We did a systematic review and metaanalysis of randomized controlled trials of
antibiotics for treatment of ReA. We searched electronic databases and conference proceedings up to November 2011. Included trials reported on remission, joint counts, and
pain or patient global scores in any language.
RESULTS: Twelve trials were eligible for inclusion and 10 provided data for metaanalysis. The pooled relative risk of failure to achieve remission from a random effects model showed no significant benefit of
antibiotic treatment on remission (7 trials, 375 participants, RR 0.74, 95% CI 0.49-1.10); however, substantial heterogeneity was observed (I(2) = 76.3%, p < 0.0001). The treatment effect did not differ significantly by the type of organism triggering the ReA (chlamydia, 4 trials, RR 0.80, 95% CI 0.63-1.03, vs other microorganisms, 5 trials, RR 0.72, 95% CI 0.29-1.79, metaregression p = 0.477) or use of combination
antibiotics (monotherapy, 6 trials, RR 0.70, 95% CI 0.39-1.26, vs combination
therapy, 1 trial, RR 0.79, 95% CI 0.63-0.99, metaregression p = 0.466). When unblinded trials were excluded, the treatment effect was attenuated and heterogeneity decreased (RR 0.87, 95% CI 0.70-1.10, I(2) = 32.8%, p = 0.19). No significant effects of
antibiotic treatment were observed on joint counts,
pain, or patient global scores; however,
antibiotics were associated with a 97% increase in gastrointestinal adverse events.
CONCLUSION: