Clarithromycin Treatment for Polymyalgia Rheumatica
Abstract
Macrolide antibiotics, such as clarithromycin (CAM), provide not only antibacterial activity but also anti-inflammatory effects. Several recent studies have reported the successful treatment of rheumatoid arthritis and polymyalgia rheumatic (PMR) using CAM due to its anti-inflammatory effects. Herein, we also report two cases of PMR treated using CAM. Case 1: An 83-year-old man with PMR was treated using prednisolone (PSL) (15 mg/day) and CAM. When muscle pain disappeared and C-reactive protein (CRP) decreased, the PSL dosage was reduced. When PSL was reduced to 5 mg/day, CAM was discontinued. However, following this discontinuation, muscle pain returned and CRP became positive. Therefore, CAM was successfully readministered. Case 2: A 68-year-old woman with PMR was treated using PSL (15 mg/day). When muscle pain disappeared and CRP decreased, the PSL dosage was reduced. When PSL was reduced to 7 mg/day, muscle pain returned, and CRP became positive. CAM was successfully added and the PSL dosage could be decreased to 5 mg/day. These two cases suggest that treatment using CAM may be effective in some cases of PMR.References
Weyand CM, Goronzy JJ. Giant-cell arteritis and polymyalgia rheumatica. N Engl J Med 2014;371:50-7.
Ogrendik M. Effect of clarithromycin in patients with active rheumatoid arthritis. Current Med Res Opin 2007;23:515-22.
Saviola G, Abdi Ali L, Campostrini L, Sacco S, Baiardi P, Manfredi M, et al. Clarithromycin in rheumatoid arthritis: the addition to methotrexate and low-dose methylprednisolone induces a significant additive value-a 24-month single-blind pilot study. Rheumatol Int 2013;33:2833-8.
Ohe M, Bohgaki T. Successful treatment with clarithromycin for patients with polymyalgia rheumatica. Korean J Intern Med 2014;29:539-41.
Ohe M, Shida H, Horita T, Oku K. Successful treatment with clarithromycin and/or tacrolimus for two patients with polymyalgia rheumatic. Drug Discov Ther 2017;11:223-5.
Khan AA, Slifer TR, Araujo FG, Remington JS. Effect of clarithromycin and azithromycin on production of cytokines by human monocytes. Int J Antimicrob Agent 1999;11:121-32.
van der Geest KSM, Abdulahad WH, Rutgers A, Horst G, Bijzet J, Arends S, et al. Serum markers associated with disease activity in giant cell arteritis and polymyalgia rheumatica. Rheumatol 2015;54:1397-402.
Yamaguchi K, Murashima A, Yamamoto Y. Clarithromycin reduces prednisolone requirements for treatment of intractable Takayasu arteritis. Clin Exp Rheumatol 2004;220:S102.