Antibiotics for Rheumatoid Arthritis: Do They Work? Meta-analysis Suggests a Benefit for Early Onset Disease

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Antibiotics for Rheumatoid Arthritis: Do They Work? Meta-analysis Suggests a

Benefit for Early Onset Disease

Category:  30 Health services research

Millicent A Stone, R Fortin, Cesar Pacheco-Tena, D Inman

University of Toronto, Toronto, ON, Canada

Presentation Number: 134

Poster Board Number: 134

Keywords: rheumatoid arthritis, meta-analysis, antibiotics

Purpose: To compare the effectiveness of antibiotic therapy versus placebo

or conventional treatment in rheumatoid arthritis (RA) for the reduction of

disease activity as defined by American College of Rheumatology (ACR)

criteria.

Data sources: MEDLINE (1966-February 2002), EMBASE (1980 to February 2002),

Cochrane controlled trials register (Issue 1, 2002 Cochrane Library).

Reference lists of published trials were searched by hand for further

identification of published work and presentations at scientific meetings.

Study Selection: 1) Randomized controlled trials comparing antibiotics to

control (placebo or conventional disease modifying antirheumatic therapy)

were selected for inclusion if at least one of the following outcomes was

reported: Tender joint count (TJC), swollen joint count (SJC), patient pain

score by visual analogue scale (PT PAIN), patient global assessment of

disease activity (PT GA), physician global assessment of disease activity

(MD GA), ESR and CRP, joint space narrowing (JSN) and erosions, adverse

events and quality of life as measured by the Health Assessment

Questionnaire (HAQ).2) In addition, subjects were required to have RA as

defined by the 1987 ARA criteria.

Data synthesis: Eleven randomized-controlled trials including 656

individuals were included in this systematic review. Only 3 trials were

considered high quality, in the remainder elements of bias could not be

excluded.Tetracyclines, when administered for 3 months or more, were

associated with a significant reduction in disease activity in RA; TJC:

[sMD= -0.39 95 % confidence interval (CI) (-0.74, -0.05)] and in acute phase

reactants; ESR: [sMD=-8.82, 95% CI (-12.95,- 4.70)]. The treatment effect

was more marked in the subgroup of patients with disease duration less than

one year who were seropositive. However, no beneficial effect was

demonstrated on radiological progression of disease as defined by erosions:

[sMD=0.09 95% CI (-0.14, 0.32)]. There were more adverse events in the

antibiotic treatment group: [RR=1.78, 95% CI (1.09, 3.16)]. In addition,

sub-group analysis excluding trials with doxycycline showed that minocycline

alone had a greater effect on reduction of disease activity, [TJC:

SMD:-0.69: 95% CI (-0.89, -0.49)] and for [ESR: SMD: -10.14; 95% CI (-14.72,

-5.57)].

Conclusion: Tetracyclines, in particular minocycline were associated with a

clinically significant improvement in disease activity in RA, with effects

most marked within one year of onset of disease. Further research is

warranted to define the potential of antimicrobials for altering structural

damage in RA.