Early rheumatoid arthritis: combination therapy of doxycycline plus methotrexate versus methotrexate monotherapy
Graciela S Alarcón
Correspondence The Faculty Office Towers, 510 20th Street South, Room 832, University of Alabama at Birmingham, Birmingham, AL 35294-3408, USA
Email graciela.alarcon@ccc.uab.edu
This article has no abstract so we have provided the first paragraph of the full text.
O'Dell and his colleagues in the Rheumatoid Arthritis Investigational Network group should be admired for their tenacity in conducting this and other RA clinical trials with relatively limited financial support. This group first introduced the concept of triple therapy using hydroxychloroquine, sulfasalazine and methotrexate,1 and have subsequently examined the role of minocycline versus hydroxychloroquine for the treatment of RA.2 In this study, O'Dell and colleagues go on to examine the role of combining doxycycline (rather than minocycline) with methotrexate to treat patients with early, seropositive RA who had not received previous treatment with disease-modifying antirheumatic drugs. All patients received escalating doses of methotrexate plus doxycycline either at a low dose or a standard dose. The hypothesis that patients in the low-dose doxycycline group would not have antimicrobial activity made it possible to determine if the benefit of doxycycline was due to its antimicrobial or its anti-inflammatory and autoimmune properties. Patients in the three treatment groups received a similar final dose of methotrexate, but the ACR50 response was significantly higher in the high-dose and low-dose doxycycline groups compared with the methotrexate monotherapy group.
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