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.

Researchers at University of Bern ( Switzerland ), have examined the effects of Doxycycline compared with placebo or no intervention on pain and function in patients with osteoarthritis of the hip or knee.

One randomised controlled trial 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 on a visual analogue scale from 0 to 10 cm for pain and -1.10 units 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 ), 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 ).

In conclusion, 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.

Nüesch E et al, Cochrane Database Syst Rev 2009;(4):CD007323

XagenaMedicine2009


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