TREAT RHEUMATOID ARTHRITIS EARLY WITH ANTIBIOTICS.html

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TREAT RHEUMATOID ARTHRITIS EARLY WITH ANTIBIOTICS

TREAT RHEUMATOID ARTHRITIS EARLY WITH ANTIBIOTICS

Report #7013; 8/1/97

Exciting new research shows that in the future, rheumatoid arthritis may be

treated with antibiotics as soon as a physician suspects that disease. Once

joints are destroyed, no available treatment heals cartilage.

Rheumatoid arthritis is characterized by pain in many muscles and joints and is

thought to be caused by a person's own antibodies and cells attacking and

destroying cartilage in joints. Several recent studies show that rheumatoid

arthritis may be triggered by infection and that antibiotics may help to prevent

and treat this joint destruction (1 to 10). Antibiotics are effective in

controlling the symptoms of rheumatoid arthritis (6,7,8,9,10,11,12,13,14,14A,26)

and higher doses are more effective (1). Short-term antibiotics are ineffective

(5). Doxycycline may prevent joint destruction by stabilizing cartilage (3) in

addition to helping clear a germ from the body.

What are the theories on how germs cause arthritis? When a germ gets into your

body, you manufacture cells and proteins called antibodies that attach to and

kill that germ. Sometimes, the germ has a surface protein that is similar to the

surface protein on your cells. Then, not only do the antibodies and cells attach

to and kill the germ, they also attach to and kill your own cells that have the

same surface membranes. People with rheumatoid arthritis have high antibody

titre to E. Coli, a bacteria that lives normally in everyone's intestines (15).

It has the same surface protein as many cells in your body (15). Normal

intestines do not permit E. Coli to get into your bloodstream. The people who

get rheumatoid arthritis may be those whose intestines allow E. coli to pass

into the bloodstream and cause the immune reaction that destroys muscles and

joints. The same type of reaction applies to several other bacteria and viruses

that can pass into your bloodstream (15A). Venereal diseases, such as gonorrhea,

chlamydia and ureaplasma have been found in the joint fluids of many people with

arthritis (16). People with rheumatoid arthritis are more likely to have staph

aureus in their noses (17) and carry higher antibody titer against that germ

(18) and patients with a type of arthritis, called Behcet's, cleared when they

were given monthly injections of long-acting penicillin (19). Some people with

rheumatoid arthritis have had chronic lung infections, caused by mycoplasma and

chlamydia, prior to getting rheumatoid arthritis (20,21).

Most rheumatologist treat rheumatoid arthritis with immune suppressants. The

vast majority of rheumatologists do not treat rheumatoid arthritis with

antibiotics, but I feel that in the future, there will be enough data for them

to recommend doxycycline 100 mg twice a day or azithromycin 500 mg twice a week

as soon as the disease is suspected, before joints are damaged permanently.

I'm Dr. Gabe Mirkin on fitness.

a.. 1) Higher doses more effective. M Kloppenburg, H Mattie, N Douwes, BAC

Dijkmans, FC Breedveld. Minocycline in the treatment of rheumatoid arthritis:

Relationship of serum concentrations to efficacy. Journal of Rheumatology 22: 4

(APR 1995):611-616.

b.. 2) Lancet July 11, 1992.

c.. 3) AA Cole, S Chubinskaya, LJ Luchene, K Chlebek, MW Orth, RA Greenwald,

KE Kuettner, TM Schmid: Doxycycline disrupts chondrocyte differentiation and

inhibits cartilage matrix degradation.(39 references and summary) Arthritis and

Rheumatism 37: 12 (DEC 1994):1727-1734.

d.. 4) Barbara Tilley, Henry Ford Health Science Center in Detroit. ls of

Internal Medicine. January 14, 1995.

e.. 5) Short-term antibiotic treatment has no effect in manifest ReA, whereas

a tendency to improvement has been seen with treatment over months, at least

after chlamydia infection. B Svenungsson. International Journal of STD & AIDS 6:

3:(MAY-JUN 1995):156-160.

f.. 6) Kloppenburg et al. Minocycline double blind for RA. Arthritis and

Rheumatism 1994;37:629-636.

g.. 7) Langevitz et al. RA with Minocycline. J.Rheumatlogy 1992;19:1502-1504.

h.. 8) Breedveld et al. J Rheumatology 1990;17:43-46.

i.. 9) Good summary in Lancet 1995(May 27);345:1319-1322.

j.. 10) Kloppenburg et al. Minocycline double blind for RA. Arthritis and

Rheumatism 1994;37:629-636.

k.. 11) Langevitz et al. RA with Minocycline. J.Rheumatlogy 1992;19:1502-1504.

l.. 12) Breedveld et al. J Rheumatology 1990;17:43-46.

m.. 13) Good summary in Lancet 1995(May 27);345:1319-1322.

n.. 14) Kloppenburg M et al. Minocycline in Rheumatoid arthritis. Clin

Immunother 1996(Jan);5(1):1-4.

o.. 14A) Keystone E. et al. Nature Medicine. April, 1995.

p.. 15) S Aoki, K Yoshikawa, T Yokoyama, T Nonogaki, S Iwasaki, T Mitsui, S

Niwa. Role of enteric bacteria in the pathogenesis of rheumatoid arthritis:

Evidence for antibodies to enterobacterial common antigens in rheumatoid sera

and synovial fluids. ls of the Rheumatic Diseases 55: 6 (JUN 1996):363-369.

q.. 15A) LB Siegel, EP Gall. Viral infection as a cause of arthritis. American

Family Physician 54: 6 (NOV 1 1996):2009-2015. (parvovirus, chronic hepatitis B

virus and hepatitis C) virus infections.

r.. 16) F Li, R Bulbul, HR Schumacher, T Kieberemmons, PE Callegari, JM

Vonfeldt, D Norden, B Freundlich, B Wang, V Imonitie, CP Chang, I Nachamkin, DB

Weiner, WV . Molecular detection of bacterial DNA in venereal-associated

arthritis. Arthritis and Rheumatism 39: 6 (JUN 1996):950-958.

s.. 17) D Tabarya, WL Hoffman. Staphylococcus aureus nasal carriage in

rheumatoid arthritis: Antibody response to toxic shock syndrome toxin-1. ls

of the Rheumatic Diseases 55: 11 (NOV 1996):823-828.

t.. 18) T Origuchi, K Eguchi, Y Kawabe, I Yamashita, A Mizokami, H Ida, S

Nagataki. Increased levels of serum IgM antibody to staphylococcal enterotoxin B

in patients with rheumatoid arthritis. ls of the Rheumatic Diseases 54: 9

(SEP 1995):713-720.

u.. 19) M Calguneri, S Kiraz, I Ertenli, M Benekli, Y Karaarslan, I Celik. The

effect of prophylactic penicillin treatment on the course of arthritis episodes

in patients with Behcet's disease: A randomized clinical trial. Arthritis and

Rheumatism 39: 12 (DEC 1996):2062-2065.

v.. 20) J Despaux, JC Polio, E Toussirot, JC Dalphin, D Wendling. Rheumatoid

arthritis and bronchiectasis - A retrospective study of fourteen cases. Revue du

Rhumatisme 63: 11 (DEC 1996):801-808.

w.. 21) H Lena, B Desrues, A Lecoz, C Belleguic, ML Quinquenel, J Kernec, G

Chales, P Delaval. Rheumatoid arthritis and bronchial dilatation: A little

recognised association. Revue Des Maladies Respiratoires 14: 1 (JAN 1997):37-43.

x.. 22) IC Tracey, GM Strand, K Singh, M Macaluso. Survival and drug

discontinuation analyses in a large cohort of methotrexate treated rheumatoid

arthritis patients. ls of the Rheumatic Diseases 54: 9 (SEP 1995):708-712.

y.. 23) M , D Symmons, J Finn, F Wolfe. Does exposure to

immunosuppressive therapy increase the 10 year malignancy and mortality risks in

rheumatoid arthritis? A matched cohort study. British Journal of Rheumatology

35: 8 (AUG 1996):738-745.

z.. 24) EM Veys, CJ Menkes, P Emery. A randomized, double-blind study

comparing twenty-four-week treatment with recombinant interferon-gamma versus

placebo in the treatment of rheumatoid arthritis. (Doesn't work) Arthritis and

Rheumatism 40: 1 (JAN 1997):62-68.

aa.. 25) C , A Thakore, D Isenberg, A Ebringer. Correlation between

anti-Proteus antibodies and isolation rates of P-mirabilis in rheumatoid

arthritis. Rheumatology International 16: 5 (JAN 1997):187-189.

ab.. 26) JR Odell, CE Haire, W Palmer, W Drymalski, S Wees, K Blakely, M

Churchill, PJ Eckhoff, A Weaver, D Doud, N son, F Dietz, R Olson, P Maloley,

LW Klassen, GF . Treatment of early rheumatoid arthritis with minocycline

or placebo: Results of a randomized, double-blind, placebo-controlled trial.

Arthritis and Rheumatism 40: 5 (MAY 1997):842-848. In patients with early

seropositive RA, therapy with minocycline is superior to placebo.

ac.. 27) C Bologna, P Viu, MC Picot, C nsen, J Sany. Long-term follow-up

of 453 rheumatoid arthritis patients treated with methotrexate: An open,

retrospective, observational study. British Journal of Rheumatology 36: 5 (MAY

1997):535-540. 59.3% had side-effects. A Ritchie's index less than or equal to

10, a lower polymorphonuclear cell count and the absence of RF were predictive

of side-effects. The probability of being on MTX at 5 yr was 73%. This study

confirms the high efficacy of MTX in RA.

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