Reactive Arthritis

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Combination antibiotics as a treatment for chronic Chlamydia-induced reactive arthritis: A double-blind, placebo-controlled, prospective trial†

  1. J. D. Carter1,*,
  2. L. R. Espinoza2,
  3. R. D. Inman3,
  4. K. B. Sneed1,
  5. L. R. Ricca1,
  6. F. B. Vasey1,
  7. J. Valeriano1,
  8. J. A. Stanich4,
  9. C. Oszust4,
  10. H. C. Gerard4,
  11. A. P. Hudson4

Article first published online: 12 FEB 2010

DOI: 10.1002/art.27394

Issue

Arthritis & Rheumatism

Arthritis & Rheumatism

Volume 62, Issue 5, pages 1298–1307, May 2010

Additional Information

How to Cite

Carter, J. D., Espinoza, L. R., Inman, R. D., Sneed, K. B., Ricca, L. R., Vasey, F. B., Valeriano, J., Stanich, J. A., Oszust, C., Gerard, H. C. and Hudson, A. P. (2010), Combination antibiotics as a treatment for chronic Chlamydia-induced reactive arthritis: A double-blind, placebo-controlled, prospective trial. Arthritis & Rheumatism, 62: 1298–1307. doi: 10.1002/art.27394

Author Information

  1. 1

    University of South Florida College of Medicine, Tampa

  2. 2

    Louisiana State Health Science Center, New Orleans

  3. 3

    University of Toronto, Toronto, Ontario, Canada

  4. 4

    Wayne State University School of Medicine, Detroit, Michigan

*Department of Internal Medicine, Division of Rheumatology, University of South Florida College of Medicine, 12901 Bruce B. Downs Boulevard, MDC 81, Tampa, FL 33612

  1. †

    ClinicalTrials.gov identifier: NCT00351273.

Publication History

  1. Issue published online: 29 APR 2010
  2. Article first published online: 12 FEB 2010
  3. Accepted manuscript online: 12 FEB 2010 12:00AM EST
  4. Manuscript Accepted: 4 FEB 2010
  5. Manuscript Received: 10 JUL 2009

Funded by

  • NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases). Grant Numbers: AR-053646, AR-52541

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Abstract

Objective

Chlamydia trachomatis and Chlamydophila (Chlamydia) pneumoniae are known triggers of reactive arthritis (ReA) and exist in a persistent metabolically active infection state in the synovium, suggesting that they may be susceptible to antimicrobial agents. The goal of this study was to investigate whether a 6-month course of combination antibiotics is an effective treatment for patients with chronic Chlamydia-induced ReA.

Methods

This study was a 9-month, prospective, double-blind, triple-placebo trial assessing a 6-month course of combination antibiotics as a treatment for Chlamydia-induced ReA. Eligible patients had to be positive for C trachomatis or C pneumoniae by polymerase chain reaction (PCR). Groups received 1) doxycycline and rifampin plus placebo instead of azithromycin; 2) azithromycin and rifampin plus placebo instead of doxycycline; or 3) placebos instead of azithromycin, doxycycline, and rifampin. The primary end point was the number of patients who improved by 20% or more in at least 4 of 6 variables without worsening in any 1 variable in both combination antibiotic groups combined and in the placebo group at month 6 compared with baseline.

Results

The primary end point was 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. Six of 27 patients (22%) randomized to combination antibiotics believed that their disease went into complete remission during the trial, whereas no patient in the placebo arm achieved remission. Significantly more patients in the active treatment group became negative for C trachomatis or C pneumoniae by PCR at month 6. Adverse events were mild, with no significant differences between the groups.

Conclusion

These data suggest that a 6-month course of combination antibiotics is an effective treatment for chronic Chlamydia-induced ReA.

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