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1 September 1995 | Volume 123 Issue 5 | Page 391
Tilley and colleagues [1] have provided compelling evidence that minocycline has therapeutic benefit in rheumatoid arthritis, although the mechanism of action is unknown. The authors suggest that the nonantibiotic effects of tetracyclines are possible mediators of this benefit. However, Caperton and colleagues [2] found similar results with ceftriaxone in their controlled and blinded study of antibiotic efficacy in chronic inflammatory arthritides, including rheumatoid arthritis. This finding suggests that antimicrobial properties may be responsible for the observed therapeutic effect. Although mycoplasma has been suggested as a possible etiologic agent, Sigal [3] noted the similarity between rheumatoid synovium and the synovium found in Lyme arthritis. The study by Tilley and colleagues does not exclude Borrelia burgdorferi as a potential etiologic agent because seronegativity in late disease is well documented [4]. Treatment failures despite aggressive therapy have also been noted in Lyme disease [5]. Tilley and colleagues' study mandates a vigorous search for a microbial cause of rheumatoid arthritis; this search must include B. burgdorferi. As a clinician in a Lyme-endemic area who has followed a patient for 10 years in whom rheumatoid arthritis was preceded by an erythema migrans ras, I found this study particularly intriguing.
1. Tilley CB, Alarcon GS, Heyse SP, Trentham DE, Neuner R, Kaplan DA, et al. Minocycline in rheumatoid arthritis. A randomized, doubleblind, placebo-controlled trial. Ann Intern Med. 1995; 122:81-9.
2. Caperton EM, Heim-Duthoy KL, Matzke GR, Peterson PK, Johnson RC. Ceftriazone therapy of chronic inflammatory arthritis. Arch Intern Med. 1990; 150:1677-82.
3. Sigal LH. Clinical manifestations of Lyme disease. NJ Med. 1990; 87:549-55.
4. Dattwyler RJ, Volkman DJ, Luft BJ, Halperin JJ, Golightly MG. Seronegative Lyme disease: dissociation of the specific T- and B-lymphocytic responses to Borrelia burgdorferi. N Engl J Med. 1988; 319:1441-6.
5. Emerging infectious disease. Lyme disease—United States, 1991-1992. MMWR Morb Mortal Wkly Rep. 1993; 42:345-8. About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
LETTER
Minocycline in Rheumatoid Arthritis
TO THE EDITOR:
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Community Medical Center; Toms River, NJ 08753
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