Combination Antibiotics as a Treatment for Chronic Chlamydia-Induced Reactive Arthritis A Double-Blind, Placebo-Controlled, Prospective Trial
Combination Antibiotics as a Treatment for Chronic Chlamydia-Induced Reactive Arthritis A Double-Blind, Placebo-Controlled, Prospective Trial
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DOI：
10.1002/art.27394
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发表时间：
2010-05-01
影响因子：
--
通讯作者：
Hudson, A. P.
中科院分区：
文献类型：
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作者：
Carter, J. D.;Espinoza, L. R.;Hudson, A. P.
客观的。沙眼衣原体和肺炎衣原体是已知的反应性关节炎 (ReA) 触发因素，并且在滑膜中以持续代谢活跃的感染状态存在，表明它们可能对抗菌药物敏感。本研究的目的是调查 6 个月的联合抗生素疗程是否能有效治疗慢性衣原体诱发的 ReA 患者。方法。这项研究是一项为期 9 个月的前瞻性、双盲、三安慰剂试验，评估 6 个月的联合抗生素疗程作为衣原体诱导的 ReA 的治疗方法。符合条件的患者必须通过聚合酶链反应（PCR）检测沙眼衣原体或肺炎衣原体呈阳性。各组接受 1) 强力霉素和利福平加安慰剂代替阿奇霉素； 2）阿奇霉素和利福平加安慰剂代替多西环素；或 3) 使用安慰剂代替阿奇霉素、多西环素和利福平。主要终点是在第 6 个月时，与基线相比，两个联合抗生素组和安慰剂组中 6 个变量中的至少 4 个变量改善 20% 或更多，且任何 1 个变量没有恶化的患者人数。结果。接受联合抗生素治疗的 27 名患者中有 17 名 (63%) 达到了主要终点，接受安慰剂的 15 名患者中有 3 名 (20%) 达到了主要终点。次要疗效终点显示出相似的结果。随机接受联合抗生素治疗的 27 名患者中有 6 名 (22%) 认为他们的疾病在试验期间完全缓解，而安慰剂组中没有患者获得缓解。在第 6 个月，积极治疗组中显着更多的患者通过 PCR 检测沙眼衣原体或肺炎衣原体转为阴性。不良事件轻微，各组之间没有显着差异。结论。这些数据表明，6 个月的联合抗生素疗程是治疗慢性衣原体诱发的 ReA 的有效方法。
Objective. 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.Methods. 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.Results. 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.Conclusion. These data suggest that a 6-month course of combination antibiotics is an effective treatment for chronic Chlamydia-induced ReA.