联合使用抗生素治疗慢性衣原体诱导的反应性关节炎：一项双盲、安慰剂对照的前瞻性试验。
Combination antibiotics as a treatment for chronic Chlamydia-induced reactive arthritis: a double-blind, placebo-controlled, prospective trial.
作者信息
Carter J D, Espinoza L R, Inman R D, Sneed K B, Ricca L R, Vasey F B, Valeriano J, Stanich J A, Oszust C, Gerard H C, Hudson A P
机构信息
Department of Internal Medicine, Division of Rheumatology, University of South Florida College of Medicine, Tampa, FL 33612, USA.
出版信息
Arthritis Rheum. 2010 May;62(5):1298-307. doi: 10.1002/art.27394.
OBJECTIVE
Chlamydia trachomatis and Chlamydophila (Chlamydia) pneumoniae are known triggers of reactive arthritis (ReA) and exist in a persistent metabolically active infection state in the synovium, suggesting that they may be susceptible to antimicrobial agents. The goal of this study was to investigate whether a 6-month course of combination antibiotics is an effective treatment for patients with chronic Chlamydia-induced ReA.
METHODS
This study was a 9-month, prospective, double-blind, triple-placebo trial assessing a 6-month course of combination antibiotics as a treatment for Chlamydia-induced ReA. Eligible patients had to be positive for C trachomatis or C pneumoniae by polymerase chain reaction (PCR). Groups received 1) doxycycline and rifampin plus placebo instead of azithromycin; 2) azithromycin and rifampin plus placebo instead of doxycycline; or 3) placebos instead of azithromycin, doxycycline, and rifampin. The primary end point was the number of patients who improved by 20% or more in at least 4 of 6 variables without worsening in any 1 variable in both combination antibiotic groups combined and in the placebo group at month 6 compared with baseline.
RESULTS
The primary end point was achieved in 17 of 27 patients (63%) receiving combination antibiotics and in 3 of 15 patients (20%) receiving placebo. Secondary efficacy end points showed similar results. Six of 27 patients (22%) randomized to combination antibiotics believed that their disease went into complete remission during the trial, whereas no patient in the placebo arm achieved remission. Significantly more patients in the active treatment group became negative for C trachomatis or C pneumoniae by PCR at month 6. Adverse events were mild, with no significant differences between the groups.
CONCLUSION
These data suggest that a 6-month course of combination antibiotics is an effective treatment for chronic Chlamydia-induced ReA.
目的
沙眼衣原体和肺炎衣原体是反应性关节炎（ReA）已知的诱发因素，且在滑膜中以持续代谢活跃的感染状态存在，这表明它们可能对抗菌药物敏感。本研究的目的是调查为期6个月的联合抗生素疗程对慢性衣原体诱导的ReA患者是否为有效治疗方法。
方法
本研究是一项为期9个月的前瞻性、双盲、三联安慰剂试验，评估为期6个月的联合抗生素疗程作为衣原体诱导的ReA的治疗方法。符合条件的患者经聚合酶链反应（PCR）检测沙眼衣原体或肺炎衣原体必须呈阳性。分组情况如下：1）强力霉素和利福平加安慰剂而非阿奇霉素；2）阿奇霉素和利福平加安慰剂而非强力霉素；或3）安慰剂而非阿奇霉素、强力霉素和利福平。主要终点是与基线相比，在第6个月时，联合抗生素组和安慰剂组中至少6个变量中的4个变量改善20%或更多且任何1个变量未恶化的患者数量。
结果
接受联合抗生素治疗的27例患者中有17例（63%）达到主要终点，接受安慰剂治疗的15例患者中有3例（20%）达到主要终点。次要疗效终点显示了类似结果。随机接受联合抗生素治疗的27例患者中有6例（22%）认为其疾病在试验期间完全缓解，而安慰剂组中无患者达到缓解。在第6个月时，活性治疗组中通过PCR检测沙眼衣原体或肺炎衣原体呈阴性的患者明显更多。不良事件轻微，各组之间无显著差异。
结论
这些数据表明，为期6个月的联合抗生素疗程是慢性衣原体诱导的ReA的有效治疗方法。
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