rifampin and Arthritis--Reactive

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Reactive; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Diagnosis, Differential; Female; Haplotypes; HLA-B27 Antigen; Humans; Magnetic Resonance Imaging; Male; Polymerase Chain Reaction; Prognosis; Rifampin; Sulfasalazine; Time Factors; Urine

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents; Antibodies, Bacterial; Arthritis, Reactive; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Ciprofloxacin; Clinical Trials as Topic; Diagnosis, Differential; DNA, Bacterial; Drug Therapy, Combination; Enteritis; Female; Humans; Male; Models, Theoretical; Polymerase Chain Reaction; Rifampin; Salmonella; Salmonella Infections; Sensitivity and Specificity; Tetracyclines; Time Factors; Urethritis; Uterine Cervicitis; Yersinia; Yersinia Infections

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.. 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.. 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.. These data suggest that a 6-month course of combination antibiotics is an effective treatment for chronic Chlamydia-induced ReA.

Topics: Adult; Aged; Anti-Bacterial Agents; Antibiotics, Antitubercular; Arthritis, Reactive; Azithromycin; Chlamydia Infections; Chlamydia trachomatis; Chlamydophila pneumoniae; Chronic Disease; DNA, Bacterial; Double-Blind Method; Doxycycline; Drug Therapy, Combination; Female; Humans; Joints; Male; Middle Aged; Placebos; Prohibitins; Prospective Studies; Rifampin; Treatment Outcome

Chlamydia is a known trigger of reactive arthritis (ReA). It may also be common cause of undifferentiated spondyloarthropathy (uSpA). Persistent, metabolically active, Chlamydiae have been observed in the synovial tissue of these patients years after their initial exposure. Trials with lymecycline and rifampin have shown benefit in early/acute Chlamydia-induced arthritis. In vitro data suggest that persistent Chlamydia become resistant to chronic monotherapy of tetracyclines or rifampin, whereas no such resistance is noted when rifampin is added to antimicrobials that are active against Chlamydia. Rifampin and doxycycline also show synergistic effect against Chlamydia. In addition, rifampin inhibits chlamydial production of heat shock proteins (HSP). HSP60 plays a key role in the chronic persistent state of Chlamydia. We conducted a prospective, randomized 9-month trial to evaluate the efficacy of doxycycline versus a combination of doxycycline and rifampin in the treatment of uSpA.. The study enrolled 30 patients with chronic inflammatory arthritis (average disease duration 10 yrs) who fulfilled the European Spondylarthropathy Study Group criteria, with no evidence of inflammatory bowel disease, psoriasis, ankylosing spondylitis, or preceding dysentery. Patients received doxycycline 100 mg po twice daily or a combination of doxycycline 100 mg po twice daily and rifampin 600 mg po daily. They received a 4-question self-questionnaire and a blinded joint examination at each visit. The questions include a visual analog scale (VAS) for their current amount of back pain, duration of morning stiffness, back pain at night, and peripheral joint pain. The blinded joint examination consisted of a swollen joint count (SJC) and a tender joint count (TJC). These 6 variables were assessed at baseline and at 1, 3, 6, and 9 months. Responders were defined as those who improved > or = 20% in at least 4 of the 6 variables at 9 months of therapy.. Comparing the doxycycline + rifampin arm (D/R) versus the doxycycline arm (D) at 9 months of therapy, all 6 variables improved more in D/R versus D, 4 of which were statistically significant. The mean VAS (scale of 100) decreased 24.4 points in D/R in contrast to 3 points in D (p < 0.03). Duration of morning stiffness decreased by 1.2 h in D/R, with a slight increase of 0.1 h in D (p < 0.003). The back pain at night and peripheral joint pain both improved in D/R group versus D (not statistically significant). Finally, the SJC and TJC also improved in D/R (-2.1 and -2.5) versus D (-0.4 and -0.6; p = 0.02, p = 0.03, respectively). Eleven of 15 patients in the D/R arm were responders, whereas only 2 of 15 D group patients were considered responders (p < 0.003).. The combination of doxycycline and rifampin for 9 months seemed to be effective in treatment of chronic uSpA. This is the first study to demonstrate therapeutic benefit with antimicrobials to a chronic inflammatory arthritis possibly secondary to persistent Chlamydia.

Topics: Adult; Aged; Anti-Bacterial Agents; Antibiotics, Antitubercular; Arthritis, Reactive; Chlamydia Infections; Doxycycline; Drug Synergism; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Pain Measurement; Prohibitins; Prospective Studies; Retrospective Studies; Rifampin; Spondylarthropathies; Surveys and Questionnaires

Poncet's disease is a rare reactive polyarthritis associated with active tuberculosis and no evidence of Mycobacterium tuberculosis in the affected joint.. We report a case of a 35 year old Human Immunodeficiency Virus positive Kenyan male of Kikuyu ethnicity from Kiambu County who presented to hospital with a 6 day history of bilateral knee pain and swelling, bilateral ankle pain with right ankle swelling. The patient reported 6 months history of cough and weight loss. Chest radiograph had features consistent with pulmonary tuberculosis and sputum smear was positive for acid fast bacilli. Analysis of fluid from knee effusion showed no evidence of tuberculosis. Resolution of joint swelling was seen after 3 weeks of tuberculosis chemotherapy suggesting that this was reactive arthritis following pulmonary tuberculosis in a patient infected with human immunodeficiency virus.. This case represents a rare manifestation of tuberculosis presenting as a reactive arthritis. There are very few cases of Poncet's disease reported in literature and the diagnosis of Poncet's disease in Human Immunodeficiency Virus/tuberculosis coinfected patient is extremely uncommon. This case report has been presented to raise awareness of this unusual tuberculosis complication and review its diagnosis and treatment.

Topics: Adult; Antibiotics, Antitubercular; Antiretroviral Therapy, Highly Active; Arthritis, Reactive; Ethambutol; HIV Infections; Humans; Isoniazid; Male; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Pulmonary

Topics: Adult; Anti-Bacterial Agents; Arthritis, Reactive; Doxycycline; Female; Foot; HLA-B27 Antigen; Humans; Keratosis; Rifampin; Urinary Tract Infections

To document the clinical course and the treatment of episcleritis associated with brucellosis.. Three consecutive cases of patients with recurrent episcleritis associated with brucellosis were evaluated through clinical and laboratory data including serology (tube agglutination), blood culture, and synovial fluid culture.. All the patients had ingested contaminated milk and/or fresh cheese. The diagnosis of brucellosis was confirmed by high antibody titer, positive blood culture, negative synovial fluid culture and unresponsive condition to the previous nonspecific therapy for episcleritis and reactive arthritis. The patients responded well to the therapy with doxycycline and rifampicin.. We proposed that recurrent episcleritis had a co-occurence with reactive arthritis in the course of the brucellosis, and that it responded well to the antibrucellar antibiotics rather than to steroids. This also implies that brucellosis as a rule is an underlying triggering infection associated with reactive arthritis.

Topics: Aged; Antibodies, Bacterial; Arthritis, Reactive; Brucella; Brucellosis; Doxycycline; Drug Therapy, Combination; Eye Infections, Bacterial; Female; Humans; Middle Aged; Recurrence; Rifampin; Scleritis; Synovial Fluid

Topics: Actinomycetales Infections; Animals; Anti-Bacterial Agents; Antibiotics, Antitubercular; Arthritis, Reactive; Drug Resistance, Microbial; Drug Therapy, Combination; Erythromycin; Female; Horse Diseases; Horses; Lung; Pneumonia, Bacterial; Rheumatoid Factor; Rhodococcus equi; Rifampin; Synovial Fluid