Rheumatoid arthritis (RA) is the most common of several autoimmune diseases that primarily affect the joints.
It is characterized by abnormal inflammatory responses that damage the synovial lining of the joints and other tissues. Components of the immune system mistakenly identify normal body tissues as potentially harmful organisms and attack them causing substantial collateral damage.
This results in joint pain, swelling and permanent damage to joint cartilage and the underlying bone. Other parts of the body such as the blood, nerves and heart may also be affected in severe cases.
Moreover the conventional drugs used in the treatment of RA often cause as many health problems as the disease itself. Bone marrow and immune suppression, liver toxicity, osteoporosis and stomach ulcer are some of the common side effects produced by these drugs.
While antibiotics also have potential side effects, they are generally fewer and milder than those associated with the conventional drugs used in the treatment of RA.
TYPES OF INFECTIONS CAUSING RHEUMATOID ARTHRITIS
Most scientists agree that infections initiate the abnormal inflammatory response seen in RA patients. The theory is that the immune system reacts to an infection of some sort and then becomes confused between the antigens on the pathogenic organism and similar antigens on normal body tissues. The conventional view is that the infection is only a transient trigger of the autoimmune response and not a persistent factor underlying its chronic progression.
However, countless studies have shown that there are indeed a number of chronic, "hidden" infections underlying RA. Some of the pathogenic organisms have been found in the joints of RA patients but mostly these low-grade infections occur in areas such as the genito-urinary tract, mouth or intestines. They work indirectly from these areas by sustaining the aberrant inflammatory response so characteristic of RA.
Mycoplasma, chlamydia, E.coli, and proteus are all bacteria that are capable of causing the low-grade, asymptomatic urinary tract infections that underlie RA. Porphyromonas gingivalis is a bacteria that causes gingivitis and periodontitis and also has a strong association with RA.
Although lab tests often confirm the presence of one or more of these infections, negative results do not preclude an infectious cause of an individual's disease.
Because many of the infections underlying RA are so difficult to find, even those patients who do not have positive lab tests should be treated with antibiotics.
ANTBIOTICS USED TO TREAT RHEUMATOID ARTHRITIS
For many years the mainstay of antibiotic treatment for RA has been minocycline or other tetracycline antibiotics such as doxycycline. These of antibiotics are still very useful as they also have anti-inflammatory properties and stimulate the regeneration of damaged joint cartilage.
However many bacteria have developed resistance to the tetracyclines and it is now common practice to use combinations with other antibacterials such as azithromycin, clindamycin, metronidazole, levofloxacin and others.
RESULTS OF ANTIBIOTIC TREATMENT FOR RA
Patients may notice improvements in their symptoms anywhere from days, weeks or months, depending on how long they have the disease. They must also expect to remain on the antibiotics for several months to over a year until full remission occurs.
Information from doctors who have used this treatment for many years show that at least 80% of patients benefit from this relatively simple therapeutic modality.
WHY IS THIS EFFECTIVE TREATMENT NOT WIDELY AVAILABLE
There are two reasons for the delay in getting this "new" treatment more widely accepted:
Firstly there is the research "time-lag effect" ? the period it takes from the time a new medical discovery is made until it is accepted and implemented by the majority of doctors. This interval may be over 20 years long.
Secondly, in spite of extensive evidence that certain organisms are associated with RA and other autoimmune diseases, no one specific organism has been shown to be responsible for this group of diseases. This is because autoimmune diseases comprise a spectrum of overlapping conditions that can be caused by several types of microbes located in various parts of the body.
REFERENCES
1. Effects of clarithromycin in patients with active rheumatoid arthritis, Curr Med Res Opin. 2007 Mar;23(3):515-22
2. Levofloxacin treatment in patients with rheumatoid arthritis receiving methotrexate, M Ogrendik, South Med J. 2007 Feb;100(2):135-9.
3. Single-blind randomized trial of combination antibiotic therapy in rheumatoid arthritis, Gompels LL, Smith A, Charles PJ, Rogers W, Soon-Shiong J, Mitchell A, Dore C, Taylor PW, Mackworth-Young CG. J Rheumatol. 2006 Feb;33(2):224-7.
4. Treatment of early seropositive rheumatoid arthritis: Doxycycline plus methotrexate versus methotrexate alone. O'dell JR, Elliott JR, Mallek JA, Mikuls TR, Weaver CA, Glickstein S, Blakely KM, Hausch R, Leff RD, , Arthritis Rheum. 2006 Feb;54(2):621-7. University of Nebraska Medical Center, Omaha.
5. Treatment of early seropositive rheumatoid arthritis: a two-year, double-blind comparison of minocycline and hydroxychloroquine. O'Dell JR, Blakely KW, Mallek JA, Eckhoff PJ, Leff RD, Wees SJ, Sems KM, Fernandez AM, Palmer WR, Klassen LW, Paulsen GA, Haire CE, Moore GF - Arthritis & Rheumatism 2001 Oct;44(10):2235-41
