BENEFIT OF LONG-TERM ANTIBIOTIC TREATMENT ON RECENT REACTIVE ARTHRITIS

Background: The interest of antibiotherapy in Reactive Arthritis (e.g. Spondylarthropathy) is debated. Some authors suggest a particular place of long-course antibiotic treatment for recent Reactive Arthritis. Objectives: To evaluate the benefit of long-term antibiotic therapy compared with traditional antibiotic treatment of the episode. Methods: Databases used were MEDLINE, COCHRANE LIBRARY and EMBASE. The search was conducted from 1968 to December 2009. We used the Medline MeSH term ``Reactive, Arthritis'' AND ``Antibiotics'' as a text word in all fields. In addition, we performed a manual search of the references cited in each paper. We collected Randomised Clinical Trials, comparing long-course of one antibiotic (3 or 4 months) to short-length treatment (<15 days) or to placebo. Patients must be adults treated for Reactive Arthritis, with our without bacterial identification of the preceding urogenital/enteric infection. The Reactive Arthritis duration must be < 3 months. The antibiotic (Macrolid, Quinolone or Cycline) must be efficient on the pathogens generally associated with reactive arthritis. The interest was evaluated in terms of swollen-joints, tender-joints, ESR, CRP, VAS global state and remission at the end of treatment. Statistics were made with EasyMA. Results: Among the 58 studies, only 6 fulfilled our criteria. Data and results were not statistically comparable, mainly because of their type. Considering this heterogeneity, a Meta-analysis was not possible. So we made a systematic review and analysis of literature. We did not manage to collect 1 study (6). 5 of 6 papers (1,2,3,4,5) did not show statistically significant difference between the 2 compared groups. However, in 2 studies (4,5), this strategy seems to be worthwhile specifically for Chlamydia induced reactive arthritis. Conclusion: To date, there is no statistical proof of superiority of long-term antibiotic treatment for the management of recent reactive arthritis. However results concerning Chlamydia induced reactive arthritis need to be confirmed with further studies. References: 1. Putschky N, et al. Ann Rheum Dis. 2006;65:1521-1524 2. Kvien TK, et al. Ann Rheum Dis. 2004;63:1113-1119 3. Yli-Kerttula T, et al. Ann Rheum Dis. 2000;59:565-570 4. Sieper J, et al. Arthritis Rheum. 1999;42:1386-1396 5. Lauhio A, et al. Arthritis Rheum. 1991;34:6-14 6. Kellner H, et al. Clin ImmTher. 1995;4(5):338-345 Disclosure of Interest: Y. Degboé None Declared, J. F. Boyer: None Declared, T. Barnetche Consultant for: Abott, A. Cantagrel: None DeclaredCitation: Annals of the Rheumatic Diseases, volume 69, supplement 3, year 2010, page 694Session: Spondylarthropathies – treatment (Abstracts accepted for publication )