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