Ceftriaxone therapy of chronic inflammatory arthritis. A double-blind placebo co

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Arch Intern Med. 1990 Aug;150(8):1677-82. Related Articles, Links

Ceftriaxone therapy of chronic inflammatory arthritis. A double-

blind placebo controlled trial.

Caperton EM, Heim-Duthoy KL, Matzke GR, PK, RC.

Arthritis Associates of Minnesota, P.A., Minneapolis 55404.

To determine whether chronic inflammatory arthritis may respond to

antibiotic therapy (implying a bacterial origin), we conducted a

placebo-controlled, double-blind study. Sixty patients with

inflammatory arthritis and antibody titers to Borrelia burgdorferi

1:64 or more were randomized to receive placebo (n = 20) or 2 g/d of

ceftriaxone intravenously (n = 40) for 2 weeks. Two of 20 placebo-

and 19 of 40 antibiotic-treated patients improved. At 1 month, the

placebo-treated patients could elect to receive ceftriaxone.

Altogether, 58 patients were treated with ceftriaxone and followed

up for 13 to 24 months. Improvement was noted in 27 of the 58

antibiotic-treated patients. Patients with a wide diversity of

inflammatory arthritis were studied. Response to ceftriaxone was

seen in all groups, including 5 of 12 with rheumatoid arthritis, 5

of 8 with psoriatic arthritis, 3 of 5 with vasculitis, and 14 of 33

with less well-differentiated chronic inflammatory arthritis. In 16

of the 27 who responded to the antibiotic, the arthritis worsened 6

to 18 months after the initial response to ceftriaxone. Previous

improvement of arthritis after oral antibiotic was a better

predictor of response to ceftriaxone than either duration of disease

or Lyme antibody titer. Side effects to ceftriaxone were frequent

and included diarrhea (29/60) and acute allergic reactions (9/58).

We conclude that some patients may have an occult bacterial

infection underlying their chronic inflammatory arthritis, and may

respond to antibiotic therapy. The response to ceftriaxone in

patients with even weakly reactive Lyme titers encourages further

prospective placebo-controlled studies of antibiotics in various

subsets of chronic arthritis.

Publication Types:

Clinical Trial

Randomized Controlled Trial

PMID: 2383162 [PubMed - indexed for MEDLINE]