Role of long term antibiotics in Chlamydia related Reactive Arthritis
Should long term antibiotics be used in Chlamydia related Reactive Arthritis?
In chronic Chlamydia -related ReA, chlamydial organisms have been demonstrated in a metabolically active state in the synovial tissue; therefore, antibiotic therapy has been trialed. Results are mixed in randomized trials of long-term therapy with single antibiotics, and most do not show benefit. By contrast, there is one prospective, double-blind, triple-placebo trial of combination of either doxycycline (100 mg twice a day) plus rifampin (300 mg daily) or azithromycin (500 mg daily for 5 days, then twice a week) plus rifampin for 6 months that showed antibiotics to be effective therapy in patients with chronic Chlamydia -induced ReA. Improvement of joint symptoms (63% versus 20%) and increased rate of remission (22% versus 0) was seen. Further studies with larger numbers of patients are required to confirm these findings, but a trial of antibiotics in patients with chronic Chlamydia -related ReA is recommended.