A perspective on the use of minocycline for rheumatoid arthritis

Although a number of clinical trials have shown minocycline to be effective in the treatment of rheumatoid arthritis, its use is limited and may become more limited with the recent introduction of new agents. The clinical studies providing the evidence for the efficacy of minocycline are reviewed. Laboratory investigations that support a possible anti-arthritic action of tetracyclines through their effect on nitric oxide generation, matrix metalloprotease inhibition, and chondrocyte apoptosis are discussed. A personal perspective is that minocycline may fit into the current therapeutic repertoire as an additional drug for patients who are not adequately responding to other disease-modifying agents.