Is antibiotic appropriate for arthritic knee?
DEAR DR. GOTT: I am being encouraged to try tetracycline therapy for my arthritic knee. Is this a legitimate therapy to avoid surgery?
DEAR READER: Information obtained from the U.S. Library of Medicine, as reported by the Division of Rheumatology in Toronto, Ontario, regarding an October 2003 study, indicated published trials had been hand-searched for further identification of reports and presentations regarding this very subject. Of the 10 randomized trials that included 535 individuals, only three were considered to be of high quality, and elements of bias could not be excluded in the remainder.
In part, it stated that tetracyclines, when administered for up to three months, were associated with a significant reduction in disease activity in rheumatoid arthritis (RA), with absolutely no increased risk of adverse events. Tetracyclines, particularly minocycline, were associated with a clinically significant improvement in patients with RA, without any increased risk of side effects. Unfortunately, the available information was insufficient to allow for a detailed analysis of individual side effects, and further research at that time was warranted regarding efficacy, cost-effectiveness and safety.
In 2005, Medical News Today reported that doxycycline (closely related to tetracycline), with its anti-inflammatory properties, could inhibit the degradation of cartilage in a way that could be useful in treating osteoarthritis (OA). It went on to indicate that on the strength of pre-clinical evidence, a team of rheumatologists affiliated with six clinical research centers across the United States conducted the first long-term trial to determine any benefits in treating OA, particularly of the knee. Their findings, printed in the July 2005 issue of the journal Arthritis & Rheumatism, suggested doxycycline might slow the progression of joint damage and pointed to the need for further research into the effects of the drugs on the symptoms of the disease.
Also in 2005, Science Daily, reporting on a study in Arthritis and Rheumatism, indicated similar findings. For the trial, the team recruited 431 overweight women between the ages of 45 and 64 with moderately advanced OA in one knee. Progression of the disorder was assessed by measuring joint space narrowing in the medial tibiofemoral compartment through baseline X-rays obtained at both 16 and 30 months. The severity of joint pain was assessed every six months after a washout period of all non-steroidal anti-inflammatory drugs and analgesics.
Three hundred and six subjects completed the treatment protocol. After 16 months, the mean loss of joint space width in the diseased knee in the doxycycline group was 40 percent less than that in the placebo group. After 30 months, it was 33 percent less. Despite the obvious slowing of the progression of the disease, the doxycycline did not reduce the severity of joint pain. Side effects were minimal throughout the trial; however, some participants dropped out due to side effects as compared with the placebo group.
The conclusion was that doxycycline showed benefits in slowing the rate of joint space narrowing in knees with known OA. Whether the drug has any value in the early treatment and symptomatic management of OA will require further investigation. Unfortunately, the reputable reports I have access to are several years old.
Speak with your orthopedic specialist or a rheumatologist, who can assess your entire medical profile to determine if this treatment is an option or if surgery is even in the picture. Some things are within your control, such as weight loss if appropriate, or changing your occupation. Those things out of your control include being female, of an advanced age, having gout, Paget’s disease of the bone or a joint injury.
Readers who would like additional information can order my Health Report “Osteoarthritis” by sending a self-addressed, stamped No. 10 envelope and a $2 U.S. check or money order to Dr. Peter Gott, P.O. Box 433, Lakeville, CT 06039. Be sure to mention the title, or print an order form from my website’s direct link: www.AskDrGottMD.com/order_form.pdf.
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Dr. Peter H. Gott is a retired physician and the author of several books, including “Live Longer, Live Better,” “Dr. Gott’s No Flour, No Sugar Diet” and “Dr. Gott’s No Flour, No Sugar Cookbook,” which are available at most bookstores or online. His website is www.AskDrGottMD.com.
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DR. GOTT 8/31/11 4