August 22, 2013
by Gabe Mirkin, MD
There are two major types of arthritis: osteoarthritis,
also called degenerative arthritis, and reactive
arthritis. Osteoarthritis means that cartilage wears
away and doctors don’t have the foggiest idea why and
therefore they have no effective treatment. Doctors
usually prescribe non-steroidal pills that help to
block pain but do not even slow down destruction of
cartilage. Most serious scientists agree that an
infection initiates the reactive arthritises and many
think that the germ is often still there when symptoms
start. Short-term antibiotics are ineffective, but if
antibiotics are started before the joint is destroyed,
they can prevent joint damage.
You are more likely to suffer reactive arthritis when
I) positive blood tests for arthritis; all tests used
to diagnose arthritis are measures of an overactive
II) swelling of the knuckles and middle joints of your
fingers, causing them to look like cigars;
III) a history of a long-standing infection such as a
chronic cough, burning on urination or pain when the
bladder is full, chronic diarrhea and belching and
burning in the stomach; and
IV) pain that starts at an age younger than 50.
Most rheumatologists refuse to treat their rheumatoid
arthritis patients with antibiotics even though several
controlled prospective studies show that minocycline
drops the rheumatoid factor towards zero and helps to
alleviate the pain and destruction of rheumatoid
arthritis. The studies, referenced below, include: 1)
First Netherlands study, 10 patients, J of Rheumatology
1990;17(1):43-46. 2) 2nd Netherlands Study, 80
patients, Arthritis and Rheumatism 1994;37(5):629-636.
3) Israel Study, 18 patients, J of Rheumatology
1992;19(10):1502-1504. 4) U.S.Mira Study, 219 patients,
Annals of Internal Medicine. 1995(Jan15);122(2):81-89.
5) U.S. U of Nebraska Study, 40 patients, Arthritis and
I treat my reactive arthritis patients with Minocycline
100 mg twice a day, (sometimes azithromycin 500 mg
twice a week), but this must still be considered
experimental because most doctors are not yet ready to
accept antibiotics as a treatment. There is also
possibility of a rare serious side effect of lupus.
Many patients do not feel better for the first few
weeks after they start taking minocycline. If a patient
does not feel better after taking 100 mg of minocycline
twice day for 2 months, I add Zithromax 500 mg twice a
week. If the patient does not feel better after taking
the two antibiotics for 6 months, I do add the immune
suppressants that most rheumatologists prescribe. But
as soon as they feel better, I stop the immune
supppressants and continue the antibiotics.
Other papers show that even osteoarthritis may respond
to antibiotics (27). People who have chlamydia in their
joints usually have no antibodies to that germ in their
bloodstream and therefore cannot cure it (30). Reactive
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. This type of arthritis may be triggered by
infection and antibiotics may help to prevent and treat
this joint destruction (1 to 10). Short-term
antibiotics are ineffective (5). Doxycycline may
prevent joint destruction by stabilizing cartilage (3)
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 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. Some people with
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. Some people who get
reactive arthritis may have intestines that 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 reactive
arthritis are more likely to have staph aureus in their
noses (17) and carry higher antibody titre against that
germ (18). Many people with reactive arthritis have had
chronic lung infections, caused by mycoplasma and
chlamydia, prior to getting joint pains(20,21).
Mycoplasma has been found in joint fluid of people with
arthritis (28,29). The treatment of arthritis with
antibiotics is controversial and not accepted by many
doctors; discuss this with your doctor.
1A) O’dell et al. Minocycline therapy for early
rheumatoid arthritis continued efficacy at three years.
Annual meeting of the American College of Rheumatology.
November 9, 1997.
1a) 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.
2) Lancet, July 11, 1992.
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
4) Barbara Tilley, Henry Ford Health Science Center in
Detroit. Annals of Internal Medicine. January 14, 1995.
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.
6) Kloppenburg et al. Minocycline double blind for RA.
Arthritis and Rheumatism 1994;37:629-636.
7) Langevitz et al. RA with Minocycline. J.Rheumatlogy
8) Breedveld et al. J Rheumatology 1990;17:43-46.
9) Good summary in Lancet, 1995(May 27);345:1319-1322.
10) Kloppenburg et al. Minocycline double blind for RA.
Arthritis and Rheumatism 1994;37:629-636.
11) Langevitz et al. RA with Minocycline. J.Rheumatlogy
12) Breedveld et al. J Rheumatology 1990;17:43-46.
13) Good summary in Lancet, 1995(May 27);345:1319-1322.
14) Kloppenburg M et al. Minocycline in Rheumatoid
arthritis. Clin Immunother 1996(Jan);5(1):1-4. 14A)
Keystone et al. Nature Medicine. April, 1995.
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. Annals of the
Rheumatic Diseases 55: 6 (JUN 1996):363-369. 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.
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
Williams. Molecular detection of bacterial DNA in
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17) D Tabarya, WL Hoffman. Staphylococcus aureus nasal
carriage in rheumatoid arthritis: Antibody response to
toxic shock syndrome toxin-1. Annals of the Rheumatic
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18) T Origuchi, K Eguchi, Y Kawabe, I Yamashita, A
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19) M Calguneri, S Kiraz, I Ertenli, M Benekli, Y
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