamydia trachomatis infection in a young male patient who required a stepwise escalation of his medical management. This case outlines a 32-year-old man followed over six months from his diagnosis. Initially, the patient presented with persistent joint pain in the lower extremities, elevated inflammatory markers, a positive HLA-B27 antigen, and a positive Chlamydia test. He was treated for his initial symptomatology with antibiotics and systemic steroids, and later, methotrexate was added, with clinical improvement. However, several months later, the patient relapsed and required the initiation of a biologic disease-modifying antirheumatic drug (DMARD). This case is an opportunity to follow a case of C. trachomatis-induced ReA, and through a literature review, it details the considerations clinicians must take into account to manage their patients’ symptomatology.