To determine whether chronic inflammatory arthritis may
respond to antibiotic therapy (implying a bacterial origin), we
conducted a placebo-controlled, double-blind study. Sixty patients with inflammatory arthritis and antibody titers to Borrelia
burgdorferi 1:64 or more were randomized to receive placebo
(n = 20) or 2 g/d of ceftriaxone intravenously (n = 40) for 2 weeks.
Two of 20 placebo- and 19 of 40 antibiotic-treated patients improved. At 1 month, the placebo-treated patients could elect to
receive ceftriaxone. Altogether, 58 patients were treated with
ceftriaxone and followed up for 13 to 24 months. Improvement
was noted in 27 of the 58 antibiotic-treated patients. Patients with
a wide diversity of inflammatory arthritis were studied. Response
to ceftriaxone was seen in all groups, including 5 of 12 with
rheumatoid arthritis, 5 of 8 with psoriatic arthritis, 3 of 5 with
vasculitis, and 14 of 33 with less well-differentiated chronic inflammatory arthritis. In 16 of the 27 who responded to the antibiotic, the arthritis worsened 6 to 18 months after the initial response to ceftriaxone. Previous improvement of arthritis after
oral antibiotic was a better predictor of response to ceftriaxone
than either duration of disease or Lyme antibody titer. Side effects to ceftriaxone were frequent and included diarrhea (29/60)
and acute allergic reactions (9/58). We conclude that some patients may have an occult bacterial infection underlying their
chronic inflammatory arthritis, and may respond to antibiotic
therapy. The response to ceftriaxone in patients with even weakly
reactive Lyme titers encourages further prospective placebo-controlled studies of antibiotics in various subsets of chronic
(Arch Intern Med. 1990;150:1677-1682)
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 29
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.