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Update in Rheumatology
- Stephen M. Campbell, MD; and
- Richard Wernick, MD
- From Veterans Affairs Medical Center, Providence Portland Medical Center, and Oregon Health Sciences University, Portland, Oregon.
1998-99 Series
John Roberts, MD, Editor, and David Cramer, MD, Article Editor
The 1997 literature included important information on new treatment approaches to rheumatoid arthritis and ways to moderate the potentially toxic effects of antirheumatic drugs. The literature also contained several useful reports on state-of-the-art laboratory testing and a topic of perennial interest to all physicians—low back pain. Finally, we selected a “grab bag” of papers covering diverse rheumatologic topics that matter to practicing internists.
Treatment of Rheumatoid Arthritis
Much remains to be learned about the cause and pathogenesis of rheumatoid arthritis, but we have learned enough to begin to develop rational treatment strategies. Developments in 1997 included the use of tetracyclines to affect collagenase activity or immune function and aggressive early multidrug therapy to “turn off” early rheumatoid arthritis. Another approach—use of soluble recombinant human tumor necrosis factor (TNF) receptor—is predicated on the view that immunologic factors and cytokines contribute to the pathogenesis of rheumatoid arthritis.
Minocycline Significantly Suppressed Early Rheumatoid Arthritis in a Majority of Patients
O'Dell JR, Haire CE, Palmer W, et al. Treatment of early rheumatoid arthritis with minocycline or placebo: results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 1997; 40:842-8.
On the basis of speculation that rheumatoid arthritis is an infectious disease, tetracycline was used in some parts of the United States from the 1940s through the 1960s. A negative study from Massachusetts General Hospital published in 1971 reported no benefit from this therapy (at least from low-dose tetracycline). Nevertheless, reports of clinical benefit continued to appear; these reports were supported by research findings showing that, quite apart from their antimicrobial activity, tetracyclines directly influence polymorph function and may interfere with collagenases (and possibly other proteolytic enzymes) in the joints. Two recent placebo-controlled studies suggested that tetracycline results in some improvement in clinical signs and symptoms of rheumatoid arthritis (1, 2).
O'Dell and colleagues' multicenter trial included 46 …
This 100-word excerpt has been provided in the absence of an abstract.
