Effect of a three month course of ciprofloxacin on the late prognosis of reactive arthritis.
BACKGROUND
The value of antibiotics in the treatment of reactive arthritis (ReA) is still controversial.


OBJECTIVE
To analyse the long term outcome of patients with ReA, treated with a three month course of ciprofloxacin or placebo.


METHODS
Patients who had had ReA and had participated in a double blind, placebo controlled trial on the effectiveness of ciprofloxacin 4-7 years earlier were invited to a clinical examination. Of the 71 patients who were included in the original study, 53 agreed to visit the clinic for an examination. Twenty six of 53 patients had originally received ciprofloxacin and 27 had belonged to the placebo group. Of these, 20 in the ciprofloxacin and 25 in the placebo group were HLA-B27 positive.


RESULTS
11/27 (41%) patients in the original placebo group had now developed chronic rheumatic disease, as compared with only 2/26 (8%) patients originally treated with ciprofloxacin (p=0.006). Two patients who originally had received placebo, none in the ciprofloxacin group had developed ankylosing spondylitis, and three patients in the original placebo group, none in the ciprofloxacin group had recurrent anterior uveitis. The same tendency was seen when several different measures were analysed. Of the patients with chronic spondyloarthropathy, 10 in the placebo and none in the ciprofloxacin group were HLA-B27 positive.


CONCLUSIONS
Analysis 4-7 years after the initial ReA suggests that a three month course of antibiotics in the acute phase may have a beneficial effect on the long term prognosis.
Yli-Kerttula
T
T
Department of Medicine, Turku University, Satalinna Hospital, Finland. timo.yli-kerttula@tyks.fi
Luukkainen
R
R
Yli-Kerttula
U
U
Möttönen
T
T
Hakola
M
M
Korpela
M
M
Sanila
M
M
Uksila
J
J
Toivanen
A
A
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D016918:Arthritis, Reactive / Q000188:drug therapy*; D002908:Chronic Disease; D002939:Ciprofloxacin / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D015796:HLA-B27 Antigen / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D000091402:Prohibitins; D012216:Rheumatic Diseases / Q000276:immunology / Q000517:prevention & control; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D015796:HLA-B27 Antigen; C000717331:PHB2 protein, human; D000091402:Prohibitins; D002939:Ciprofloxacin