LETTER
Minocycline in Rheumatoid Arthritis
Janice M.G. Canvin, MD, and
Rajan MD. Madhok
1 September 1995 | Volume 123 Issue 5 | Page 392
TO THE EDITOR:
We congratulate Tilley and colleagues [1] on their well-designed and well-executed study. Their data and analysis are frustratingly difficult to find fault with, but we found it unusual that no direct measurement of pain was included. The disease in question was obviously mild, as shown by the low erythrocyte sedimentation rate, the small percentage of seropositive patients, the few patients with erosions, and the low Health Assessment Questionnaire scores. These findings might make the study's applicability to the wider population of patients with rheumatoid arthritis somewhat limited.
We agree that minocycline is safe but question the conclusion on efficacy. It has been generally accepted by the North American and European outcome groups that a combination of variables giving a composite disease activity score is more valid, although which variables should be included has not yet been determined [2]. Pincus and colleagues [3] found that a simple self-report questionnaire shows a good correlation with many of the clinical outcome variables.
Tilley and colleagues failed to show an improvement in functional or global assessment outcomes, by either patient or examiner. This finding is discordant with the improvements noted in joint swelling or tenderness. We estimate that seven patients would require minocycline for 48 weeks to obtain a 50% reduction in either joint swelling or tenderness, with no subjective improvement, in one patient [4].
The role of minocycline in the treatment of rheumatoid arthritis needs to be more clearly defined. At best, we feel that the drug will be an adjunctive rather than a useful alternative to available second-line drugs.
|
Author and Article Information
|
|---|
Centre for Rheumatic Diseases; Royal Infirmary; Glasgow, United Kingdom G31 2ER
1. Tilley BC, Alarcon GS, Heyse SP, Trentham DE, Neuner R, Kaplan DA, et al. Minocycline in rheumatoid arthritis. A 48-week, double-blind, placebo-controlled trial. Ann Intern Med. 1995; 122:81-9.
2. van der Heijde DM, van't Hof MA, van Riel PL, van Leeuwen MA, van Rijswijk MH, van de Putte, LB. Validity of single variables and composite indices for measuring disease activity in rheumatoid arthritis. Ann Rheum Dis. 1992; 51:177-81.
3. Pincus T, Callahan LF, Brooks RH, Fuchs HA, Olsen NJ, Kaye JJ. Self-report questionnaire scores in rheumatid arthritis compared with traditional physical, radiographic, and laboratory measures. Ann Intern Med. 1989; 110:259-66.
4. Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ. 1995; 310:452-4.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Top
Author & Article Info
References
Article
