Treatment of Ankylosing Spondylitis with Moxifloxacin

Abstract

Ankylosing spondylitis (AS) is a human leukocyte antigen (HLA)-B27-associated chronic inflammatory disease of unknown etiology. There are few effective treatments for ankylosing spondylitis, which causes substantial morbidity. The relationship between AS and enterobacteria, especially Klebsiella pneumoniae, has been reported from several groups in several countries. We performed an open-label trial of moxifloxacin, a fluoroquinolone antibiotic, in patients with ankylosing spondylitis. Treatment with moxifloxacin resulted in significant and sustained improvement. At 12 weeks, patients treated with moxifloxacin had significantly greater improvement in primary outcome measures (P < 0.001). The moxifloxacin group also had significantly greater improvement in many of the secondary outcome measures (P < 0.001). In this twelve-week trial, moxifloxacin was safe, well tolerated, and associated with improvement in the inflammatory symptoms of AS.

Detection of oral bacterial DNA in synovial fluid

“…Given the fact that oral bacteria could contribute to the aetiology of rheumatic diseases, it is conceivable that the adjuvant administration of antibiotics could represent a strategy in addition to scaling and root planing to improve the therapeutic outcome of rheumatic disease. Therapeutically positive effects for antibiotics were already proven in particular for disease‐modifying, antirheumatic drug‐resistant rheumatic diseases (Ogrendik ,b,c, , Ogrendik & Karagoz ).…”

A Possible Role of Intestinal Microbiota in the Pathogenesis of Ankylosing Spondylitis

“…Moxifloxacin is a fluoroquinolone antibiotic with activities against both Gram-positive and -negative bacteria. The results of a similar study have shown that AS patients treated with Moxifloxacin resulted in a significant and sustained improvement and the mean of erythrocyte sedimentation rate and C-reaction protein decreased significantly after 12 weeks [108]. It was also noticed that some South African plant extracts with K. pneumoniae inhibitory activity can potentially prevent the AS onset and minimize the symptoms of the established disease [109].…”

Periodontal Pathogens are Likely to be Responsible for the Development of Ankylosing Spondylitis

“…Although the cross reactivity between HLA-B27 and Klebsiella antigens has been put forward in many publications, this cross reactivity has not been shown [21]. …”

“…HLA-B27 is present on antigen-presenting cells, and it presents endogenous peptides to CD8 (+) T-cells [21]. The arthritogenic peptide hypothesis postulates that B27 plays a direct role in pathogenesis by binding an arthritogenic peptide and presenting it to autoreactive CTLs [22].…”