Arthritis treatments

Arthritis Treatments

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
 you have:

 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
 Rheumatism 1997;40(5):842-848.

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

17) D Tabarya, WL Hoffman. Staphylococcus aureus nasal
 carriage in rheumatoid arthritis: Antibody response to
 toxic shock syndrome toxin-1. Annals of the Rheumatic
 Diseases 55: 11 (NOV 1996):823-828.>

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. Annals of the
 Rheumatic Diseases 54: 9 (SEP 1995):713-720.

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.

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.

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.

22) IC Tracey, GM Strand, K Singh, M Macaluso. Survival
 and drug discontinuation analyses in a large cohort of
 methotrexate treated rheumatoid arthritis patients.
 Annals of the Rheumatic Diseases 54: 9 (SEP 1995):708-

23) M Jones, 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.

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.

25) C Wilson, 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.

26) JR Odell, CE Haire, W Palmer, W Drymalski, S Wees,
 K Blakely, M Churchill, PJ Eckhoff, A Weaver, D Doud, N
 Erikson, F Dietz, R Olson, P Maloley, LW Klassen, GF
 Moore. 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.

27) F Blotman, E Maheu, A Wulwik, H Caspard, A Lopez.
 Efficacy and safety of avocado/soybean unsaponifiables
 in the treatment of symptomatic osteoarthritis of the
 knee and hip – A prospective, multicenter, three-month,
 randomized, double-blind, placebo-controlled trial.
 Revue du Rhumatisme 64: 12 (DEC 1997):825-834.

27a) GN Smith, LP Yu, KD Brandt, WN Capello. Oral
 administration of doxycycline reduces collagenase and
 gelatinase activities in extracts of human
 osteoarthritic cartilage. Journal of Rheumatology 25: 3
 (MAR 1998):532-535.

28) T Schaeverbeke, M Clerc, L Lequen, A Charron, C
 Bebear, B Debarbeyrac, B Bannwarth, J Dehais, C Bebear.
 Genotypic characterization of seven strains of
 Mycoplasma fermentans isolated from synovial fluids of
 patients with arthritis. Journal of Clinical
 Microbiology 36: 5 (MAY 1998):1226-1231.

29)TV Poggio, N Orlando, L Galanternik, S Grinstein.
 Microbiology of acute arthropathies among children in
 Argentina: Mycoplasma pneumoniae and hominis and
 Ureaplasma urealyticum. Pediatric Infectious Disease
 Journal 17: 4 (APR 1998):304-308.

30) NZ Wilkinson, GH Kingsley, J Sieper, J Braun, ME
 Ward. Lack of correlation between the detection of
 Chlamydia trachomatis DNA in synovial fluid from
 patients with a range of rheumatic diseases and the
 presence of an antichlamydial immune response.
 Arthritis and Rheumatism 41: 5 (MAY 1998):845-854.)

31) NS Lai, JL Lan. Treatment of DMARDs-resistant
 rheumatoid arthritis with minocycline: a local
 experience among the Chinese. Rheumatology
 International 17: 6 (APR 1998):245-247.

32) GS Alarcon. Minocycline for the treatment of
 rheumatoid arthritis. Rheumatic Disease Clinics of
 North America 24: 3(AUG 1998):489.

33) JG Kuipers, B Jurgenssaathoff, A Bialowons, J
 Wollenhaupt, L Kohler, H Zeidler. Detection of
 Chlamydia trachomatis in peripheral blood leukocytes of
 reactive arthritis patients by polymerase chain
 reaction. Arthritis and Rheumatism 41: 10 (OCT

34) M Wuorela, K Granfors. Infectious agents as
 triggers of reactive arthritis. American Journal of the
 Medical Sciences 316:4(OCT 1998):264-270.

34a) S Nikkari, K Rantakokko, P Ekman, T Mottonen, M
 Leirisalorepo, M Virtala, L Lehtonen, J Jalava, P
 Kotilainen, K Granfors, P Toivanen. Salmonella-
triggered reactive arthritis – Use of polymerase chain
 reaction, immunocytochemical staining, and gas
 chromatography mass spectrometry in the detection of
 bacterial components from synovial fluid. Arthritis and
 Rheumatism 42: 1 (JAN 1999):84-89.

35) E Veillard, P Guggenbuhl, S Bello, F Lamer, G
 Chales. Reactive oligoarthritis in a patient with
 Clostridium difficile pseudomembranous colitis – Review
 of the literature. Revue du Rhumatisme 65: 12 (DEC

36) R Oliker, BA Cunha. Streptococcus pneumoniae septic
 arthritis and osteomyelitis in an HIV-seropositive
 patient. Heart & Lung 28: 1(JAN-FEB 1999):74-76.

37) AA Butt, A Janney. Arthritis due to Mycobacterium
 fortuitum. Scandinavian Journal of Infectious Diseases
 30: 5(1998):525-527.37) JR Odell. Is there a role for
 antibiotics in the treatment of patients with
 rheumatoid arthritis? Drugs, 1999, Vol 57, Iss 3, pp

38)SM Cooper.A perspective on the use of minocycline
 for rheumatoid arthritis.Jcr – Journal of Clinical
 Rheumatology, 1999, Vol 5, Iss 4, pp 233-237.

39)DE Trentham.A perspective on the use of minocycline
 for rheumatoid arthritis – Commentary.Jcr – Journal of
 Clinical Rheumatology, 1999, Vol 5, Iss 4, pp 237.

40)DE Furst.A perspective on the use of minocycline for
 rheumatoid arthritis – Commentary.Jcr – Journal of
 Clinical Rheumatology, 1999, Vol 5, Iss 4, pp 237-238.

41) E Markerhermann, T Hohler. Pathogenesis of human
 leukocyte antigen B27-positive arthritis: Information
 from clinical materials. Rheumatic Disease Clinics of
 North America 24: 4(NOV 1998):865.

42) RD Inman, JA WhittumHudson, HR Schumacher, AP
 Hudson. Chlamydia and associated arthritis. Current
 Opinion in Rheumatology, 2000, Vol 12, Iss 4, pp 254-

43) TL Moore. Parvovirus-associated arthritis. Current
 Opinion in Rheumatology, 2000, Vol 12, Iss 4, pp 289-

44) D Buskila. Hepatitis C-associated arthritis.
 Current Opinion in Rheumatology, 2000, Vol 12, Iss 4,
 pp 295-299.

45) A Toivanen, P Toivanen. Reactive arthritis. Current
 Opinion in Rheumatology, 2000, Vol 12, Iss 4, pp 300-

46) J Haier, M Nasralla, AR Franco, GL Nicolson.
 Detection of mycoplasmal infections in blood of
 patients with rheumatoid arthritis.Rheumatology, 1999,
 Vol 38, Iss 6, pp 504-509.Nicolson GL, Inst Mol Med,
 15162 Triton Lane, Huntington Beach,CA 92649 USA.

47) M vanderHeijden, B Wilbrink, LM Schouls, JDA
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 mycobacteria in joint samples from patients with
 arthritis using a genus-specific polymerase chain
 reaction and sequence analysis. Rheumatology, 1999, Vol
 38, Iss 6, pp 547-553.

48) Mayo Clinic Proceedings 2000(Feb);75(2):144-147.

49) S Johnson, D Sidebottom, F Bruckner, D Collins.
 Identification of Mycoplasma fermentans in synovial
 fluid samples from arthritis patients with inflammatory
 disease. Journal of Clinical Microbiology, 2000, Vol
 38, Iss 1, pp 90-93.

50) M Rudwaleit, J Braun, J Sieper. Treatment of
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51) JR ODell, KW Blakely, JA Mallek, PJ Eckhoff, RD
 Leff, SJ Wees, KM Sems, AM Fernandez, WR Palmer, LW
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52) Persistent Chlamydiae and chronic arthritis.
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Checked 5/3/14