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Sellers, BS Pharmacy, PharmD — By Vincent A. Vidaurri, PharmD, BCOP — Updated on July 12, 2022Minocycline is an antibiotic that reduces inflammation. Doctors usually use minocycline to treat bacterial infections such as pneumonia, but one off-label use includes treating rheumatoid arthritis (RA). Minocycline is a medication in the tetracycline family of antibiotics. The usual dosage for minocycline is 100 milligrams twice daily, or every 12 hours, by mouth. Although its intended purpose is to help treat bacterial infections, doctors have also used it as a disease-modifying anti-rheumatic drug (DMARD). In general, DMARDs can improve the symptoms of RA and prevent long-term disabilities. However, doctors may prescribe newer treatments for the condition more often. This article examines minocycline as a treatment for RA, its effectiveness and side effects, and other standard therapies. Can minocycline help treat RA Share on PinterestGetty ImagesSome research suggests that minocycline can relieve the symptoms of RA. It seems to be more effective in the early stages of the condition and for short-term treatment. Evidence from research suggests that minocycline can improve:joint swelling and tendernessmarkers of inflammation Although minocycline can reduce redness, swelling, and tenderness, it does not entirely stop RA from worsening. Studies do not show significant improvement in fatigue, joint pain, or joint damage. Doctors use minocycline sparingly to treat RA. Newer agents and other DMARDs are more effective in reducing RA symptoms and slowing progression. Researchers have also studied it less than other treatment options. If doctors use minocycline, it likely will be combined with other medications to treat RA. The most recent recommendations from the American College of Rheumatology (ACR) for treating RA do not recommend minocycline. This is because there is no new data on its use since the late 1990s and the risk of side effects and skin discoloration. Newer, more effective treatments for RA are now available. Learn more about RA here. How does it work RA is an immune system disease that causes body defense cells to accidentally attack bones and joints. This causes injury to tissue from inflammation. Once inflammation starts, it produces many damaging proteins and cell types. This results in twisted and painful joints. These cell types and proteins fuel the process of inflammation, but the specifics of these processes can vary between inflammatory conditions. The amount of inflammation determines the type of therapy needed to control the symptoms. The same level of inflammation, however, can respond differently to different treatments. Doctors typically use minocycline as an antibiotic to treat a wide variety of bacterial infections. Although it is an antibiotic, minocycline can ease RA symptoms in ways not directly related to its antibiotic properties. Some studies suggest that minocycline may work for RA by blocking inflammatory proteins and dampening immune system cell activity. This may stop joint damage. Side effects Minocycline has fewer adverse effects than other drugs that treat RA. However, some adverse effects of minocycline can include:nauseavomitingdiarrheasun sensitivityheadacheslightheadednessdizzinessloss of appetite People may notice discolored nails and darker skin on the arms and legs called hyperpigmentation. This usually happens in areas of previous injuries or with long-term minocycline use. Minocycline may also discolor tooth enamel in children who are still developing teeth. Although minocycline is effective in treating a range of autoimmune conditions, in very rare cases, it can cause immune system problems such as lupus, Stevens-Johnson syndrome, and ANCA vasculitis. These conditions can involve redness, swelling, and pain in the skin, muscles, tissues, or joints. Fever of unknown cause is also a hallmark of these autoimmune conditions. Other rare adverse reactions can include liver, lung, or kidney inflammation. Alternative medications for RA The main treatment options for RA can include:DMARDsbiological agentsJanus kinase (JAK) inhibitorsglucocorticoids A doctor will determine what to prescribe based on how long the person has had RA and the severity of their symptoms. They may add or switch drugs if a person’s symptoms worsen. DMARDs DMARDs, a collection of unrelated drugs, form the foundation of RA treatment. The most common DMARDs are:hydroxychloroquineleflunomidemethotrexatesulfasalazine The ACR recommends using methotrexate first to treat people who have RA. They also prefer that doctors use a single drug as an initial treatment since it costs less and causes fewer adverse effects. A single agent is easier for a person to take. Doctors may suggest using different DMARDs alone or, for quicker results, start combination therapy — methotrexate plus sulfasalazine plus hydroxychloroquine. Doctors should check the therapy after 3 months to determine the effectiveness of the treatment and make changes if needed. DMARDs can reduce long-term disability but also can cause significant adverse effects. When compared with glucocorticoids, DMARDs take longer to work. Biologics Biological agents fall into two classes: tumor necrosis factor (TNF) inhibitors and non-TNF. The following drugs are in the TNF inhibitor class:adalimumab (Humira)certolizumab pegol (Cimzia)etanercept (Enbrel)golimumab (Simponi)infliximab (Remicade) These drugs block the damaging action of the protein TNF in the joints. People who take these agents are at an increased risk of infections. Doctors should screen people for hepatitis B, hepatitis C, and tuberculosis before starting treatment with a TNF drug. The guidelines recommend these drugs for people with moderate or severe cases of RA. Often, doctors recommend these drugs for people with RA who have progressed beyond DMARD treatment. Doctors should combine TNF inhibitors with methotrexate to improve their benefits when possible. The following drugs are in the non-TNF class:abatacept (Orencia)rituximab (Rituxan)sarilumab (Kevzara)tocilizumab (Actemra) Kevzara and Actemra may hinder the activity of the protein interleukin-6, which reduces inflammation. Rituxan can cancel out B-cells that can cause damage and swelling. Orencia can stop T-cells from producing antibodies that attack joints. JAK inhibitors JAK inhibitors interrupt the signals within cells that produce inflammatory proteins called cytokines. Stopping these signals halts cytokine production and suppresses inflammation. This class includes:baricitinib (Olumiant)tofacitinib (Xelijanz)upadacitinib (Rinvoq) Glucocorticoids Glucocorticoids are a type of steroid hormone. They work by suppressing the immune cells responsible for inflammation. This reduces inflammation in the body. Doctors can use a variety of glucocorticoids to treat RA. The dosages and length of treatment may vary depending on the severity of the condition. People tend to get the best results from using glucocorticoids for short periods of time to treat flareups. People with RA rarely use glucocorticoids for longer than 3 months due to the adverse effects they cause, such as infections and osteoporosis. Summary Over the past 20 years, gaining official approval of biological agents and developing a better understanding of DMARDs has changed the face of RA treatment. These changes have placed minocycline outside the circle of standard treatment options for RA. Researchers have stopped investigating minocycline to treat RA. The most recent guidelines do not recommend minocycline as other options are more beneficial. Minocycline now plays a small and retreating role in the treatment of RA. Last medically reviewed on July 12, 2022Rheumatoid ArthritisRheumatologyInfectious Diseases / Bacteria / VirusesPharmacy / PharmacistMedically reviewed by Alisha D. Sellers, BS Pharmacy, PharmD — By Vincent A. Vidaurri, PharmD, BCOP — Updated on July 12, 2022 Latest newsWhat sets 'SuperAgers' apart? Their unusually large neuronsOmega-3 may provide a brain boost for people in midlifeSeasonal affective disorder (SAD): How to beat it this fall and winterCDC: Monkeypox in the US 'unlikely to be eliminated in the near future'Why are more women prone to Alzheimer's? New clues arise Related CoverageCan cryotherapy help with rheumatoid arthritis pain?Medically reviewed by Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT Using cryotherapy to treat pain is not a new idea. 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