rifampin and Arthritis--Rheumatoid

Topics: Adrenal Cortex Hormones; Adult; Animals; Antirheumatic Agents; Antiviral Agents; Arthritis, Juvenile; Arthritis, Rheumatoid; Child; Enzyme Inhibitors; Ganciclovir; Genetic Therapy; Haplorhini; Hormones; Humans; Injections, Intra-Articular; Methotrexate; Mice; Osmium Tetroxide; Osteoarthritis; Photochemotherapy; Rats; Rifampin; Somatostatin; Synovectomy; Synovitis; Time Factors

Does the addition of 600 mg rifampicin or 50 mg methotrexate improve pain relief after injection of the rheumatoid knee with 20 mg triamcinolone hexacetonide (TH)?. Eighty-two patients on stable therapy were allocated at random to receive intra-articular TH alone, TH and methotrexate (TH+M) or TH and rifampicin (TH+R). Pain was recorded by a weekly chart and analysed using the area under the curve (AUC), periods of total pain relief and duration of effect. Examinations and microwave thermography were performed by an independent meteorologist at baseline, 3 and 6 months.. Using the AUC, pain was significantly better in the TH+R group compared with TH alone (P=0.039, Mann Whitney U). The median duration of improved pain scores was 13.5 weeks with TH alone, 10 with TH+M and 19 with TH+R. Examination and microwave thermography revealed improvements compared with baseline, but there were no significant differences between the groups. Eleven of 28 patients treated with TH + R developed a flare of post-injection pain.. Whilst the addition of rifampicin improved pain relief, the occurrence of pain after injection remains a problem. Measures to minimize this are needed when TH+R is used.

Topics: Aged; Anti-Inflammatory Agents; Antirheumatic Agents; Arthritis, Rheumatoid; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Injections, Intra-Articular; Knee Joint; Male; Methotrexate; Middle Aged; Pain; Rifampin; Severity of Illness Index; Treatment Outcome; Triamcinolone Acetonide

Sixteen patients with definite or classical Rheumatoid Arthritis (RA) of less than twelve months duration were recruited into a randomised, open twelve month study comparing Rifampicin 600 mg daily (9 patients) with Hydroxychloroquine (HCQ) 400 mg daily (7 patients). Ten patients completed twelve months of treatment (4 Rifampicin, 6 HCQ). Five patients were withdrawn from the study due to lack of efficacy (1 HCQ, 4 on Rifampicin). One further patient on rifampicin was withdrawn due to development of abnormal liver function tests. Significant improvement (p < 0.03) was noted in the Stoke Index (SI) at six and twelve months in the HCQ group which was not seen in the rifampicin group. In both groups there was no significant improvement in the single variables (Ritchie index, morning stiffness, grip strength, synovitis score, ESR, CRP). The results fail to confirm that Rifampicin may be useful in the treatment of RA in early stages of disease.

Topics: Adult; Arthritis, Rheumatoid; Female; Humans; Hydroxychloroquine; Male; Middle Aged; Radiography; Rifampin

Rifampin is known to influence the pharmacokinetics of tofacitinib owing to drug interactions. The aim of this study was to determine the efficacy of tofacitinib on co-administration with rifampin in rheumatoid arthritis (RA) patients.. Biologic-naïve RA patients treated with tofacitinib were selected, and electronic medical reports were reviewed retrospectively. All patients underwent screening for latent tuberculosis infection (LTBI) before starting tofacitinib, and patients with positive results were treated to prevent progression to active tuberculosis. To evaluate the efficacy of tofacitinib with or without rifampin, the discontinuation rates of tofacitinib were examined during the first 6 months. Kaplan-Meier analysis was used to construct cumulative discontinuation curves, and comparisons were performed using the log-rank test.. Among 81 patients who starting tofacitinib, 21 were LTBI-positive and 18 were administered rifampin concomitantly with tofacitinib. Additionally, 14 of the 81 patients (17.3%) discontinued tofacitinib during the follow-up, and 7 patients discontinued tofacitinib because of uncontrolled RA activity. The discontinuation rates of tofacitinib within the first 6 months were significantly higher in patients treated with rifampin for LTBI than in those not treated with rifampin (lack of efficacy: 24.7% vs. 5.1%, P<0.01; all causes: 38.9% vs. 11.2%, P<0.01).. Discontinuation rates were higher in RA patients who started tofacitinib during chemoprophylaxis involving rifampin than in those who did not receive rifampin. Physicians should be aware that the efficacy of tofacitinib could be decreased by chemoprophylactic regimens for tuberculosis.

Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Humans; Latent Tuberculosis; Piperidines; Pyrimidines; Retrospective Studies; Rifampin; Treatment Outcome

Topics: Aged; Antitubercular Agents; Arthritis, Rheumatoid; Drug Administration Schedule; Drug Therapy, Combination; Feasibility Studies; Female; Humans; Isoniazid; Latent Tuberculosis; Male; Middle Aged; Rifampin

Hansen's Disease (HD) is a rare, chronic granulomatous infection of the skin and peripheral nerves caused by the noncultivable organism

Topics: Aged; Antirheumatic Agents; Arthritis, Rheumatoid; Clofazimine; Cross-Over Studies; Drug Therapy, Combination; Female; Humans; Leprostatic Agents; Leprosy; Male; Methotrexate; Mycobacterium leprae; Retrospective Studies; Rifampin; Skin; Steroids; Thalidomide; United States

Biological agents inhibiting TNF-α and other molecules involved in inflammatory cascade have been increasingly used to treat rheumatoid arthritis (RA). However, it remains controversial whether biological agents can be used safely in a patient with an underlying chronic infectious disease.. A 63-year-old woman who had been treated with tocilizumab (TCZ), anti-interleukin-6 receptor antibody, for RA presented to our outpatient clinic due to hemoptysis. She was diagnosed with pulmonary Mycobacterium avium complex (MAC) infection, and high-resolution computed tomography (HRCT) showed a single cavitary lesion in the right upper lobe. After diagnosis of pulmonary MAC disease, TCZ was discontinued and combination chemotherapy with clarithromycin, rifampicin, ethambutol and amikacin was started for MAC pulmonary disease. Since the lesion was limited in the right upper lobe as a single cavity formation, she underwent right upper lobectomy. As her RA symptoms were deteriorated around the operation, TCZ was resumed. After resumption of TCZ, her RA symptoms improved and a recurrence of pulmonary MAC infection has not been observed for more than 1 year.. This case suggested that TCZ could be safely reintroduced after the resection of a pulmonary MAC lesion. Although the use of biological agents is generally contraindicated in patients with pulmonary MAC disease, especially in those with a fibrocavitary lesion, a multimodality intervention for MAC including both medical and surgical approaches may enable introduction or resumption of biological agents.

Topics: Amikacin; Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Arthritis, Rheumatoid; Clarithromycin; Ethambutol; Female; Humans; Immunocompromised Host; Lung; Middle Aged; Mycobacterium avium-intracellulare Infection; Pneumonectomy; Rifampin; Tomography, X-Ray Computed

Topics: Anti-Inflammatory Agents; Arthritis; Arthritis, Rheumatoid; Clofazimine; Dapsone; Delayed Diagnosis; Diagnosis, Differential; Humans; Leprostatic Agents; Leprosy; Male; Middle Aged; Prednisolone; Rifampin; Treatment Outcome

A female patient with rheumatoid arthritis (RA) suffered from Mycobacterium avium (M. avium) infection during tocilizumab treatment. Tocilizumab was discontinued and she was treated with a recommended chemotherapy, resulting in improvement of M. avium. Tocilizumab retreatment did not aggravate M. avium infection, and radiographic abnormalities improved over 1 year after cessation of the recommended therapy. Tocilizumab may be one candidate for intractable RA patients with M. avium if any biologic is required.

Topics: Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Antitubercular Agents; Arthritis, Rheumatoid; Clarithromycin; Ethambutol; Female; Humans; Middle Aged; Mycobacterium avium; Mycobacterium avium-intracellulare Infection; Rifampin; Treatment Outcome

Clofazimine enterophathy is a serious complication of clofazimine when used at high doses for treatment of type 2 lepra or or erythema nodosum leprosum. Objective. A woman is presented who had a delayed diagnosis of leprosy, persistent type 2 lepra reaction and lethal clofazimine enteropathy.. A 31-year-old woman presented leprosy symptoms over a 16-year period without medical diagnosis of her disease. During this period, type 2 lepra episodes occurred, but were not accurately diagnosed. These episodes became more severe during her second pregnancy. The patient and her family were interviewed, and her clinical history reviewed.. After twelve years of medical consults, lepromatous leprosy was diagnosed, based on perforation of her nasal septum, with a bacterial index of 5. Her husband and a 12-year-old daughter have leprosy symptoms. During multidrug therapy, she presented with repeated type 2 lepra reaction episodes for which she received daily clofazimine 400 mg doses. Two months after this treatment, severe and frequent episodes of intense abdominal pain began to occur. These persisted for more than a year and were managed with in-hospital administration of several classes of painkillers and antispasmodic medication, including morphine. She also presented with sporadic diarrhea, constipation, nausea, weight loss and mesenteric adenopathies. She died finally due to this intestinal condition. No autopsy was performed.. The patient's clinical presentation suggested a clofazimine-induced lethal enteropathy, a complication not previously seen in Colombia. This connection was not recognized by the medical officers that treated the patient.

Topics: Abdominal Pain; Adult; Arthritis, Rheumatoid; Child; Child, Preschool; Clofazimine; Constipation; Diagnostic Errors; Diarrhea; Drug Therapy, Combination; Erythema Nodosum; Family Health; Fatal Outcome; Female; Humans; Intestinal Diseases; Leishmaniasis, Mucocutaneous; Leprostatic Agents; Leprosy, Lepromatous; Male; Paresthesia; Pregnancy; Pregnancy Complications, Infectious; Rifampin

Topics: Aged, 80 and over; Anti-Bacterial Agents; Arthritis, Rheumatoid; Azithromycin; Drug Therapy, Combination; Ethambutol; Female; Glucocorticoids; Humans; Immunocompromised Host; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Prednisone; Rifampin; Skin Diseases, Bacterial

We present a case of tuberculous peritonitis in a woman with rheumatoid arthritis (RA), treated with adalimumab, and we review the association between anti-tumour necrosis factor (anti-TNF) therapy and tuberculosis. There have been only 2 case reports of peritoneal tuberculosis associated with anti-TNF and only 1 with adalimumab.

Topics: Adalimumab; Aged; Antibiotics, Antitubercular; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Arthritis, Rheumatoid; Female; Humans; Isoniazid; Mycobacterium tuberculosis; Opportunistic Infections; Peritonitis, Tuberculous; Pyrazinamide; Rifampin

Etanercept is a tumor necrosis factor (TNF) inhibitor that has been licensed in the United States for the treatment of adult and juvenile rheumatoid arthritis as well as psoriatic arthritis. Reactivation of tuberculosis is a complication of its use. We report the first case of tuberculous uveitis due to etanercept.. We performed a clinical chart review.. A 58-year-old Caucasian woman was referred to our hospital for chronic unilateral granulomatous panuveitis of the right eye (RE). She was on etanercept and methotrexate for rheumatoid arthritis. Since the patient was immunosuppressed with etanercept and since the uveitis was granulomatous we considered tuberculosis as a possible etiology. An aqueous humor tap was performed and sent for polymerase chain reaction analyses of Herpes simplex, Herpes zoster, and Mycobacterium tuberculosis (MT). This last test was positive. Another aqueous humor sample was taken and sent for microscopic examination of sputum for acid-fast bacilli and culture, both of which were positive for MT. A diagnosis of tuberculous uveitis was established; the patient was treated with rifampin, isoniazid pyrazinamide, and ethambutol and etanercept was stopped. Four months later there were no cells in the anterior chamber and the vitreous was clear.. To our knowledge this is the first reported case of tuberculous uveitis following treatment with etanercept. This etiology has to be considered in patients taking this drug who present with intraocular inflammation.

Topics: Antirheumatic Agents; Antitubercular Agents; Aqueous Humor; Arthritis, Rheumatoid; Drug Therapy, Combination; Etanercept; Female; Granuloma; Humans; Immunoglobulin G; Isoniazid; Middle Aged; Mycobacterium tuberculosis; Panuveitis; Pyrazinamide; Receptors, Tumor Necrosis Factor; Retrospective Studies; Rifampin; Tuberculosis, Ocular

A 54-year-old man with a 22-year history of rheumatoid arthritis and an 8-year history of chronic obstructive pulmonary disease presented with dyspnea on exertion, nonproductive cough and fatigue of 1 month's duration. His medication at presentation consisted of etanercept, azathioprine, naproxen and inhaled fluticasone and salbutamol.. At presentation, the patient underwent physical examination, chest X-ray and high-resolution CT, blood tests, and bronchoalveolar lavage fluid analysis including auramine stains and gene sequence analysis of cultured Mycobacterium szulgai. The patient underwent minithoracotomy after 6 months, and bronchoalveolar lavage fluid analysis, culture and chest X-ray after 18 months. Further chest imaging and culture of sputum samples were performed another year later.. Pulmonary M. szulgai infection.. Triple drug therapy with rifampicin, ethambutol hydrochloride and clarithromycin. Anti-tumor necrosis factor treatment was continued.

Topics: Adalimumab; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Antitubercular Agents; Arthritis, Rheumatoid; Bronchoalveolar Lavage Fluid; Clarithromycin; Drug Therapy, Combination; Etanercept; Ethambutol; Humans; Immunoglobulin G; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Receptors, Tumor Necrosis Factor; Rifampin; Sputum; Thoracotomy; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Pulmonary; Tumor Necrosis Factor-alpha

Tumor necrosis factor (TNF) is essential for host defense against Mycobacterium tuberculosis, and the risk of reactivation of latent tuberculosis infection (LTBI) increases with anti-TNF therapy. This study estimated the prevalence of LTBI and evaluated the safety and completion rate of short-course therapy with isoniazid plus rifampin for 3 months to treat LTBI in a cohort of Korean arthritis patients before initiating anti-TNF therapy. We retrospectively studied the files of 112 consecutive patients to evaluate LTBI before starting anti-TNF drugs. Screening tests were performed, including a tuberculin skin test and chest radiography. LTBI treatment was indicated in 41 patients (37%). Of these, three patients refused the LTBI treatment. Of the 38 patients who underwent LTBI treatment, 36 (95%) took isoniazid plus rifampin for 3 months. Six patients (16%) showed transient elevations of liver enzymes during the LTBI treatment. Overall, 35 patients (92%) completed the LTBI treatment as planned. In conclusion, LTBI was diagnosed in one-third of Korean arthritis patients before initiating anti-TNF therapy. A high percentage of these patients completed 3 months of LTBI treatment with isoniazid plus rifampin without serious complications.

Topics: Adult; Antibiotics, Antitubercular; Arthritis, Rheumatoid; Female; Humans; Korea; Male; Middle Aged; Retrospective Studies; Rifampin; Spondylitis; Spondylitis, Ankylosing; Tuberculin Test; Tuberculosis; Tumor Necrosis Factor-alpha

A major concern surrounding the use of tumor necrosis factor-alpha (TNF-alpha) inhibitors is their potential to increase the risk of opportunistic infections, particularly tuberculosis (TB).. To estimate the incidence of active TB in patients with rheumatic diseases receiving anti-TNF drug therapy and to evaluate the effectiveness of an antituberculosis chemoprophylaxis regimen.. Retrospective study of the files of 613 patients with rheumatic diseases who had received anti-TNF agent (etanercept, infliximab and adalimumab) therapy from July 2000 to June 2004 at the Aristotle University of Thessaloniki, Greece. All patients had a tuberculin skin test (TST) and a postero-anterior chest radiograph (CXR) prior to anti-TNF therapy. When indicated (TST > or =10 mm and/or fibrotic lesions on CXR), treatment for latent TB was established (6 months isoniazid [INH] or 3 months INH and rifampicin [RMP]). Anti-TNF agent therapy was started again 2 months later.. Of 45 patients who fulfilled the criteria for chemoprophylaxis, only 36 were treated correctly. Eleven patients developed active TB 2-35 months after the beginning of anti-TNF therapy. Six patients developed pulmonary and five extra-pulmonary TB. Eight of these had received infliximab and three adalimumab.. The incidence of active TB in this study population was estimated at 449 cases per 100,00 population annually. Anti-tuberculosis chemoprophylaxis was only of partial preventive success in these patients.

Topics: Adalimumab; Adult; Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Antitubercular Agents; Arthritis; Arthritis, Rheumatoid; Comorbidity; Etanercept; Female; Greece; Humans; Immunoglobulin G; Incidence; Infliximab; Isoniazid; Male; Middle Aged; Receptors, Tumor Necrosis Factor; Retrospective Studies; Rifampin; Spondylitis, Ankylosing; Tuberculosis; Tuberculosis, Pulmonary

A 66-year old female suffering from rheumatoid arthritis was treated with methotrexate and intra-articular steroid injections. She had gone through pulmonary tuberculosis at the age of 2 years, also, surgery had been performed 2 years ago because of perforated sigmoid diverticulitis. The patient now presented with episodes of abdominal pain and diarrhea as well as occasional night sweats. Laboratory investigation (normal BSR, CRP and white blood cell counts) did not indicate the presence of an inflammatory process, such as reoccurrence of diverticulitis. However, leukocyturia was repetitively found in this patient with the conventional urine culture yielding no significant bacterial growth. Further urine investigation did not indicate infection with Chlamydia trachomatis or Neisseria gonorrhoeae. Ziehl Neelson stains of morning urinary samples did not show acid-fast rods, however, Mycobacterium tuberculosis was finally isolated by culture. Thus, urogenital tuberculosis was finally diagnosed in this patient. Infection, hematogenic dissemination, and spontaneous remission of pulmonary tuberculosis had occurred more than 60 years ago. After a long latent period, reactivation of tuberculosis happened during drug-induced immunosuppression. The patient was successfully treated with an anti-tuberculosis triple-drug therapy during 2 months followed by a double-drug therapy during 4 months.

Topics: Aged; Antibiotics, Antitubercular; Antitubercular Agents; Arthritis, Rheumatoid; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Isoniazid; Mycobacterium tuberculosis; Pyrazinamide; Pyridoxine; Radiography, Abdominal; Rifampin; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis, Urogenital; Urine

Topics: Aged; Arthritis, Infectious; Arthritis, Rheumatoid; Arthroplasty, Replacement, Knee; Autoimmune Diseases; Ciprofloxacin; Cloxacillin; Drug Therapy, Combination; Fatal Outcome; Humans; Immunocompromised Host; Knee Prosthesis; Male; Phlebitis; Postoperative Complications; Prosthesis-Related Infections; Pulmonary Embolism; Recurrence; Rifampin; Staphylococcal Infections; Staphylococcus; Virulence

Topics: Antibiotic Prophylaxis; Arthritis, Rheumatoid; Arthroplasty, Replacement, Knee; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Knee Joint; Middle Aged; Preoperative Care; Prosthesis Failure; Prosthesis-Related Infections; Recurrence; Reoperation; Rifampin; Staphylococcal Infections; Treatment Outcome; Vancomycin

A patient with rheumatoid arthritis developed ulcerated nodules predominantly on his legs. Skin biopsy and culture demonstrated rheumatoid vasculitis and infection with Mycobacterium haemophilum. Improvement was not seen until clarithromycin was added to his treatment regimen.

Topics: Aged; Arthritis, Rheumatoid; Ciprofloxacin; Clarithromycin; Drug Therapy, Combination; Humans; Male; Mycobacterium Infections, Nontuberculous; Prednisone; Rifampin; Skin; Vasculitis

Following a report that seven of 20 patients with rheumatoid arthritis (RA) had come into clinical and laboratory remission after treatment with rifampicin, and that six of the seven responders had a disease duration of less than three years, 21 patients with classical or definite RA of recent onset were treated with 600 mg rifampicin and 300 mg isoniazid daily for six months. Fourteen of 21 patients completed six months' treatment, but there was no significant improvement in the mean values of the clinical and laboratory parameters measured. The improvement suggested by preliminary studies in patients with early RA is not seen in this larger group. In patients with a disease duration of less than 18 months, however, there was a significant decrease in the erythrocyte sedimentation rate and the serum concentrations of C reactive protein after treatment for six months, although there was no significant clinical improvement. Future studies of this drug in patients with RA should concentrate on this group.

Topics: Arthritis, Rheumatoid; Blood Sedimentation; C-Reactive Protein; Drug Therapy, Combination; Female; Humans; Isoniazid; Male; Middle Aged; Rifampin; Time Factors

Topics: Arthritis, Rheumatoid; Humans; Rifampin

Jewish immigrants from Russia, and Arabs added to the population register since 1967, have a relatively high incidence of bone and joint tuberculosis. These patients now account for most of this disease in Israel. Skeletal tuberculosis imitates various joint conditions, most commonly, rheumatoid arthritis, and therefore presents a diagnostic problem. Injections of corticosteroids and/or immunosuppressive therapy can reactivate quiescent tuberculous lesions. During a 12-year period 14 patients with tuberculous arthritis involving 16 joints were seen in this hospital. They included 9 males and 5 females, 14-70 years old, 4 of whom were known to have had previous skeletal tuberculosis: 3 had spinal and 1 had hip involvement. None of the other 10 had a clinical history of tuberculosis, nor X-ray evidence of active pulmonary disease. 7 patients were diagnosed postoperatively as having joint tuberculosis on histopathological and bacteriological examination; 3 had positive cultures from joint aspirations. Most commonly involved were the spine and knee--4 cases of each. The wrist and acromioclavicular joint were affected in 2 cases each, and the hip, sacroiliac joint, ankle and elbow joints in 1 case each. The youngest patient, 14 years old, had triple-joint involvement of the wrist and the acromioclavicular and sacroiliac joints; the others had single-joint disease. In 1 patient the disease was reactivated after 36 years by surgical conversion of a fused hip to a mobile artificial joint. 3, whose joints were injected with corticosteroids, developed active, destructive tuberculous arthritis. A patient with rheumatoid arthritis who underwent total knee replacement was found to have active tuberculous arthritis.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Arthritis, Infectious; Arthritis, Rheumatoid; Diagnosis, Differential; Ethambutol; Female; Humans; Isoniazid; Joint Prosthesis; Male; Middle Aged; Rifampin; Tuberculosis, Osteoarticular

Mycobacterium kansasii was isolated from an area of cavitating pneumonia in a man with rheumatoid arthritis. Standard antituberculosis treatment, including isoniazid 300 mg daily, had to be stopped because of peripheral neuropathy. The patient, a slow acetylator, subjectively deteriorated despite withdrawal of isoniazid and treatment with pyridoxine 150 mg daily. Improvement occurred only after the pyridoxine had also been withdrawn. Pyridoxine may cause peripheral neuropathy and this case illustrates the need for caution in the use of this vitamin in the prevention and treatment of isoniazid induced peripheral neuropathy.

Topics: Acetylation; Arthritis, Rheumatoid; Ethambutol; Humans; Isoniazid; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Peripheral Nervous System Diseases; Pyridoxine; Rifampin; Tuberculosis, Pulmonary

Several second-line antirheumatic agents possess both immunosuppressive and antimicrobial properties. Rifampin is an antimicrobial agent recently found to exhibit immunosuppressive activity in both animal and human studies. Intraarticular rifamycin SV, a rifampin derivative, has been reported to cause dramatic improvement in gonarthritis in 15 patients with rheumatoid arthritis (RA). These reports along with the personal observation of spontaneous improvement of arthritic symptoms in 2 patients with RA treated with rifampin at our institution, prompted us to conduct a pilot study using oral rifampin at 600-1200 mg daily in 8 patients with active, adult onset, seropositive RA. Although, no clinically important or statistically significant improvement occurred in any of the outcome variables measured (p greater than 0.12), the power of this study to detect such differences was limited. Alkaline phosphatase increased modestly in 7 patients. One patient developed an acute, drug induced, flu-like syndrome with marked elevation of liver enzymes which resolved promptly with drug withdrawal. We conclude that the potential effectiveness of oral rifampin therapy in RA is doubtful.

Topics: Administration, Oral; Adult; Aged; Arthritis, Rheumatoid; Drug Evaluation; Female; Humans; Male; Middle Aged; Pilot Projects; Rifampin; Safety; Time Factors

A patient with rheumatoid arthritis (RA) experienced great improvement in her RA when given antituberculous treatment for pulmonary tuberculosis (TB). Two of the drugs used in TB, rifampicin and isoniazid, include immunomodulatory effects among their properties. To investigate whether these drugs have any effect in RA, we studied 20 patients who were given either rifampicin 600 mg daily (10 patients) or rifampicin 600 mg with isoniazid 300 mg daily (10 patients). Eighteen patients completed at least 3 months' treatment. Six of the 7 patients with early RA (less than 3 years) improved; their median erythrocyte sedimentation rate fell from 43.5-10 mm/h (p = 0.036) and median serum C-reactive protein from 40-0 mg/l (p = 0.036). Eleven patients with longer histories of RA did not improve. Our results suggest rifampicin with or without isoniazid may be effective in RA.

Topics: Adolescent; Adult; Arthritis, Rheumatoid; Blood Sedimentation; C-Reactive Protein; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Isoniazid; Male; Middle Aged; Rifampin

Topics: Adult; Arthritis, Rheumatoid; Diagnosis, Differential; Female; Humans; Isoniazid; Male; Rifampin; Streptomycin; Tuberculosis, Hepatic; Tuberculosis, Ocular; Tuberculosis, Osteoarticular

Topics: Ampicillin; Arthritis, Rheumatoid; Fusidic Acid; Humans; Lincomycin; Male; Middle Aged; Penicillin Resistance; Potassium; Rifampin; Sepsis; Staphylococcal Infections; Urea

Topics: Aged; Aminosalicylic Acids; Antitubercular Agents; Arthritis, Rheumatoid; Bronchitis; Diabetes Complications; Drug Therapy, Combination; England; Female; Humans; Male; Mass Chest X-Ray; Mycobacterium tuberculosis; Nose; Occupations; Pneumoconiosis; Pulmonary Emphysema; Rifampin; Silicotuberculosis; Sputum; Streptomycin; Tuberculosis, Miliary; Tuberculosis, Pulmonary

Topics: Adrenal Cortex Hormones; Arthritis, Rheumatoid; Azathioprine; Cephalosporins; Humans; Liver Abscess, Amebic; Metronidazole; Purpura, Thrombocytopenic; Respiratory Tract Infections; Rifampin; Sarcoidosis; Urinary Tract Infections