Doxycycline for osteoarthritis of the knee or hip
Division of Clinical Epidemiology and Biostatistics, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, Bern, Switzerland, 3012. Cochrane database of systematic reviews (Online)
(Impact Factor: 6.03).
10/2009; 11(4):CD007323. DOI: 10.1002/14651858.CD007323.pub2
Osteoarthritis is a chronic joint disease that involves degeneration of articular cartilage. Pre-clinical data suggest that doxycycline might act as a disease-modifying agent for the treatment of osteoarthritis, with the potential to slow cartilage degeneration.
To examine the effects of doxycycline compared with placebo or no intervention on pain and function in patients with osteoarthritis of the hip or knee.
We searched CENTRAL ( The Cochrane Library 2008, issue 3), MEDLINE, EMBASE and CINAHL up to 28 July 2008, checked conference proceedings, reference lists, and contacted authors.
We included studies if they were randomised or quasi-randomised controlled trials that compared doxycycline at any dosage and any formulation with placebo or no intervention in patients with osteoarthritis of the knee or hip.
We extracted data in duplicate. We contacted investigators to obtain missing outcome information. We calculated differences in means at follow-up between experimental and control groups for continuous outcomes and risk ratios for binary outcomes.
We found one randomised controlled trial that compared doxycycline with placebo in 431 obese women. After 30 months of treatment, clinical outcomes were similar between the two treatment groups, with a mean difference of -0.20 cm (95% confidence interval (CI) -0.77 to 0.37 cm) on a visual analogue scale from 0 to 10 cm for pain and -1.10 units (95% CI -3.86 to 1.66) for function on the WOMAC disability subscale, which ranges from 17 to 85. These differences correspond to clinically irrelevant effect sizes of -0.08 and -0.09 standard deviation units for pain and function, respectively. The difference in changes in minimum joint space narrowing was in favour of doxycycline (-0.15 mm, 95% CI -0.28 to -0.02 mm), which corresponds to a small effect size of -0.23 standard deviation units. More patients withdrew from the doxycycline group compared with placebo due to adverse events (risk ratio 1.69, 95% CI 1.03 to 2.75).
The symptomatic benefit of doxycycline is minimal to non-existent. The small benefit in terms of joint space narrowing is of questionable clinical relevance and outweighed by safety problems. Doxycycline should not be recommended for the treatment of osteoarthritis of the knee or hip.
Available from: Sean E Gill
- "Furthermore, doxycyline at 2.0 mg/kg attenuates lung injury induced by LPS, doxycycline-resistant S. pneumoniae and bleomycin; and reduces inflammation in a model of asthma [4,5,14]. In humans, doxycycline has been used in the treatment of lymphangioleiomyomatosis (LAM) [15,16] and decreases proteinuria in diabetic nephropathy , although it was found to have no effect in osteoarthritis . Clearly, doxycycline has anti-inflammatory properties that are independent of its antimicrobial activity. "
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ABSTRACT: Tetracyclines are broad-spectrum antibiotics that are also used to induce gene expression using the reverse tetracycline transactivator / tetracycline operator system (rtTA/tetO system). The system assumes that tetracyclines have no effects on mammals. However, a number of studies suggest that tetracyclines may have powerful anti-inflammatory effects. We report that the tetracycline, doxycycline, inhibits neutrophil (PMN) influx into the lungs of mice treated with bacterial endotoxin (LPS).
Mice were challenged with intratracheal LPS in the presence or absence of doxycyline. bronchoalveolar lavage cell counts and differential, total bronchoalveolar lavage protein, lung homogenate caspase-3 and tissue imaging were used to assess lung injury. In addition, PMN chemotaxis was measured in vitro and syndecan-1 was measured in bronchoalveolar lavage fluid.
The administration of doxycycline resulted in a significant decrease in the number of bronchoalveolar lavage PMNs in LPS-treated mice. Doxycycline had no effect on other markers of lung injury such as total bronchoalveolar lavage protein and whole lung caspase-3 activity. However, doxycycline resulted in a decrease in shed syndecan-1 in bronchoalveolar lavage fluid.
We conclude that doxycycline has an important anti-inflammatory effect that can potentially confound the experiments in which the rtTA/tetO system is being used to study the immune response.
Available from: Fabio Zaina
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ABSTRACT: Since 2007 we focused our attention as EJPRM to the best available clinical evidence offered by the Cochrane Collaboration. Due to the absence of a specific Rehabilitation Group (only a field exists), reviews of PRM interest are in different groups and not easy to find. Consequently, the EJPRM lists and presents all these reviews systematically.
The aim of the present paper is to systematically review all the new rehabilitation papers published in the Cochrane Library 4th Issue 2009 in order to provide to physicians involved in the field a summary of the best evidence nowadays available.
The author systematically searched all the new papers of rehabilitative interest in the Cochrane Library 4th Issue 2009. The retrieved papers have been divided in subgroups on the base of the topic and the Cochrane Groups.
The number of included papers was 19: 11 were new reviews. Three new reviews deal with neurological rehabilitation, 6 with musculoskeletal disorders, 3 with pain management. Moreover, 8 reviews have been updated: 4 related to musculoskeletal disorders, 2 to neurological disorders, and 1 to respiratory rehabilitation. All these are listed at the end of the paper.
The Cochrane Collaboration and its product, the Cochrane Library, are really relevant instruments to improve EBM in medical practice and thus also in the Rehabilitation Field. The present paper can help Rehabilitation Specialists to easily retrieve the conclusions of the most relevant and updated reviews in order to change their clinical practice in a more rapid and effective way.
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