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

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 <i>Chlamydia trachomatis</i> <i> </i>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 <i>Chlamydia</i> 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 <i>C. trachomatis-</i>induced ReA, and through a literature review, it details the considerations clinicians must take into account to manage their patients' symptomatology.