Successful treatment of postvenereal reactive arthritis with synovectomy and 3 months' azithromycin.
BACKGROUND
The effects of antibiotic therapy on the course of postvenereal reactive arthritis have not yet been elucidated.


OBJECTIVE
The objective of this study was to observe the clinical course and outcome of synovectomy and 3 months of azithromycin therapy in patients with reactive arthritis and previously diagnosed triggering bacteria.


METHODS
We performed an open, prospective study on 20 (14 male/6 female) patients with postvenereal reactive knee arthritis, aged 36.7 +/- 14.8 years, and with 16.5 +/- 20.4 months' duration of the disease. Detection of bacteria triggers was done by polymerase chain reaction, isolation and identification, and electron microscopy. Synovectomy was performed in all patients at entry into the study. Azithromycin was given at a dose of 500 mg per day for 5 days, and then 500 mg twice a week, during a 3-month period. Patients without remission were treated with combined antibiotic therapy using a macrolide, quinolone, and tetracycline for the next 4 months. Outcome evaluations of therapeutic efficacy and azithromycin safety were done after 1 and 3 months and 2 years of follow up.


RESULTS
Remission, defined by the absence of joint swelling and tenderness, and extraarticular signs, was reached after 3 months in 15 of 20 (75.0%) patients (P = 0.025). Of 5 patients with persistent knee arthritis, remission was achieved with combined antibiotic therapy in 4. Visual analog scale scores (P < 0.01), the number of patients (P = 0.002), and the number of samples (P = 0.01) with a positive finding of bacteria or their DNA were significantly lower after 3 months of therapy. During the azithromycin therapy, there were no significant adverse effects.


CONCLUSIONS
These patients with reactive arthritis did extremely well on the regimen described. In our study group, the number of patients and the number of samples with positive findings of bacteria or their DNA were lower after the antibiotic treatment combined with surgery, although not all bacteria were eradicated. Adverse effects of prolonged azithromycin administration were insignificant. This open treatment approach is recommended but does need a study with controls.
Pavlica
Ljiljana
L
Department of Rheumatology and Clinical Immunology, Military Medical Academy, Belgrade, Serbia and Montenegro. lpavlica77@hotmail.com
Nikolic
Dragan
D
Magic
Zvonko
Z
Brajuskovic
Goran
G
Strelic
Natasa
N
Milicic
Biljana
B
Jovelic
Aleksandra
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016918:Arthritis, Reactive / Q000382:microbiology / Q000628:therapy*; D017963:Azithromycin / Q000627:therapeutic use*; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D004269:DNA, Bacterial / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007719:Knee Joint; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D019535:Mycoplasma hominis / Q000302:isolation & purification; D010147:Pain Measurement; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D000074402:Synovectomy; D016896:Treatment Outcome; D016990:Ureaplasma urealyticum / Q000302:isolation & purification
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D017963:Azithromycin