Combination Antibiotic Treatment for Reactive Arthritis Caused by Chlamydia Bacteria
Combination Antibiotic Treatment for Reactive Arthritis Caused by Chlamydia Bacteria
Reactive arthritis, also known as Reiter's syndrome, is a form of arthritis that occurs as a
 reaction to an infection elsewhere in the body. It is characterized by inflammation of the
 joints, tendons, urogenital tract, and eyes. Pain and swelling in the knees, ankles, and feet
 are common. This study will determine the effectiveness of antibiotic therapy in treating
 people with chlamydia-induced reactive arthritis that has lasted for more than 6 months.
The initial infection that causes reactive arthritis is caused by one of two bacteria:
 Chlamydia trachomatis, which is usually acquired through sexual contact, or Chlamydia
 pneumoniae, which can cause respiratory infections. Most people recover fully from the
 initial flare of arthritis symptoms. However, about 20% of people with reactive arthritis
 experience long-lasting symptoms. In these individuals, the Chlamydia bacteria exist in a
 persistent metabolically active state within the joint tissue, even years after the initial
 exposure. The bacteria produce heat shock proteins (HSPs), which are thought to play a key
 role in the chronic persistent state of Chlamydia and which may stimulate the immune
 inflammatory response seen in reactive arthritis. This indicates the need for antimicrobial
 therapy that can reduce Chlamydia's HSP production and block its metabolism. The purpose of
 this study is to determine the effectiveness of long-term combination antibiotic therapy in
 treating people with chronic reactive arthritis. The study will use two different
 combinations of common antibiotics: doxycycline paired with rifampin and azithromycin paired
 with rifampin.

 This study will entail 6 months of treatment followed by 3 months of follow-up. After
 screening, eligible participants will be randomly assigned to one of three treatment groups:
 rifampin once a day plus doxycycline twice a day; rifampin once a day plus azithromycin once
 a day for 5 days, then twice weekly; or placebo. Study visits will occur at baseline and
 Months 1, 3, 6, and 9. At all visits, participants will undergo an interview, a physical
 examination, and blood collection. They will also complete a questionnaire related to their
 symptoms and functional status. At screening and Month 6, a synovial biopsy may be performed.
 This will involve taking a sample of the tissue that lines the joints.
Inclusion Criteria:

 -  Meet the following European Spondyloarthropathy Study Group Criteria:

 1. inflammatory spinal pain OR

 2. synovitis AND

 3. one or more of the following:

 1. positive family history

 2. urethritis or cervicitis within 1 month prior to onset of arthritis

 3. buttock pain

 4. enthesopathy

 5. sacroiliitis

 -  Disease duration of at least 6 months

 -  Negative pregnancy test at study baseline and willing to use an effective method of
 contraception other than combined oral contraceptives for the duration of the study
 (for women of childbearing age)

 Exclusion Criteria:

 -  Sensitivity or history of allergic reaction to rifampin, doxycycline, or azithromycin

 -  Currently taking any medications that may interact with the study medications,
 specifically rifampin

 -  Liver transaminases greater than or equal to two times the normal level

 -  Significant abnormalities in the complete blood count (CBC)

 -  Pregnant

 -  Current psoriasis

 -  Diagnosis of inflammatory bowel disease

 -  Diagnosis of ankylosing spondylitis

 -  Previous prolonged exposure to antibiotics (more than 2 weeks) as a potential
 treatment for reactive arthritis