DO MINOCYCLINE AND OTHER TETRACYCLINES HAVE A PLACE IN RHEUMATOLOGY

Tetracyclines are a family of antimicrobials with activity against a b road range of organisms including those that develop intracellularly, Links have been reported between some infections and some inflammatory joint diseases, with the most notable example involving mycoplasmas a nd rheumatoid arthritis, Reactive arthritides are known to be triggere d by organisms found in the gastrointestinal or genitourinary tract, a nd antigenic material from these organisms has recently been demonstra ted in synovial tissue from patients with reactive arthritis, These fa cts led to the hypothesis that tetracyclines may be useful in rheumato id arthritis and reactive arthritis, Two controlled studies found that minocycline benefited rheumatoid arthritis patients when it was given either as an adjunct to another second-line treatment or as the only slow-acting drug, Lymecycline has been found to expedite recovery from reactive arthritis due to Chlamydia trachomatis, and tetracycline to decrease the incidence of reactive arthritis due to sexually-transmitt ed diseases, The safety profiles of these treatments were acceptable i n all available studies but require further investigation during long- term administration, The benefits may be related to the immunomodulati ng effects of tetracyclines and/or to their ability to inhibit metallo proteases such as collagenases, Whether tetracycline therapy influence s the course of radiologic lesions in rheumatoid arthritis remains unk nown. However, minocycline therapy has given sufficient proof of its e fficacy to make it an attractive alternative in rheumatoid arthritis.