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.
RCT Entities:
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.
Authors: S F Dowell; R W Peeling; J Boman; G M Carlone; B S Fields; J Guarner; M R Hammerschlag; L A Jackson; C C Kuo; M Maass; T O Messmer; D F Talkington; M L Tondella; S R Zaki Journal: Clin Infect Dis Date: 2001-07-20 Impact factor: 9.079
Authors: Herve C Gerard; Zhao Wang; Judith A Whittum-Hudson; Hani El-Gabalawy; Rafaela Goldbach-Mansky; Thomas Bardin; H Ralph Schumacher; Alan P Hudson Journal: J Rheumatol Date: 2002-09 Impact factor: 4.666
Authors: T Yli-Kerttula; R Luukkainen; U Yli-Kerttula; T Möttönen; M Hakola; M Korpela; M Sanila; J Uksila; A Toivanen Journal: Ann Rheum Dis Date: 2003-09 Impact factor: 19.103
Authors: T K Kvien; J S H Gaston; T Bardin; I Butrimiene; B A C Dijkmans; M Leirisalo-Repo; P Solakov; M Altwegg; P Mowinckel; P-A Plan; T Vischer Journal: Ann Rheum Dis Date: 2004-09 Impact factor: 19.103
Authors: Udaya S Toti; Bharath R Guru; Mirabela Hali; Christopher M McPharlin; Susan M Wykes; Jayanth Panyam; Judith A Whittum-Hudson Journal: Biomaterials Date: 2011-06-08 Impact factor: 12.479