Tetracyclines may be therapeutically beneficial in rheumatoid arthritis.

Several clinical trials have been conducted in the past 3 years using minocycline as an anti-inflammatory agent for rheumatoid arthritis (RA), Depending on one's viewpoint, these trials have or have not shown a mild beneficial effect on conventional RA parameters of inflammation. In the context of currently available anti-inflammatory therapy, the magnitude of the reported effects would not seem to justify additional large scale trials. There is, however, compelling basic science data as well as preliminary clinical data, suggesting that certain tetracyclines may have a valuable role to play in treatment of RA. There is even reason to believe that such an agent could be the Holy Grail of rheumatology, namely the drug that prevents connective tissue degradation in destructive arthritides. This concept is based on the properties of tetracyclines as inhibitors of matrix metalloproteinases. In this article, the properties of the tetracyclines in this regard are reviewed, and concepts are suggested for the design of a trial addressing the unique properties of these drugs.