MAY DOXYCYCLINE-RIFAMPICIN COMBINATION BE THE FIRST-LINE THERAPY FOR OSTEOARTICULAR BRUCELLOSIS?

Abstract

Aims: Brucellosis is an infectious disease which can mimic rheumatoid diseases due to its osteoarticular (OA) involvements. Treatment failure and recurrences have not been completely eliminated yet in patients with OA brucellosis. This study aimed to investigate rheumatologic manifestations observed in patients with OA brucellosis and the outcomes of combination therapy with doxycycline and rifampicin (DR) in such patients. Materials and Methods: The study enrolled patients who were diagnosed with brucellosis based on blood cultures and serological examinations conducted for differential diagnosis due to presence of rheumatologic symptoms. Serological tests and radiological examinations were performed for diagnosis of the OA involvements. As for treatment, DR therapy was given for 45 days to patients with OA involvement other than spondylitis and for 12 weeks to patients with spondylitis. Clinical and serological evaluations were repeated at 2 weeks and 1, 2, 3, 6 and 12 months after treatment initiation. Results: Mean age of the 49 patients enrolled in the study was 44.08 +/- 13.04 years. The most common osteoarticular manifestation was spondylitis which was observed in 17 patients (34.7%). In addition, 14 patients (28.6%) had sacroiliitis, nine patients (18.4%) had monoarthritis and 3 patients (6.1%) had oligoarthritis. Complete recovery was observed in all patients based on clinical and serological evaluations. During follow-up visits up to 12 months, none of the patients had recurrence. Conclusion: Brucellosis should be considered in the differential diagnosis of the rheumatic diseases, mainly spondy-loarthropathies. When administered for a sufficient period of time, DR combination is a powerful therapeutic option for patients with osteoarticular brucellosis including those with spondylitis.