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Antibiotic for reactive arthritis




Scientists from University of South Florida College of Medicine found a combination of antibiotics to be an effective therapy for Chlamydia-induced reactive arthritis, a major step forward in the management, and possibly cure, of this disease. Results of this study are reported in the recent issue of Arthritis & Rheumatism, a journal of the American College of Rheumatology.



Antibiotic for reactive arthritis

Reactive arthritis (ReA), also known as Reiter's syndrome, occurs in response to an infection. As per National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the bacterium most often linked to ReA is Chlamydia trachomatis. Respiratory infections with Chlamydia pneumoniae can also trigger ReA, while associated infections in the digestive tract include Salmonella, Shigella, Yersinia, and Campylobacter. ReA symptoms commonly last 3 to 12 months, eventhough symptoms can return or develop into a long-term disease. In the past it was thought that only a small percentage of people would experience chronic symptoms of ReA. However, more recent data suggests that as a number of as 30%-50% of patients could develop a chronic form of the disease. In chronic ReA, symptoms can be severe and difficult to control with therapy, which could lead to joint damage.

The use of long-term antibiotic therapy for patients with ReA is controversial. Several reported studies have indicated that prolonged antimicrobial monotherapy is not efficacious, while other studies suggest there might be a benefit, specifically with early-stage Chlamydia-induced ReA.

The study led by J.D. Carter, M.D., focused on combinations including 2 antibiotics found to have specific effects on the Chlamydia bacteria. The first, rifampin, has excellent tissue penetration, an important weapon against intracellular pathogens such as Chlamydia. Rifampin also has been shown to interfere with chlamydial gene transcription, including the heat-shock proteins (HSPs), which can ultimately lead to the demise of the infected cell. Dr. Carter explains why this is important. "Combining this effect with antibiotics that block chlamydial protein synthesis (e.g., doxycycline or azithromycin) may allow for successful eradication of the cell harboring persistently infecting intracellular organisms. A recent pilot study conducted by our group suggested that prolonged therapy with a combination of doxycycline and rifampin significantly improves symptoms of chronic undifferentiated spondylarthritis (SpA) (with a special focus on Chlamydia) compared with doxycycline alone. The goal of the present study was to further investigate whether a 6-month course of combination antibiotics, one of which is rifampin, is effective in the therapy of patients with chronic Chlamydia-induced ReA".

The 9-month, prospective, double-blind, triple-placebo trial screened a total of 80 subjects, and 42 were enrolled and randomized to therapy. Twelve subjects were randomized to doxycycline and rifampin, 15 were randomized to azithromycin and rifampin, and 15 were randomized to matching oral placebos. The primary end pointan improvement of 20% or morewas achieved in 17 of 27 patients (63%) receiving combination antibiotics and in 3 of 15 patients (20%) receiving placebo. Secondary efficacy end points showed similar results, demonstrating that compared with placebo, a 6-month course of combination antibiotics resulted in a significantly higher response rate in patients with chronic Chlamydia-induced ReA, eventhough which combination of antibiotics was most effective remained undetermined as the trial wasn't powered to compare the 2 regimens.

Dr. Carter concludes, "The results of this study are encouraging for the management of chronic post-Chlamydia ReA. These data suggest that there is potential for eradication of this persistent infection and that improvement in the clinical sequelae that are the result of these infections can be achieved in a substantial number of patients".

In an Editorial published in this month's issue, Dr. Henning Zeidler agrees. "The study by Carter et al shows impressive effects and, with them, the potential for the eradication of Chlamydia, which would cure Chlamydia-induced ReA".


Posted by: Mark    Source




Did you know?
Scientists from University of South Florida College of Medicine found a combination of antibiotics to be an effective therapy for Chlamydia-induced reactive arthritis, a major step forward in the management, and possibly cure, of this disease. Results of this study are reported in the recent issue of Arthritis and Rheumatism, a journal of the American College of Rheumatology.

Medicineworld.org: Antibiotic for reactive arthritis

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