Minocycline in the treatment of rheumatoid arthritis : 

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They have been many theories of an infective cause for rheumatoid arthritis. These have included Epstein barr virus, mycoplasma, rubella virus, parvovirus, and many other claimed agents. For many years, Minocycline and the tetracyclines were advocated for treatment of rheumatoid arthritis by Thomas McPherson Brown. The studies done by Brown however received much criticism because of study methods and protocol.
Studies were poorly controlled and much of the data unsubstantiated.

However more recently, studies have been performed looking at tetracyclines in rheumatoid arthritis.

The tetracyclines have many potential influences against rheumatic disease.

1. An immunomodulating action by inhibition of chemotaxis, lymphocyte proliferation and differentiation.
2. An anti-bacterial activity / antiviral activity.
3. An Anti-inflammatory activity with inhibition of metalloproteinases.

Most studies now show Minocycline to have some efficacy in rheumatoid arthritis when compared to placebo. These results do not show definite difference in preventing disease progression.
The Minocycline in rheumatoid arthritis study (Tilley et al. annals of internal medicine: volume 122 No. 2, Jan. 1995, pp. 81 to 89.), 109 patients on Minocycline were compared to 110 patients on placebo. Patients are studied over 48 weeks. There is an improvement in joint swelling of 54 percent versus 39 percent. There was improvement in joint tenderness-56 percent versus 41 percent with no serious toxicity.
The conclusion was that Minocycline was a safe effective treatment for patients with mild to moderate rheumatoid arthritis.

The side effect profile of Minocycline include:

skin rash
interstitial nephritis
acute hepatic injury
lupus like Syndrome
photo sensitivity

The usual dose of Minocycline in the studies was 100 mg twice daily.

Further studies are required to confirm the place of Minocycline in the management of Rheumatoid arthritis.
My personal feeling is that it has an efficacy comparable to hydroxychloroquine, and is best used in mild disease.



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