THE INFLUENCE OF ADDING ANTIBIOTIC IN TREATMENT OF RHEUMATOID ARTHRITIS PATIENTS ON STREPTOCOCCUS PYOGENES CARRIER RATE AND ON THE LIPIDS PROFILE

  • Elham N Al-kaissi Associated Prof .
  • Najah I Al-muhtaseb associated Prof.
  • Naheyah Al-muhtaseb Physician, Rheumatologist

Abstract

Objective: The main goal is to evaluate the clinical efficacy, safety, and tolerability of antibiotics and methotrexate (MTX) treatment on the disease severity, on Streptococcus pyogenes carrier rate and on the lipid profile of patients with rheumatoid arthritis (RA).

Methods: In a 6-months, double –blind trial, 130 patients with active RA were treated for four weeks with MTX therapy at a stable low dose of 12.5 mg/week instructed to receive either levofloxacin (500 mg) or placebo orally once daily while continuing to receive MTX. Before and after the treatment, disease activity parameters, rheumatoid factor (CF), C reactive protein (CRP), anti-streptolysin O (ASO) titer and lipid profile were measured. Throat swab cultures were done on suitable medium.

Results: Antibiotic adds to treatment causes a significant reduction in disease activity, lower the side effects and concomitant decrease in MTX treatment dose, most of the lipid levels had returned to baseline levels, decreased S. pyogenes carrier rate from 25-30% to 3.2-6% and lower ASO titers to undetectable.

Conclusion: RA patients who are treated with MTX, addition of antibiotics lower the signs, symptoms and risk factors of RA patient and S. pyogenes could be important in the etiopathogenesis of RA.


 

Keywords: Antirheumatic drug, Lipid profile, Antistreptolysin O, Rheumatoid arthritis

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Author Biographies

Elham N Al-kaissi, Associated Prof .
Dept. pharmaceuticsand Pharmaceutical Biotech.
Najah I Al-muhtaseb, associated Prof.
Dept. of Medicinal chemistry
Naheyah Al-muhtaseb, Physician, Rheumatologist
Rehabitation Medicine

References

1. Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. Rhematology. 4th ed. Mosby; 2007. p. 2288.
2. Solomon DH, Karlson EW, Rimm EB, Cannuscio CC, Mandl LA, Manson JE, et al. Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circ 2003;107:1303-7.
3. Van Doornum S, McColl G, Wicks IP. Accelerated atherosclerosis: an extra articular feature of rheumatoid arthritis. Arthritis Rheum 2002;46:862-73.
4. Park YB, Ahn CW, Choi HK, Lee SH, In BH, Lee HC, et al. Atherosclerosis in rheumatoid arthritis: morphologic evidence obtained by carotid ultrasound. Arthritis Rheum 2002;46:1714-9.
5. Gabriel SE, Crowson CS, Kremers HM, Doran MF, Turesson C, O'Fallen WM, et al. Survival in rheumatoid arthritis: a population–based analysis of trends over 40 years. Arthritis Rheum 2003;48:54-8.
6. Smith JB, Haynes MK. Rheumatoid arthritis: a molecular understanding. Ann Intern Med 2002;136:908-22.
7. Gregersen PK, Silver J, Winchester RJ. The shared epitope hypothesis. An approach to understanding the molecular genetics of susceptibility to rheumatoid arthritis. Arthritis Rheum 1987;30:1205-13.
8. Begovich AB, Carlton VE, Honigberg LA, Schrodi SJ, Chokkalingam AP, Alexander HC, et al. Amissense single-nucleotide polymorphism in a gene encoding a protein tyrosine phosphate (PTPN22) is associated with rheumatoid arthritis. Am J Hum Genet 2004;75:330-7.
9. Johansson M, Ärlestig L, Hallmans G, Rantapää-Dahlqvist S. PTPN22 and anti-cyclic citrullinated peptide antibodies in combination polymorphism strongly predicts future onset of rheumatoid arthritis and has a specificity of 100% for the diease. Arthritis Res Ther 2006;8:R19.
10. Klareskog L, Stolt P, lundberg K, Källberg H, Bengtsson C, Grunewald J, et al. A new model for an etiology of rheumatoid arthritis: smoking may trigger HLA-DR (shared epitope)-restricted immune reactions to autoantigens modified by citrullination. Arthritis Rheum 2002;54:38-46.
11. Symmons DP. Epidemiology of rheumatoid arthritis: determinants of onset, persistence and outcome. Best Pract Res Clin Rheumatol 2002;16:707-22.
12. Södergren A. Epidemiological and pathogenic aspects on cardiovascular disease in rheumatoid arthritis UMEA University medical dissertation; 2008.
13. Arts E, Fransen J, Lemmers H, Stalenhoef A, Joosten L, van Riel P, et al. High-density lipoprotein cholesterol subfractions HDL2 and HDL3 are reduced in women with rheumatoid arthritis and may augment the cardiovascular risk of women with RA: a cross-sectional study. Arthritis Res Ther 2012;14:R116.
14. Assous N, Touze E, Meune C, Kahan A, Allanore Y. Morbimortlite cardiovasculaire au cours de la polyarthrite rhumatoide: etude de cohort hospitaliere monocentrique fencaise. Rev Rhum 2007;74:72-8.
15. Garcia-Gomez C, Nolla JM, Valverde J, Gomez-gerique JA, Castro MJ, Pinto X. Conventional lipid profile and lipoprotein (a) concentrations in treated patients with rheumatoid arthritis. J Rheumatol 2009;36:1365-70.
16. Van Halm VP, Nielen MMJ, Nurmohamed MT, van Schaardenburg D, Reesink HW, Voskuyl AE, et al. lipids and inflammation: serial measurement of the lipid profile of blood donors who later develop RA. Ann Rheum Dis 2007;66:184-8.
17. Solomon DH, Curhan GC, Rimm EB, Cannuscio CC, Karlson EW. Cardiovascular risk factors in women with and without rheumatoid arthritis. Arthritis Rheum 2004;50:3444-9.
18. Park YB, Choi HK, Kim MY, Lee WK, Song J, Kim DK, et al. Effects of antirheumatic therapy on serum lipid levels in patients with rheumatoid arthritis: prospective study. Am J Med 2002;113:188-93.
19. Lems WF, Dijkmans BAC. Rheumatoid arthritis: clinical aspects and its variants. In Fireestein GS, Panayi GS., Wollheim FA, eds. Rheumatoid arthritis: new frontiers in pathogenesis and treatment. New York: Oxford University Press; 2000. p. 213-25.
20. Park YB, Lee SK, Lee WK, Suh CH, Lee CW, Lee CH, et al. Lipid profiles in untreated patients with rheumatoid arthritis. J Rheumatol 1999;26(8):1701-4.
21. Austin MA, Hokanson JE, Edwards KL. Hypertriglyceridemia as a cardiovascular risk factor. Am J Cardiol 1988;81:7B-12B.
22. Choy E, Sattar N. Interpreting lipid levels in the context of high-grade inflammatory states with a focus on rheumatoid arthritis: a challenge to conventional cardiovascular risk actions. Ann Rheum Dis 2009;68:460-9.
23. Castelli WP, Garrison RJ, Wilson PW, Abbott RD, Kalousdian S, Kannel WB. Incidence of coronary heart disease and lipoprotein cholesterol levels. The framingham study. JAMA 1986;256:2835-8.
24. Mercado FB, Marshall RI, Klestov AC, Bartold PM. Relationship between rheumatoid arthritis and periodontitis. J Periodontol 2001;72:779-87.
25. Greenwald RA, Kirkwood K. Adult periodontitis as a model for rheumatoid arthritis (with emphasis on treatment strategies). J Rheumatol 1999;26:1650-3.
26. Katz J, Goultschin J, Benoliel R, Brautbar C. Human leukocyte antigen (HLA) DR4:positive association with rapidly progressing periodontitis. J Periodontal 1987;58:607-10.
27. Gran JT, Husby G, Thorsby E. The association between rheumatoid arthritis and HLA antigen DR4. Ann Rheum Dis 1983;42:292-6.
28. Moen K, Brun JG, Madland TM, tynning T, Jonsson R. Immunoglobulin G and A antibody responses to Bacteriodes forsythus and Prevotella intermedia in sera and synovial fluids of arthritis patients. Clin Diagn Lab Immunol 2003;10:1043-50.
29. Orgrendik M, Kokino S, Ozdemir F, Bird PS, Hamlet S. Serum antibodies to oral anaerobic bacteria in patients with rheumatoid arthritis. Med Gen Med 2005;7(2):2.
30. Riise OR, Lee A, Cvancarova M, Handeland KS, Wathne KO, Nakstad B, et al. Recent-onset childhood arthritis-association with Streptococcus pyogenes in a population-based study. Rheumatol (Oxford) 2008;47:1006-11.
31. Zeliadt N. When good germs go bad: "friendly” gut bacteria can trigger rheumatoid arthritis inmice. Sci Am 2010;22:1.
32. Gompels LL, Smith A, Charles PJ, Rogers W, Soon-Shiong J, Mitchell A, et al. Single-blind randomized trial of combination antibiotic therapy in rheumatoid arthritis. J Rheumatol 2006;33:224-7.
33. O’Dell JR, Blakely KW, Mallek JA, Eckhoff PJ, Leff RD, Wees SJ, et al. Treatment of early seropositive rheumatoid arthritis: a two-year, double-blind comparison of minocycline and hydroxychloroquine. Arthritis Rheum 2001;44:2235-41.
34. Koga T, Kakimoto K, Hirofuji T, Kotani S, Ohkuni H, Watanabe K. et al. Acute joint inflammation in mice after systemic injection of the cell wall, its peptidoglycan, and chemically defined peptidoglycan subunits from various bacteria. Infect Immun 1985;50:27-34.
35. Sakurai A, Okahashi N, Nakagawa I, Kawabata S, Amano A, Ooshima T, et al. Streptococcus pyogenes infection induces septic arithritis with increased production of receptor activator of the NF-kB ligand. Infect Immun 2003;71(10):6019-26.
36. Arnett FC, Edworthy SM, Bloch DA, MCShane DJ, FriesJF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315-24.
37. Fransen J, van Riel PL. The disease activity score and EULAR response criteria. Clin Exp Rheumatol 2005;23:S93-S99.
38. Friedewald WT, Levy RI, Fredricksan DS. Estimation of the concentration of low density lipoprotein cholesterol in plasma. Without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502.
39. Belin DC, Morse E, Weinstein A, Westergren W. The sedimentation rate reevaluated. J Rheumatol 1981;8:331-5.
40. Bauer AW, Kirby WMM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol 1966;36:493-6.
41. Georgiadis AN, Papavasiliou EC, Lourida ES, Alamanos Y, Kostara C, Tselepis AD, et al. Atherogenic lipid profile is a feature characteristic of patients with early rheumatoid arthritis: effect of early treatment-a prospective, controlled study. Arthritis Res Ther 2006;8:R82.
42. Del Rincon ID, Williams K, Stern MP, Freeman GL, Escalante A. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum 2001;44:2737-45.
43. Al-Muhtaseb N, Al-Kaissi E, Thawaini AJ, Muhi-eldeen Z, Al-Muhtaseb S, Al-Saleh B. The role of human xanthine oxidoreductase (HXOR), anti-HXOR antibodies, and microorganisms in synovial fluid of patients with joint inflammation. Rheumatol Int 2012;32:2355-62.
44. Al-Muhtaseb N, Al-Kaissi E, Muhi-eldeen Z, Al-muhtaseb N. The Prevelance of dislipidemia and xanthine oxidoreductase level in Jordanian patients with rheumatoid arthritis. Eur J Sci Res 2013;99(1):102-18.
45. Tian LI, Yanhua XU, Mingde FU, Tao Peng, Yinghui Liu, Long S. The impact of plasma triglyceride and apolipoprotiens concentrations on high-density lipoprotein subclasses distribution. Lipids Health Dis 2011;10:17.
46. Chen DY, Chih HM, Lan JL, Chang HY, Chen WW, Chiang EPI. Blood lipid profiles and peripheral blood mononuclear cell cholesterol metabolism gene expression in patients with and without methotrexate treatment. BMC Med 2011;9:14.
47. Boutaga K, van Winkelhoff AJ, Vandenbrouke-Grauls CM, Savelkoul PH. Peridental pathogens; a quantitative comparison of anaerobic culture and real-time PCR. FEMS Immunol Med Microbiol 2005;45:191-9
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How to Cite
Al-kaissi, E. N., N. I. Al-muhtaseb, and N. Al-muhtaseb. “THE INFLUENCE OF ADDING ANTIBIOTIC IN TREATMENT OF RHEUMATOID ARTHRITIS PATIENTS ON STREPTOCOCCUS PYOGENES CARRIER RATE AND ON THE LIPIDS PROFILE”. International Journal of Pharmacy and Pharmaceutical Sciences, Vol. 7, no. 2, Dec. 2014, pp. 245-51, https://innovareacademics.in/journals/index.php/ijpps/article/view/3916.
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