Corresponding Author: Masashi Ohe, Department of General Medicine, Hokkaido Social Insurance Hospital

Macrolide antibiotics provide not only anti-bacterial activity but also anti-inflammatory effects. We report herein a case of rheumatoid arthritis (RA) successfully treated using clarithromycin (CAM), a macrolide, in expectation of its antiinflammatory effects. A 77-year-old woman suffering from RA, presented with exacerbation of arthralgia and articular swellings. Because she was suffering from non-tuberculous mycobacterium and could not receive biological agents, CAM was successfully added to prednisolone and a nonsteroidal anti-inflammatory drug which had been administered before exacerbation. The present case suggests that CAM treatment may be effective for RA.

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1. Ogrendik M. Effects of clarithromycin in patients with active rheumatoid arthritis. Curr Med Res Opin 2007; 23: 515-522.

2. Saviola G, Abdi Ali L, Rossini P, et al. Clarithromycin in rheumatoid arthritis patients not responsive to disease-modifying antirheumatic drugs: an open, uncontrolled pilot study. Clin Exp Rheumatol 2002; 20: 373-378.

3. Saviola G, Abdi-Ali L, Campostrini L, 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: 2833-2838.

4. Tkalcevic VI, Bosnjak B, Pasalic I, et al. The antiinflammatory activity of clarithromycin inhibits TNFalpha production and prolongs survival following lipopolysaccharide administration in mice. Int J Antimicrob Agents 2008; 32: 195-196.

5. Wells G, Becker JC, Teng J, et al. Validation of the 28-joint Disease Activity Score (DAS28) and European League Against Rheumatism response criteria based on C-reactive protein against disease progression in patients with rheumatoid arthritis, and comparison with the DAS28 based on erythrocyte sedimentation rate. Ann Rheum Dis 2009; 68: 954-960.

6. JungYO, Kim HA. Recent paradigm shifts in the diagnosis and treatment of rheumatoid arthritis. Korean J Intern Med 2012; 27: 378-387.

7. Koike R, Takeuchi T, Eguchi K, Miyasaka N. Update on the Japanese guidelines for the use of infliximab and etanercept in rheumatoid arthritis. Mod Rheumatol 2007; 17: 451-458.

8. Ogrendik M. Antibiotics for the treatment of rheumatoid arthritis. Int J Gen Med 2014; 7: 43- 47.

9. Rubin BK, Henke MO. Immunomodulatory activity and effectiveness of macrolides in chronic airway diseases. Chest 2004; 125: 70-78.