Double‐blind, placebo‐controlled study of three‐month treatment with lymecycline in reactive arthritis, with special reference to Chlamydia arthritis

Abstract

We conducted a double-blind, placebo-controlled, randomized study of 3-month treatment with lymecycline, a form of tetracycline, in reactive arthritis (ReA). Lymecycline therapy significantly decreased the duration of the illness in patients with Chlamydia trachomatis-triggered ReA, but not in other ReA patients. In 2 ReA patients, C trachomatis was found in the throat, an uncommon locale for this organism. Our results suggest that it is important to verify the triggering microbe and that it is beneficial to treat Chlamydia arthritis patients with a prolonged course of tetracycline.

Comparative microbicidal activity of synovial fluid on arthritogenic organisms

“…There is also evidence that local cytokines such as interferongamma can suspend the metabolic activity of Chlamydia and set the stage for a chronic infection [20]. Finally, antibiotic trials have demonstrated a salutory effect on Chlamydia-induced ReA but not on Yersinia-induced ReA, suggesting a role for active infection only in the former [21]. We thus compared the susceptibility of Chlamydia and the enteric pathogens to the cidal effect of SF.…”

Ocular Symptoms (Conjunctivitis, Uveitis) in Reactive Arthritis

“…It was also shown that it is vital that the sexual partner of a person who has Chlamydia infection is treated in parallel with the patient. Another study documented the use of limecycline for 3 months in patients with acute Chlamydia-induced ReA, revealing a beneficial therapeutic effect on arthritis, with an ESR reduction and normalization of C reactive protein (CRP) levels in the group treated with antibiotic (Lauhio et al 1991).…”

Pathogenesis of spondylarthropathies

“…This may merely represent a technical difficulty, or there may be a genuine difference between Yersinia and Chlamydia. The latter possibility is supported by the fact that antibiotic treatment seems to decrease the duration of illness in patients with Chlamydia-induced ReA, but not in patients who have been infected with Yersinia or Campylobacter (47). Persistent elevation of Yersiniaspecific IgA levels in ReA is evidence for persistence of Yersinia in the gut mucosa (48), from which bacterial protein might reach the joint.…”