Yli-Kerttula T, Luukkainen R, Yli-Kerttula U, Möttönen T, Hakola M, Korpela M, Sanila M, Uksila J, Toivanen A
Department of Medicine, Turku University, Satalinna Hospital, Finland.
Ann Rheum Dis. 2003 Sep;62(9):880-4. doi: 10.1136/ard.62.9.880.
The value of antibiotics in the treatment of reactive arthritis (ReA) is still controversial.
To analyse the long term outcome of patients with ReA, treated with a three month course of ciprofloxacin or placebo.
Patients who had had ReA and had participated in a double blind, placebo controlled trial on the effectiveness of ciprofloxacin 4-7 years earlier were invited to a clinical examination. Of the 71 patients who were included in the original study, 53 agreed to visit the clinic for an examination. Twenty six of 53 patients had originally received ciprofloxacin and 27 had belonged to the placebo group. Of these, 20 in the ciprofloxacin and 25 in the placebo group were HLA-B27 positive.
11/27 (41%) patients in the original placebo group had now developed chronic rheumatic disease, as compared with only 2/26 (8%) patients originally treated with ciprofloxacin (p=0.006). Two patients who originally had received placebo, none in the ciprofloxacin group had developed ankylosing spondylitis, and three patients in the original placebo group, none in the ciprofloxacin group had recurrent anterior uveitis. The same tendency was seen when several different measures were analysed. Of the patients with chronic spondyloarthropathy, 10 in the placebo and none in the ciprofloxacin group were HLA-B27 positive.
Analysis 4-7 years after the initial ReA suggests that a three month course of antibiotics in the acute phase may have a beneficial effect on the long term prognosis.
抗生素在反应性关节炎（ReA）治疗中的价值仍存在争议。
分析接受为期三个月环丙沙星或安慰剂治疗的ReA患者的长期预后。
邀请4 - 7年前曾患ReA并参与环丙沙星有效性双盲、安慰剂对照试验的患者进行临床检查。在最初纳入研究的71名患者中，53名同意到诊所接受检查。53名患者中，26名最初接受环丙沙星治疗，27名属于安慰剂组。其中，环丙沙星组20名、安慰剂组25名患者HLA - B27呈阳性。
最初安慰剂组的11/27（41%）患者现已发展为慢性风湿性疾病，而最初接受环丙沙星治疗的患者中只有2/26（8%）出现这种情况（p = 0.006）。最初接受安慰剂治疗的两名患者、环丙沙星组无患者发展为强直性脊柱炎，最初安慰剂组的三名患者、环丙沙星组无患者出现复发性前葡萄膜炎。分析几种不同指标时也出现同样趋势。在慢性脊柱关节病患者中，安慰剂组10名、环丙沙星组无患者HLA - B27呈阳性。
对最初患ReA 4 - 7年后的分析表明，急性期为期三个月的抗生素治疗可能对长期预后有有益影响。
