Caperton E M, Heim-Duthoy K L, Matzke G R, Peterson P K, Johnson R C
Arthritis Associates of Minnesota, P.A., Minneapolis 55404.
Arch Intern Med. 1990 Aug;150(8):1677-82.
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.
为了确定慢性炎症性关节炎是否对抗生素治疗有反应（提示细菌起源），我们进行了一项安慰剂对照的双盲研究。60例炎症性关节炎患者且抗伯氏疏螺旋体抗体滴度为1:64或更高，被随机分为接受安慰剂组（n = 20）或静脉注射头孢曲松2g/d组（n = 40），为期2周。20例接受安慰剂治疗的患者中有2例改善，40例接受抗生素治疗的患者中有19例改善。在1个月时，接受安慰剂治疗的患者可以选择接受头孢曲松治疗。总共58例患者接受了头孢曲松治疗并随访13至24个月。58例接受抗生素治疗的患者中有27例有改善。研究了多种类型的炎症性关节炎患者。所有组均观察到对头孢曲松的反应，包括12例类风湿关节炎患者中的5例、8例银屑病关节炎患者中的5例、5例血管炎患者中的3例以及33例分化较差的慢性炎症性关节炎患者中的14例。在27例对抗生素有反应的患者中，有16例在最初对头孢曲松有反应后的6至18个月关节炎恶化。与疾病持续时间或莱姆抗体滴度相比，先前口服抗生素后关节炎的改善是对头孢曲松反应的更好预测指标。头孢曲松的副作用很常见，包括腹泻（29/60）和急性过敏反应（9/58）。我们得出结论，一些患者的慢性炎症性关节炎可能存在隐匿性细菌感染，并且可能对抗生素治疗有反应。即使莱姆滴度反应较弱的患者对头孢曲松的反应也鼓励在慢性关节炎的各个亚组中进一步进行前瞻性安慰剂对照的抗生素研究。
