zithromax 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

The effects of antibiotic therapy on the course of postvenereal reactive arthritis have not yet been elucidated.. 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.. 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.. 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.. 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.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Arthritis, Reactive; Azithromycin; Chlamydia trachomatis; DNA, Bacterial; Female; Humans; Knee Joint; Male; Microscopy; Middle Aged; Mycoplasma hominis; Pain Measurement; Polymerase Chain Reaction; Prospective Studies; Synovectomy; Treatment Outcome; Ureaplasma urealyticum

To determine the efficacy of weekly treatment with oral azithromycin for 13 weeks on the severity and resolution of reactive arthritis (ReA).. 186 patients from 12 countries were enrolled in a randomised, double blind, placebo controlled trial. Inclusion criteria were inflammatory arthritis of < or =6 swollen joints, and disease duration of < or =2 months. All patients received a single azithromycin dose (1 g) as conventional treatment for possible Chlamydia infection, and were then randomly allocated to receive weekly azithromycin or placebo. Clinical assessments were made at 4 week intervals for 24 weeks.. 152 patients were analysable (34 failed entry criteria), with a mean (SD) age of 33.8 (9.4) and duration of symptoms 30.7 (17.5) days. Mean C reactive protein (CRP) was 48 mg/l, and approximately 50% of those typed were HLA-B27+, suggesting that the inclusion criteria successfully recruited patients with acute ReA. Treatment and placebo groups were well matched for baseline characteristics. There were no statistical differences for changes in any end point (swollen and tender joint count, joint pain, back pain, heel pain, physician and patient global assessments, and CRP) between the active treatment and placebo groups, analysed on an intention to treat basis or according to protocol completion. The time to resolution of arthritis and other symptoms or signs by life table analyses was also not significantly different. Adverse events were generally mild, but were more commonly reported in the azithromycin group.. This large trial has demonstrated that prolonged treatment with azithromycin is ineffective in ReA.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Arthritis, Reactive; Azithromycin; Double-Blind Method; Female; Humans; Male; Middle Aged; Prohibitins; Severity of Illness Index; Survival Analysis; Treatment Outcome

Topics: Anti-Bacterial Agents; Arthritis, Reactive; Azithromycin; Chlamydia Infections; Humans; Treatment Outcome

Topics: Anti-Bacterial Agents; Antigens, Bacterial; Arthritis, Reactive; Azithromycin; Chlamydia; Chlamydia Infections; Follow-Up Studies; Humans; Joints; RNA, Bacterial; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Arthritis, Reactive; Azithromycin; Breast Feeding; Chlamydia Infections; Chlamydia trachomatis; Diagnosis, Differential; Female; Humans; Rheumatic Fever; Treatment Outcome

Topics: Arthritis, Reactive; Azithromycin; Chlamydia Infections; Erythromycin; Female; Humans; Male