TETRASYKLIINIÄ NIVELTULEHDUKSEEN

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Lähettäjä: Soijuv Lähetetty: 30.11.2005 12:13

Tutkimuksen mukaan doksisykliini hidasti nivelvaurioiden etenemistä:

The Promise of a Tetracycline Antibiotic for Treating Osteoarthritis

Kenneth D. Brandt; Steven A. Mazzuca; Barry P. Katz; Kathleen A. Lane;
Kenneth A. Buckwalter; David E. Yocum; Frederick Wolfe; Thomas J. Schnitzer;
Larry W. Moreland; Susan Manzi; John D. Bradley; Leena Sharma; Chester V.
Oddis; Steven T. Hugenberg; Louis W. Heck
Arthritis & Rheumatism. 2005;52(7):2015-2025. ©2005 Wiley InterScience
Posted 08/22/2005

The Promise of a Tetracycline Antibiotic for Treating Osteoarthritis

Study Shows Effectiveness of Doxycycline in Slowing Disease Progression

A tetracycline antibiotic, doxycycline, has been successfully used to treat
a wide-range of bacterial infections. In addition to its effects as an
antibiotic, doxycycline has other actions as a drug and, in laboratory
studies with animals and with human tissue, can inhibit the degradation of
cartilage in a way that could be useful for the treatment of osteoarthritis
(OA). OA is a common form of arthritis associated with pain and disability
related to the breakdown of cartilage, the tissue in the joint that absorbs
shock and promotes smooth movement On the strength of preclinical evidence,
a team of rheumatologists affiliated with six clinical research centers
across the United States conducted the first long-term clinical trial to
determine the benefits of doxycycline in the treatment of OA-particularly,
OA of the knee. Their findings, featured in the July 2005 issue of Arthritis
& Rheumatism (http://www.interscience.wiley.com/journal/arthritis), suggest
that doxycycline may slow the progression of joint damage and point to the
need for further research into the drug's effect on the signs and symptoms
of this disease.

For the trial, the team recruited 431 overweight women between the ages of
45 and 64 with moderately advanced OA in one knee. The subjects were
randomly assigned to receive either 100 milligrams of doxycycline or a
placebo twice a day for 30 months. At baseline, the 2 treatment groups were
roughly equal with respect to all demographic variables, body mass index,
and types of drugs taken for pain, as well as for the x-ray severity of OA
in the affected knee and the level of knee pain and functional impairment.
OA progression was assessed by measuring joint space narrowing in the medial
tibiofemoral compartment through X-rays obtained at baseline, 16 months and
30 months. Severity of joint pain was assessed every 6 months after a
washout period of all nonsteroidal anti-inflammatory drugs (NSAIDs) and
analgesics.

Seventy-one percent of the subjects completed the treatment protocol.
Radiographs were obtained from 85 percent of all subjects at 30 months.
After 16 months of treatment, the mean loss of joint space width in the
diseased knee in the doxycycline group was 40 percent less than in the
placebo group. After 30 months, it was 33 percent less. Yet, despite
significantly slowing disease progression, doxycycline did not reduce the
severity of joint pain. However, mean pain scores at baseline were low in
both treatment groups, leaving only limited opportunity to demonstrate
improvement in joint pain. On the other hand, the drug significantly reduced
the frequency with which subjects reported increases in knee pain 20 percent
or greater than the level of pain they had at their previous semi-annual
visit.

Notably, doxycycline seemed to have no effect on joint space narrowing or
pain in the relatively disease-free knee. In both knees in both treatment
groups, the rate of joint space narrowing was more than twice as rapid in
subjects who reported frequent increases in pain than in those with a stable
pain score. "Joint pain may serve as an indicator of synovitis that leads to
cartilage destruction," observes the study's leading author, Kenneth D.
Brandt, M.D.

Throughout the trial, fewer than 5 percent of all subjects reported side
effects. In general, doxycycline seemed to be well tolerated. Subjects in
the active treatment group experienced the unexpected side benefits of fewer
urinary tract and upper respiratory tract infections than their placebo
counterparts.

In conclusion, in this study, doxcycyline showed benefits in slowing the
rate of joint space narrowing in knees with established OA. Whether this
drug has any value in the early treatment and symptomatic management of OA,
however, will require further investigation.

Item is available via Wiley InterScience at
http://www.interscience.wiley.com/journal/arthritis.