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The Hidden Epidemic-2

By Gabe Mirkin M.D.

Return to treatment with antibiotics

Reactive and Rheumatoid Arthritis

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Most rheumatologist refuse to treat their rheumatoid arthritis patients with antibiotics even though all five controlled prospective studies conducted to date show that minocycline drops the rheumatoid factor towards zero and helps to alleviate the pain and destruction of cartilage of rheumatoid arthritis. There are two major types of arthritis: osteoarthritis, also called degenerative arthritis; and reactive arthritis, which includes rheumatoid arthritis. Osteoarthritis means that cartilage wears away and doctors donít have the foggiest idea why. There is no effective treatment. Doctors usually prescribe non-steroidal pills that help to block pain but do not stop or even slow down the destruction of cartilage.

Most scientists agree that an infection initiates rheumatoid and other reactive arthritides and most think that the germ is still there when the symptoms start. Short-term antibiotics are ineffective, but if antibiotics are started before the joint is destroyed, many months and years of antibiotics are effective in reducing and preventing joint damage. Your arthritis is likely to be classified as reactive arthritis if you have: 1) positive blood tests for arthritis (all tests used to diagnose arthritis are measures of an overactive immunity); 2) swelling of the knuckles and middle joints of your fingers, causing them to look like cigars; 3) a history of a long-standing infection such as a chronic cough, burning on urination or pain when the bladder is full, chronic diarrhea, burning in the stomach, throat or nose, or gum disease; and 4) symptoms that begin before age 50.

Rheumatoid arthritis is characterized by pain in many muscles and joints and is thought to be caused by a personís own antibodies and cells and cells attacking and destroying cartilage in joints. Rheumatoid arthritis may be triggered by infection and antibiotics may help to prevent and treat this joint destruction. Most rheumatologists treat rheumatoid arthritis with immune suppressants, which are extraordinarily expensive, highly toxic and, in my opinion, far less effective in controlling rheumatoid arthritis than antibiotics. Antibiotics are effective in controlling the symptoms of rheumatoid arthritis and higher doses are more effective. Short-term antibiotics are ineffective. Doxycycline may prevent joint destruction by stabilizing cartilage in addition to clearing the germ from the body.

How do 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 in your cells. Then, not only do the antibodies 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 titer to E. Coli, a bacteria that lives normally in everyoneís intestines. It has the same surface protein as many cells in your body. 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 blood stream 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 blood stream. Venereal diseases, such as gonorrhea, chlamydia, mycoplasma, and ureaplasma have been found in the joint fluid of many people with arthritis. People with rheumatoid arthritis are more likely to have staph aureus in their noses and carry higher antibody titer against that germ. Many people with rheumatoid arthritis have had chronic lung infections, caused by mycoplasma and chlamydia, prior to getting rheumatoid arthritis.

I have seen antibiotics reduce high rheumatoid factors to zero, alleviate symptoms and stop the progressive destruction of cartilage in joints. The lead paper at a recent meeting of the American Academy of Rheumatology showed that Minocycline is the safest and least expensive drug that effectively stops progressive joint damage caused by rheumatoid arthritis. It is most effective when given before extensive cartilaginous damage occurs. I treat my reactive arthritis patients with Minocycline 100 mg twice a day, (sometimes azithromycin 500-mg twice a week). This must still be considered experimental because most doctors are not yet ready to accept antibiotics as treatment. There is also concern about a rare, serious side effect of lupus. However, other papers show that even osteoarthritis may respond to antibiotics.

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