Antibiotics as a Treatment for RA?

In a recent post on the rheumatoidarthritis.net Facebook page, a person mentioned that they had been treated for RA with a long-term antibiotic. This fosters an interesting, oft-neglected, scantily researched, and misunderstood treatment option. It is grounded in the idea that bacteria are a causative agent of rheumatoid arthritis. In an earlier post, I discussed the three currently accepted hypothesized causes of RA – 1. an environmental trigger, 2. a genetic susceptibility, and 3. a so-called “leaky gut”. The environmental trigger could apply to the notion that bacteria actually cause RA.

The germ theory of disease – the idea that diseases are caused by microorganisms such as bacteria and viruses – was hypothesized by Louis Pasteur[1] and further described by Robert Koch via his Postulates.[2] While not applicable to all diseases, the theory has been successfully applied to a myriad of diseases leading to amazing treatments, cures, and vaccines in this modern scientific era.

Microorganisms, primarily bacteria, have been hypothesized as a cause of rheumatoid arthritis for years. In fact, some early treatments of RA included antibiotics and similar drugs. Sulphasalazine is one such drug and is still prescribed for RA today. But most scientists believe that no bacteria can be directly linked to triggering rheumatoid disease. Recently, scientists from Harvard University and New York University reported research on mice that demonstrated a relationship between the presence of a common bacteria found in the gut and an immune response leading to arthritis.[3] [4] Mice genetically susceptible to autoimmune arthritis were raised in germ-free environments. They demonstrated a lack of arthritic symptoms. The mice were then exposed to a single type of gut bacterium and they immediately began to show symptoms of arthritis. They also found that a certain type of T cell connected to the production of arthritis-causing antibodies was connected to the presence of bacteria. The researchers argued that the mice didn’t “catch” arthritis from bacteria, but that there’s an interaction between the genetic make-up of the mouse and the autoimmune response to bacteria.

One small group of primitive bacteria called mycoplasmas have also been implicated as a causative agent of various diseases generally[5] and RA specifically.[6] These primitive bacteria don’t have cell walls and only live inside the body of another organism as a parasite. They are extremely hard to isolate in people but one set of researchers examining mycoplasmas argued that a large proportion of RA patients have mycoplasma infections.[7] While mycoplasmas may be present in RA patients, this does not prove a direct cause and effect link between these bacteria and RA. Never the less, some researchers argue for further investigation in order to develop possible treatment options.[8]

If bacteria are linked to RA, then antibiotic therapy would logically follow suit. The tetracycline family of antibiotics, which are effective in treating mycoplasmas, is proposed for antibiotic protocol therapy. The most commonly used tetracycline antibiotic proposed for treating RA is minocycline. Some studies show that patients given antibiotic protocol did not show benefit.[9] [10] [11] Other studies demonstrate a reduction in RA symptoms.[12] [13] Two fairly recent reviews of controlled experimental studies on the efficacy of the antibiotic tetracycline family revealed mixed results leading to insufficient conclusions.[14] [15] The exact reason why antibiotics may impact RA is not fully understood but it may include antibiotics killing off bacteria that are causing RA or it may simply be that antibiotics cause a reduction of inflammatory cytokines.[16] The scientific evidence for the use of at least the tetracycline family of antibiotics remains unclear at this time.

Antibiotic protocols (AP) are not widely espoused by official medical rheumatology medical societies and non-profit arthritis organizations. In spite of this, there are several groups devoted to antibiotic treatments for autoimmune diseases and a small number of rheumatologists will prescribe it.

What does this mean for those of us with RA? Probably not much for the immediate future. We can’t live in germ-free environments like the mice in the study. A general wiping out of bacteria in the gut would wreck havoc on the digestive system and current antibiotic treatments don’t work for everyone with RA. But perhaps this research will spark more attention and funding on these issues leading to potential discoveries of causes of autoimmune diseases leading to the development of effective treatments.

The gut bacteria/genetics combination recently discovered shows the most promise. But I suspect that any resultant treatments from this line of research – many years down the line – are not likely to be generic, whole body administration of antibiotics. They are more likely to be genetic-based treatments designed to impact some biochemical process connected with bacteria’s impact on the immune system.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The RheumatoidArthritis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
[1] http://www.accessexcellence.org/RC/AB/BC/Louis_Pasteur.php [2] http://www.medterms.com/script/main/art.asp?articlekey=7105 [3] http://somvweb.som.umaryland.edu/absolutenm/templates/?a=837&z=2 [4] http://cbdm.hms.harvard.edu/assets/Publications/2010/JoyceWImmunity.pdf [5] http://microbewiki.kenyon.edu/index.php/Mycoplasma [6] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2433307/ [7] http://www.ncbi.nlm.nih.gov/pubmed/10402069?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum [8] http://www.sciencedirect.com/science/article/pii/S0006291X08003124 [9] http://onlinelibrary.wiley.com/doi/10.1002/art.1780140607/abstract [10] http://www.jrheum.org/content/28/9/1967.short [11] http://www.ncbi.nlm.nih.gov/pubmed/8434246 [12] http://www.annals.org/content/122/2/81.full [13] http://www.okmicro.co.jp/Abt/MinocyclineERA1.pdf [14] http://www.formularymonographs.com/PDF/fandc-olf5026.pdf [15] http://www.jrheum.org/content/30/10/2112.abstract [16] http://www.formularymonographs.com/PDF/fandc-olf5026.pdf

Comments

View Comments (13)
  • Karmel
    5 years ago

    Andrew….In my mind I am wondering what, ingredient or mechanism in the antibiotics in the large doses (that work for me) have anything to do with stopping inflammation ?

    Has this ever been looked at ….

  • Ecomike
    3 years ago

    I have had RA symptoms (unknown to me at the time) triggered mostly by taking antibiotics for 30 years. I found the name of it to be RA when the trigger symptoms got disabling the last few years. Always took the antibiotic for aggressive bronchitis triggered by aspirating gut contents in acid reflux attacks in my sleep. I think the trigger is in the putrification of the digestive track as the oral antibiotics kill off gut bacteria!!

    That said healthy and unhealthy gut bacteria produce waste products (and what they produce varies as a function of what we eat) that under the right circumstances can trigger immune responses IMHO.

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Couldn’t say. Some researchers argue that some antibiotics have anti-inflammatory properties that may knock down RA temporarily.

  • Karmel
    5 years ago

    Great article. I tried low dose anti-biotic Minocycline/doxycycline I think it was years ago for about 1 year. It did nothing for me.

    Funny though I get pneumonia every few years or so – they put me on intravenous anti-biotics then tablets and sure enough it helps my Rheumatoid and my CRP goes down to 20 !

    My rheumatoid is hereditary in my genes. I think if your Rheumatoid is caused by Lyme the Minocycline may work for you.

    I am hoping our state gets Medical Marijuana oil lawfully as I hear from others with RA works well on inflammation because of its Omega 3/6/9 oils ALA, THC.

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Glad you liked the article! Sorry it didn’t work for you. The results seem to be mixed. Lyme disease, while causing arthritic symptoms similar to RA, is different and can be effectively treated with antibiotics.

  • Josephine LaCascia
    5 years ago

    I have had many infections due to RA effect on immune system. However when antibiotic is administered my symptoms of RA and related effects clear. Am more energized, bloating and fluid levels diminish and I lose weight. However, my RA doctor will not prescribe antibiotics as part of my RA treatment. I am on prednisone and placquenil treatmen. I have been told I have severe RA but I am in sort of remission. I started to have symptoms 40 years ago. Joint Hands and feet affected. In my case I do believe doxycyclene would be helpful. I also suffer from extreme fatigue and must nap once or twice a day.

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Thanks for reading Josephine. I’ve heard similar stories about people being on antibiotics. But the protocol for antibiotics for RA use low dose over a long period of time, many months, and is really unlike the high dose, short term therapy used for treating a bacterial infection.

  • JoAnn Clarke
    5 years ago

    Thank you for your concise, detailed article! I was diagnosed over 20 yrs ago- and wanted to take a different approach after 5 yrs of NSAIDS (which were not working)& 2 yrs of DMARDS– I also researched McPherson Brown, MD’s theory (roadback.com) re: antibiotic treatment-luckily- since I provided my Rheumy with vast info- he was willing to support me and write the RX for Minocycline–It worked fabulously for 4 yrs- then when the Mfg of the timed-release minocycline got their patent for the Biologic-Enbrel-they stopped producing the timed release form -unfortunately- since I could not find it anymore- the regular Minocycline stopped working (my body could not tolerate the reg. mino) the I had to got to Biologics (Enbrel):-( Question: what other Antibiotics would be suitable to try again??

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Hi Joanne, I’m glad you liked the article. I really don’t know much about the potential protocol or antibiotics proposed. The only current one proposed in minocycline. Doxycycline has also been examined. Any of the tetracylcline related antibiotics might be possible. You should talk to your rheumy about it.

  • Kathy P.
    5 years ago

    I can see where Lyme Disease and similar spirochetal organisms could have a dramatic response to antibiotics. You have to remember that Lyme was only relatively recently recognized as being a bacterial infection that causes symptoms very similar to RA. It has only been in the last few years that similar bacterium, which also closely mimic Lyme and RA, have been identified, yet these organisms have been present in the U.S. for much longer than when they recently became prevalent.

    Perhaps if people recognize that their symptoms improve when they are on strong antibiotics for a different infection, then the rheumatologists need to explore antibiotic therapy for those patients at the very least.

    Been there and done this, including 4 of our children and a dog for Lyme Disease.

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Hi Kathy, Lyme disease has been confused with RA for a long time. In fact, many bacterial infections can cause symptoms similar to RA – it’s called reactive arthritis.

  • Carla Kienast
    5 years ago

    Very interesting post, Andrew. Inflammation is part of the body’s standard response to invading organisms — both bacterial and allergic contaminants, so it would follow that antibiotics might provide at least part of the solution. Fingers crossed for more research followed by (one day) a cure.

  • Andrew Lumpe, PhD moderator author
    5 years ago

    Thanks Carla. I hope research is ongoing but unfortunately I suspect that any fruitfulness will come after we’re gone.

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