This common antibiotic has been studied for decades for its effectiveness as a rheumatoid arthritis drug. Find out how it works, possible side effects, and whether you should consider it.
Researchers are still working to unravel the mystery of rheumatoid arthritis. It's known that rheumatoid arthritis is an autoimmune disease in which the immune system attacks the lining of the joints. This results in the accumulation of fluid, which leads to inflammation and joint pain often throughout the body.
What's not known, however, is exactly what causes it, though experts suspect it’s a mix of environmental and genetic factors. But it's this lack of knowledge that decades ago resulted in a treatment that is still sometimes used today.
Without firm evidence to the contrary, physicians throughout much of the 20th century believed that rheumatoid arthritis was the result of a hidden infection. Therefore, it was treated with antibiotics.
In the 1930s, the common rheumatoid arthritis drug was a sulfa-based medication called azulfidine. By the 1950s, tetracycline became a popular choice. In the 1970s, minocycline, a broader-spectrum tetracycline derivative, was first synthesized and gained some popularity over the years for the treatment of mild early RA, according to Natalie E. Azar, MD, a clinical assistant professor of medicine and rheumatology at NYU Langone Medical Center in New York City. A number of studies over the years found mixed results, but the findings of a clinical trial in 1995, published in the journal Annals of Internal Medicine, led the National Institutes of Health to add minocycline to its list of recommended RA treatments.
Though technically an antibiotic, minocycline has other properties that allow it to be helpful in improving the symptoms of RA. Specifically it discourages the creation of leukotrienes, metalloproteinases, and prostaglandins — all substances that cause inflammation. It also helps create more interleukin-10, which fights inflammation.
Typical dosing of minocycline is 100 milligrams twice a day in capsule form, often taken at mealtimes to avoid an upset stomach. Because minocycline can interact with other drugs — including antacids, iron pills, and blood thinners — your doctor will need to review all medications you're taking, whether prescription, over-the-counter, or alternative therapies.
Once you start taking minocycline for RA, you may have to wait to see results — two to three months is typical, and maximum relief can take up to a year to achieve.
“It is important to understand that there is no cure for RA, but minocycline helps in reducing RA symptoms by slowing RA progression,” says epidemiologist and researcher Janky Patel, MPH, of Yale University. “It is important to be aware of the side effects while taking this medication.”
Side effects can affect your skin (causing photosensitivity or hyperpigmentation), nails, or mucous membranes. You may experience stomach upset and dizziness, according to Dr. Azar. Your liver function should be checked regularly, and if you're a woman taking oral contraceptives, that form of birth control could be less effective.
Minocycline has been the subject of study for decades — and not just as a treatment for RA or acne. In fact, in a study published in the May 2013 issue of the British Journal of Pharmacology, researchers in Spain reviewed research on minocycline as a potential treatment for other illnesses and conditions. Those included periodontitis, atherosclerosis, inflammatory bowel disease, traumatic brain injury, neuropathic pain, Parkinson's disease, Alzheimer's, multiple sclerosis, Huntington's disease, and amyotrophic lateral sclerosis.
In the meantime, minocycline remains one of a number of possibilities for RA treatment, though it does have some fierce competition. “Strictly speaking, it is not FDA-approved for RA," said Azar, "and, compared to other more established disease-modifying anti-rheumatic drugs, it is much weaker."
She said that many rheumatologists prefer the newer biologic drugs like etanercept (Enbrel), adalimumab (Humira), and abatacept (Orencia). However, those drugs have their own side effects and are extremely expensive if your medical insurance won't cover them. Minocycline might still be an option, especially in people who have not responded to other treatments or who can't, for whatever reason, take other rheumatoid arthritis drugs.
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