Patients sometimes report that the rheumatic symptoms felt better during an antibiotic course (for another cause of infection). For many years, a number of research groups have been looking for evidence that bacteria (which are killed by antibiotics) are involved Rheumatoid arthritis (arthritis), Vasculitis og connective tissue disorders. Reports with varying results have been published, but final evidence of infection has not been detected (except for Borrelia arthritis and some other diseases one knows are infectious).
There may be several reasons why some antibiotics may reduce the symptoms and disease activity of non-infectious rheumatic disease. Antibiotics within the group “tetracyclines” (for example Doxycycline, Oracea, Lymecycline, Tetralysal and Minocycline, the latter are not marketed in Norway) can reduce rheumatic inflammation by inhibiting the enzymes matrix metalloproteases (MMP) in the immune system. The treatment effect ceases when the drug treatment ends (reference: Garrido-Mesa N, 2013).
Chronic rheumatic disease (as with connective tissue diseases and vasculitis) most often requires long-term treatment. Development of resistant bacteria is then a significant disadvantage (reference: Center T, 1998). The effect on rheumatic disease is hardly diminished over time, but resistance to antibiotics can lead to infections that cannot be stopped.
- In general, treatment with antibiotics against chronic rheumatic disease is not recommended with the exception of conditions that are clearly due to bacteria (for example Borrelia arthritis og Septic arthritis)
- When using strong immunosuppressive drugs, prevention of a type of pneumonia (pneumocystis) with Bactrim be needed