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


CONCLUSIONS
These data suggest that a 6-month course of combination antibiotics is an effective treatment for chronic Chlamydia-induced ReA.
Department of Internal Medicine, Division of Rheumatology, University of South Florida College of Medicine, Tampa, FL 33612, USA. jocarter@health.usf.edu
J D
JD
Carter
L R
LR
Espinoza
R D
RD
Inman
K B
KB
Sneed
L R
LR
Ricca
F B
FB
Vasey
J
J
Valeriano
J A
JA
Stanich
C
C
Oszust
H C
HC
Gerard
A P
AP
Hudson
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage / Q000009:adverse effects; D016918:Arthritis, Reactive / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D017963:Azithromycin / Q000008:administration & dosage* / Q000009:adverse effects; D002690:Chlamydia Infections / Q000150:complications*; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification*; D016993:Chlamydophila pneumoniae / Q000235:genetics / Q000302:isolation & purification; D002908:Chronic Disease; D004269:DNA, Bacterial / Q000235:genetics; D004311:Double-Blind Method; D004318:Doxycycline / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007596:Joints / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010919:Placebos; D000091402:Prohibitins; D011446:Prospective Studies; D012293:Rifampin / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000904:Antibiotics, Antitubercular; D004269:DNA, Bacterial; C000717331:PHB2 protein, human; D010919:Placebos; D000091402:Prohibitins; D017963:Azithromycin; D004318:Doxycycline; D012293:Rifampin