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Antibiotics as a Treatment for RA?

Posted Aug 29 2010 9:41pm
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A Bacterial Cause of RA?

Using the Germ Theory of Disease (discussed in my previous post ), microorganisms such as bacteria have been suspected for many years as being the cause of RA. But a direct link has never been found. Lately, some researchers found evidence that common bacteria found in the gut, along with genetics, may serve as triggers of autoimmune diseases. [i]

Another small group of primitive bacteria called mycoplasmas have also been implicated as a causative agent of various diseases generally [ii] and RA specifically. [iii] These bacteria don’t have cell walls and only live inside the body of another organism as a parasite (plant, animal, etc.). They are extremely hard to isolate in people but one set of researchers examining mycoplasmas stated,

The results suggest that a high percentage of RA patients have systemic mycoplasmal infections. [iv]

While mycoplasmas may be present in patients, this does not prove a direct cause and effect link between these bacteria and RA. Never the less, some researchers state that,

“Further study is necessary to prove that M. fermentans is a causative microorganism of RA; however, the new mechanisms of disease pathogenesis provides hope for the development of effective and safe immunotherapeutic strategies…” [v]

Antibiotic Protocol Therapy

If bacteria are linked to RA, then antibiotic therapy would logically follow suit. The tetracycline family of antibiotics, which is effective in treating mycoplasmas, is proposed for antibiotic protocol therapy. The most commonly used tetracycline antibiotic used in treating RA is minocycline.

Some studies show that patients given antibiotic protocol did not show benefit. [vi] [vii] [viii] Other studies demonstrate a reduction in RA symptoms. [ix] [x] Two fairly recent reviews of controlled experimental studies on the efficacy of the antibiotic tetracycline family revealed mixed results leading to insufficient conclusions. [xi] [xii] 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. [xiii] The scientific evidence for the use of at least the tetracycline family of antibiotics is unclear at this time.

Antibiotic protocols (AP) are not widely espoused by official medical rheumatology societies and non-profit arthritis organizations. In spite of this, there are several groups devoted to antibiotic treatments for autoimmune diseases and some rheumatologists will prescribe AP (see http://www.roadback.org/ , http://rheumatic.org/ , http://www.rheumaticsupport.net/index.php ).

In conclusion,

  1. Bacteria are not yet clearly linked as a direct cause of RA. Mycoplasmas may be one group of bacteria eventually implicated in autoimmune diseases.
  2. Bacteria in the gut, along with genetics, may serve as a trigger for autoimmune diseases.
  3. The efficacy of antibiotic treatments for RA is unclear at this time.
  4. More research is needed to pinpoint the cause(s) of RA. All possible causes, including bacteria, should continue to be investigated.

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 .

Personally, if I ever get to the spot where the spectrum of biologic and other current RA treatments don’t work for me, I will definitely raise the topic of antibiotic protocol with my rheumatologist. In the meantime, you can read about one person’s experience with antibiotic protocol at her blog http://rheumforgod.wordpress.com/ap-diary/ .

Disclaimer: This short post is not meant to serve as an exhaustive review of the topic and related studies. My personal goal is to learn a little, share information with others, and keep discussions ongoing. I am neither promoting nor refuting the use antibiotic treatments for RA.


[i] http://cbdm.hms.harvard.edu/assets/Publications/2010/JoyceWImmunity.pdf

[ii] http://microbewiki.kenyon.edu/index.php/Mycoplasma

[iii] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2433307/

[iv] http://www.ncbi.nlm.nih.gov/pubmed/10402069?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

[v] http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WBK-4RXK6BC-3&_user=10&_coverDate=05%2F02%2F2008&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1444535875&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=40fa71c12bc87f80e946de33d9b718d2&searchtype=a

[vi] http://onlinelibrary.wiley.com/doi/10.1002/art.1780140607/abstract

[vii] http://www.jrheum.org/content/28/9/1967.short

[viii] http://www.ncbi.nlm.nih.gov/pubmed/8434246

[ix] http://www.annals.org/content/122/2/81.full

[x] http://www.okmicro.co.jp/Abt/MinocyclineERA1.pdf

[xi] http://www.formularymonographs.com/PDF/fandc-olf5026.pdf

[xii] http://www.jrheum.org/content/30/10/2112.abstract

[xiii] http://www.formularymonographs.com/PDF/fandc-olf5026.pdf


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