What is the Effectiveness of Roxithromycin in Management of the Signs and Symptoms of Rheumatoid Arthritis?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not roxithromycin is effective in management of the signs and symptoms of rheumatoid arthritis. STUDY DESIGN: Review of three primary studies in the English language published in 2006, 2009, and 2011. DATA SOURCES: Randomized, controlled and double blind clinical trials testing the effectiveness roxithromycin in management of inflammation and signs and symptoms of rheumatoid arthritis were found using the PubMed and Ovid databases. OUTCOMES MEASURED: Improvement in the signs and symptoms of tenderness/inflammation using the American College of Rheumatology-20 (ACR-20) scoring approach, improvement of quality of life with the sinonasal outcome test-20 (SNOT-20) method, medication safety, and overall response to treatment. RESULTS: The Ogrendik studies showed a significant number of patients met ACR 20 improvement criteria with roxithromycin 300mg treatment at 6 months compared with those patients who received placebo. One study showed significant reductions in pain and duration of morning stiffness, quality of life improvement, and reduction in disease activity as demonstrated by objective clinical measurements. The Cervin et al study showed statistically significant improvements in sinonasal inflammation among patients who received roxithromycin 150mg, depicted by patient response scales. Roxithromycin-treated patients in this study also showed significant improvements in SNOT-20 scoring after 12 weeks of treatment with the macrolide; however, improvements were not noted at the 6 week mark of treatment. Conclusions: Collectively, the three RCT’s evaluated depicted the effectiveness in management of signs and symptoms of rheumatoid arthritis. Ogrendik studies indicate that this particular macrolide is effective in complaints that are most bothersome to RA patients, including morning stiffness and decreased quality of life.4,5 Also, the Cervin et al study proves the effectiveness of long-term use of roxithromycin in controlling inflammation.6 Further research is needed to assess the risk of bacterial resistance to roxithromycin with prolonged use, and whether or not there is a relationship between disease activity and antibodies to anaerobic bacteria among RA patients