Intra-articular Doxycycline: A Novel Treatment of Adhesive Capsulitis

Adhesive Capsulitis Clinical Trial

— DOXY  

Official title:

Intra-articular Doxycycline: A Novel Treatment of Adhesive Capsulitis

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03479502
• Other study ID #: 172011
• Status: Completed
• Phase: Phase 4
• Start date: March 5, 2018
• Est. completion date: February 8, 2022

Study information

• Verified date: January 2024
• Source: Vanderbilt University Medical Center
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

We will recruit a total of 40 patients from the Vanderbilt Sports Medicine Clinics who have been diagnosed with adhesive capsulitis and have not undergone any previous treatment. The 40 patients will be randomized, with 20 in the control group of 3 intra-articular injections of 40mg Methylprednisolone spaced every two weeks, and 20 in the experimental group of 3 intra-articular injection of 50mg doxycycline spaced every two weeks. Both groups will begin a standardized physical therapy program within a pain-free range of motion 4 weeks after the initiation of treatment. We will prospectively follow patients for one year, with follow-up at 6 weeks, 12 weeks, 6 months, and 12 months after the initiation of treatment.

Outcomes will be measured using the American Shoulder and Elbow Score (ASES) and objective measurements of shoulder range of motion, which will be collected by the treating physician. Both the patients and physicians participating in the study will be blinded.

Description:

Adhesive capsulitis, also known as frozen shoulder, is a common condition of the shoulder joint affecting 2-5% of the adult population and characterized by progressive, painful loss of both passive and active range of motion of shoulder [1,2]. Individuals affected by this condition find it increasingly difficult to perform activities of daily living that require overhead movement or rotation of the affected shoulder. The natural history of frozen shoulder follows a predictable progression of symptoms, lasting from 9-24 months before complete resolution, and results in significant loss of productivity and quality of life for those affected [3]. Despite the significant number of patients affected by adhesive capsulitis and the extensive literature focused on the progression and natural history of the condition, the true underlying etiology remains poorly understood. In light of this poor understanding of the condition, it is not surprising that a number of conservative and invasive modalities exist as accepted treatments. These include non-steroidal anti-inflammatory drugs (NSAIDS), oral steroids, intra-articular steroid injections, Physical Therapy (PT), and benign neglect as well as more invasive treatments such as hydroxylation, manipulation under anesthesia, and arthroscopic capsular release [2]. These treatments have all be shown to have short-term benefit in pain relief, but none have proven to be superior nor alter the long-term natural history of adhesive capsulitis.

Over the past decade, however, there has been a growing body of literature suggesting that Propionibacterium acnes infection may play a significant role in a variety of pathological conditions affecting the native shoulder, most notably frozen shoulder [4,5]. Our goal is to employ a treatment strategy focused on eradicating P acnes infection as a conservative treatment of adhesive capsulitis. Through this project, we aim to complete a prospective randomized pilot study to examine the hypothesis that administration of intra-articular antibiotics effective against P acnes will prove to be a superior treatment of adhesive capsulitis as compared to current gold standard of intraarticular steroid injection.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 1
• Est. completion date: February 8, 2022
• Est. primary completion date: February 8, 2022
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• 18 years of age and older,

• diagnosis of stage II adhesive capsulitis as determined by clinical examination of the treating physician, and

• absence of abnormal findings on X-ray.

Exclusion Criteria:

• allergy to Doxycycline or Methylprednisolone,

• pregnancy,

• diagnosis,

• Inflammatory arthritis or diabetes,

• secondary adhesive capsulitis (history of significant trauma, rotator cuff tear injury, stroke)

• evidence of arthritis on x-ray,

• current infectious disease, and

• any previous treatment for the for adhesive capsulitis of the affected shoulder.

Related Conditions & MeSH terms

• Adhesive Capsulitis
• Adhesive Capsulitis of Unspecified Shoulder
• Bursitis
• Frozen Shoulder

Intervention

Drug:
• Methylprednisolone Injectable Product
3 intra-articular injections of Methylprednisolone Injectable Product spaced every two weeks
• Doxycycline Injection
3 intra-articular injections of Doxycycline Injection spaced every two weeks

Locations

Country	Name	City	State
United States	Vanderbilt Medical Center	Nashville	Tennessee

Sponsors (2)

Lead Sponsor	Collaborator
Vanderbilt University Medical Center	Orthopedic Research and Education Foundation

Country where clinical trial is conducted

United States, 

References & Publications (16)

Athwal GS, Sperling JW, Rispoli DM, Cofield RH. Deep infection after rotator cuff repair. J Shoulder Elbow Surg. 2007 May-Jun;16(3):306-11. doi: 10.1016/j.jse.2006.05.013. Epub 2007 Feb 22. — View Citation

Aydin O, Korkusuz F, Korkusuz P, Tezcaner A, Bilgic E, Yaprakci V, Keskin D. In vitro and in vivo evaluation of doxycycline-chondroitin sulfate/PCLmicrospheres for intraarticular treatment of osteoarthritis. J Biomed Mater Res B Appl Biomater. 2015 Aug;10 — View Citation

Bernal-Lagunas R, Aguilera-Soriano JL, Berges-Garcia A, Luna-Pizarro D, Perez-Hernandez E. Haemophilic arthropathy: the usefulness of intra-articular oxytetracycline (synoviorthesis) in the treatment of chronic synovitis in children. Haemophilia. 2011 Mar — View Citation

Brandt KD, Mazzuca SA, Katz BP, Lane KA, Buckwalter KA, Yocum DE, Wolfe F, Schnitzer TJ, Moreland LW, Manzi S, Bradley JD, Sharma L, Oddis CV, Hugenberg ST, Heck LW. Effects of doxycycline on progression of osteoarthritis: results of a randomized, placebo — View Citation

Bunker TD, Boyd M, Gallacher S, Auckland CR, Kitson J, Smith CD. Association between Propionibacterium acnes and frozen shoulder: a pilot study. Shoulder Elbow. 2014 Oct;6(4):257-61. doi: 10.1177/1758573214533664. Epub 2014 May 27. — View Citation

Cylwik J, Kita K, Barwijuk-Machala M, Reszec J, Klimiuk P, Sierakowski S, Sulkowski S. The influence of doxycycline on articular cartilage in experimental osteoarthrosis induced by iodoacetate. Folia Morphol (Warsz). 2004 May;63(2):237-9. — View Citation

Dodson CC, Craig EV, Cordasco FA, Dines DM, Dines JS, Dicarlo E, Brause BD, Warren RF. Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elbow Surg. 2010 Mar;19(2):303-7. doi: 10.1016/j.jse.2009.07.065. Epub — View Citation

Haerdi-Landerer MC, Suter MM, Steiner A. Intra-articular administration of doxycycline in calves. Am J Vet Res. 2007 Dec;68(12):1324-31. doi: 10.2460/ajvr.68.12.1324. — View Citation

Hannafin JA, Chiaia TA. Adhesive capsulitis. A treatment approach. Clin Orthop Relat Res. 2000 Mar;(372):95-109. — View Citation

Hsu JE, Anakwenze OA, Warrender WJ, Abboud JA. Current review of adhesive capsulitis. J Shoulder Elbow Surg. 2011 Apr;20(3):502-14. doi: 10.1016/j.jse.2010.08.023. Epub 2010 Dec 16. No abstract available. — View Citation

Levy O, Iyer S, Atoun E, Peter N, Hous N, Cash D, Musa F, Narvani AA. Propionibacterium acnes: an underestimated etiology in the pathogenesis of osteoarthritis? J Shoulder Elbow Surg. 2013 Apr;22(4):505-11. doi: 10.1016/j.jse.2012.07.007. Epub 2012 Sep 13 — View Citation

Millett PJ, Yen YM, Price CS, Horan MP, van der Meijden OA, Elser F. Propionibacterium acnes infection as an occult cause of postoperative shoulder pain: a case series. Clin Orthop Relat Res. 2011 Oct;469(10):2824-30. doi: 10.1007/s11999-011-1767-4. Epub — View Citation

Neviaser AS, Hannafin JA. Adhesive capsulitis: a review of current treatment. Am J Sports Med. 2010 Nov;38(11):2346-56. doi: 10.1177/0363546509348048. Epub 2010 Jan 28. — View Citation

Rollason J, McDowell A, Albert HB, Barnard E, Worthington T, Hilton AC, Vernallis A, Patrick S, Elliott T, Lambert P. Genotypic and antimicrobial characterisation of Propionibacterium acnes isolates from surgically excised lumbar disc herniations. Biomed — View Citation

Schneeberger AG, Yian E, Steens W. Injection-induced low-grade infection of the shoulder joint: preliminary results. Arch Orthop Trauma Surg. 2012 Oct;132(10):1387-92. doi: 10.1007/s00402-012-1562-z. Epub 2012 Jun 17. — View Citation

Stirling A, Worthington T, Rafiq M, Lambert PA, Elliott TS. Association between sciatica and Propionibacterium acnes. Lancet. 2001 Jun 23;357(9273):2024-5. doi: 10.1016/S0140-6736(00)05109-6. No abstract available. — View Citation

* Note: There are 16 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in American Shoulder and Elbow Score (ASES)	The American Shoulder and Elbow Score questionnaire was developed to provide a standardized method for evaluating shoulder function and has been validated in patients with any array of shoulder pathologies. ASES results are in the 0 to 100 range, where 0 indicates a worse shoulder condition and 100 indicates best shoulder condition, so the lower the score, the greater the level of shoulder disability. Transforming the pain and the ADLs domains into the final score relies on the following formulas: Pain = 5 x (10 - Score from question 7)	Baseline and 12 months
Primary	Change in Range of Motion(ROM) Measurements	The ROM measurements will include forward flexion, abduction, external rotation at the side and at 90 degrees abduction, and internal rotation at the side and at 90 degrees abduction recorded by the treating physician at follow up visits	Baseline and 12 months
Secondary	Number of Medical Co-morbidities	number of medical co-morbidities per participant	Baseline
Secondary	Duration of Symptoms	Length of time participants have experienced shoulder symptoms	Baseline
Secondary	Changes in Pain	Number of participants with current dominant symptom and/or dominant symptom with disease onset	Baseline
Secondary	Pain With Sitting	Number of patients that have pain while sitting or have ever had pain while sitting will be recorded using patient-reported survey and review of the patient's electronic medical record in Epic.	Baseline
Secondary	Stiffness	Number of participants with current dominant symptom and/or dominant symptom with disease onset	Baseline