title: Antibiotics for treatment of reactive arthritis: a systematic review and metaanalysis.
abstract: OBJECTIVE
  To examine the efficacy and safety of antibiotic treatments for reactive arthritis (ReA).
  
  
  METHODS
  We did a systematic review and metaanalysis of randomized controlled trials of antibiotics for treatment of ReA. We searched electronic databases and conference proceedings up to November 2011. Included trials reported on remission, joint counts, and pain or patient global scores in any language.
  
  
  RESULTS
  Twelve trials were eligible for inclusion and 10 provided data for metaanalysis. The pooled relative risk of failure to achieve remission from a random effects model showed no significant benefit of antibiotic treatment on remission (7 trials, 375 participants, RR 0.74, 95% CI 0.49-1.10); however, substantial heterogeneity was observed (I(2) = 76.3%, p < 0.0001). The treatment effect did not differ significantly by the type of organism triggering the ReA (chlamydia, 4 trials, RR 0.80, 95% CI 0.63-1.03, vs other microorganisms, 5 trials, RR 0.72, 95% CI 0.29-1.79, metaregression p = 0.477) or use of combination antibiotics (monotherapy, 6 trials, RR 0.70, 95% CI 0.39-1.26, vs combination therapy, 1 trial, RR 0.79, 95% CI 0.63-0.99, metaregression p = 0.466). When unblinded trials were excluded, the treatment effect was attenuated and heterogeneity decreased (RR 0.87, 95% CI 0.70-1.10, I(2) = 32.8%, p = 0.19). No significant effects of antibiotic treatment were observed on joint counts, pain, or patient global scores; however, antibiotics were associated with a 97% increase in gastrointestinal adverse events.
  
  
  CONCLUSIONS
  Trials of antibiotic treatment for ReA have produced heterogeneous results that may be related to differences in study design. The efficacy of antibiotics is uncertain.
authors.affiliation: Department of Medicine and the Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. cehbarbe@ucalgary.ca
authors.forename: Claire E
authors.initials: CE
authors.lastname: Barber
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
authors.forename: Robert D
authors.initials: RD
authors.lastname: Inman
authors.forename: John M
authors.initials: JM
authors.lastname: Esdaile
authors.forename: Matthew T
authors.initials: MT
authors.lastname: James
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016918:Arthritis, Reactive / Q000188:drug therapy*; D006801:Humans; D000091402:Prohibitins; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; C000717331:PHB2 protein, human; D000091402:Prohibitins
keywords: ANTIBIOTICS; DRUG TOXICITY; REACTIVE ARTHRITIS; TREATMENT OUTCOME