Minocycline Therapy for Rheumatoid Arthritis

[Guest guest]

I think that some scientists and research doctors believe that, like the AIDS virus, some bacteria can "hide" from regular courses of treatment and needs to be under attack for a longer period of time. Actually some researchers believe that of Lyme too as many "cured" patients often go on to have more symptoms.

I'm sure I'm WAY over-simplifying it but that is my basic understanding of the long-term antibiotic therapy.

[Guest guest]

I don't understand why an antibiotic should need to be given for such a long time. If it kills the microbe, then you should be able to discontinue when this is done. This is the case with Lyme, etc. Why is the Minocycline given continually? Doesn't this also kill the beneficial bacteria in the gut?

[Guest guest]

National Rheumatoid Arthritis Society

01/09/03

" Minocycline Therapy for Rheumatoid Arthritis " :

Tetracyclines are group of antibiotic drugs. One of them is called

minocycline. It has certain interesting properties. Firstly, it is

obviously anti-bacterial being an antibiotic. Secondly, it has the

ability to inhibit enzymes which digest and degrade cartilage and the

tissues of the joint. Third, it may also be able to inhibit the function

of T lymphocytes and macrophages (a specialised white blood cell) which

are involved in initiating and perpetuating the inflammation in

rheumatoid arthritis. For these reasons, several randomised, controlled,

placebo clinical trials have been carried out.

In 1994, Kloppenburg and colleagues, Leiden, Holland treated 40 patients

with established rheumatoid arthritis with 200 mg daily of minocycline

for 26 weeks. At the end of this time there was significant improvement

in the laboratory aspects of rheumatoid arthritis but less so for the

clinical features. The adverse side-effects were minimal and mainly

involved gastrointestinal upset and dizziness.

In 1995, Tilley and colleagues, Detroit, USA treated 109 patients with

rheumatoid arthritis with 200 mg daily of minocycline for 48 weeks.

There were significant improvements in both laboratory and clinical

features of rheumatoid arthritis.

O'Dell and his colleagues, Nebraska, USA in 1997 carried out the first

controlled study of minocycline in patients with rheumatoid arthritis of

less than one year duration. The study was for six months and this again

confirmed the fact that minocycline has a positive effect on laboratory

and clinical features of rheumatoid arthritis. The same group in 1999,

reported a 4 year follow up on patients with early rheumatoid arthritis,

again treated with 200 mg daily of minocycline. They found that

remissions were more frequent and the need for other disease modifying

drugs less likely in the minocycline treated group.

Finally, O'Dell and his colleagues in 2001 compared 200 mg minocycline

daily in 30 patients with early rheumatoid arthritis (less than 1 year

duration) with hydroxychloroquine 400 mg daily in another 30 patients.

These patients were followed up for two years. The finding was quite

impressive in that 60% of the patients treated with minocycline had

reached an American College of Rheumatology 50% response rate, as

compared with 33% in patients with hydroxychloroquine. An American

College of Rheumatology 50% response is a very marked response. The

difference between the minocycline and hydroxychloroquine was

significant. There were two further fascinating findings from this

study. Firstly, minocycline reduced the amount of steroid the patients

were taking. Secondly, patients taking minocycline were more likely to

be able to stop steroids all together.

There is, therefore, no doubt that minocycline has a laboratory and

clinical effect in rheumatoid arthritis. The question is whether

minocycline also has a beneficial effect on the rate of progression of

joint damage and on the appearance of new joint damage as seen on X-ray

examination. Here the result is not so clear cut. The effects seen have

been small.

It may be concluded, therefore, that minocycline is a good drug in terms

of symptom relief and joint swelling relief and improvement in

laboratory measures of inflammation, but that it has no important affect

on joint damage. It is joint damage that is important for the long-term

functional outcome in rheumatoid arthritis. Thus, on the present

evidence, minocycline should not be recommended as the treatment of

choice for early rheumatoid arthritis and not as monotherapy. What is

needed are combination therapy studies of minocycline with other disease

modifying drugs to see if they can bring additional benefit without

increased side effects. Such investigation should particularly focus on

the affect on bone damage as detected by X-rays.

http://www.rheumatoid.org/1/new_evidence.php#minocycline

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org