Rheumatoid Arthritis

Rheumatoid arthritis (RA) can present as an acute illness (although it generally becomes chronic) which most often causes inflammation of the joints, muscles, and tissues. RA is systemic in nature so that the entire body is susceptible to the disease. Therefore, besides joints, this disease can also affect the lungs, skin, blood vessels, eyes, and other organs. In its most severe forms, RA causes joint deformation and is extremely painful and debilitating.

In addition to the pain and inflammation, symptoms may include a lack of memory and inability to concentrate, generalized weakness, fatigue, depression, and anemia. RA affects all ages and both sexes, although it affects women more often than men.

SYMPTOMS

Physical manifestations may include fatigue, lethargy, loss of appetite, swollen joints or limbs, stiffness in joints, anemia, spontaneous remissions or flare-ups for unknown reasons, primary synovitis (inflammation of the membrane that lines  joints) destruction of tissue or cartilage.

Mental aspects may include depression, memory loss, mood swings, loss of concentration.

Laboratory indicators may include unresponsive anemia, elevated SED rate (shows inflammation), and an elevated rheumatoid factor.

CONVENTIONAL TREATMENTS

Conventional treatment of RA are a combination of exercise, protection of joints,  and medication. The drugs used in treatment usually provide only symptomatic relief or disease-modifying activity with increasingly high risks of side effects. They do not address a cause.

The benefit of these drugs (gold, penicillamine, methotrexate, etc.) is greatly reduced over a period of time, allowing for a resurgence of the rheumatoid disease and decreasing effects from the treatment.

Although the cause of rheumatoid arthritis is unknown, there is growing evidence that it may be an organism. Ulcers were once thought to be caused by stress; now we know a bacteria, H. pylori, is the culprit. Just as we were mistaken by ulcers, we may also be missing the cause of RA. RA may not be curable, but it is treatable and in most cases controllable. Curiously, with RA, not curable has sunk into the psyche of both patients and physicians as not treatable, with the expected deterioration in [disease] outcome. To make a difference, we need to reestablish a scientific model for rheumatoid arthritis treatment that can be both understood and respected. (Bensen) We think antibiotic therapy fits this description.

OSTEOARTHRITIS

Although osteoarthritis is a different disease from rheumatoid arthritis, and is probably not associated with an organism, Dr. Kenneth Brandt, a rheumatologist at the University of Indiana, has been testing the antibiotic doxycycline for osteoarthritis and getting some very good results. This is one of the antibiotics which work well with RA.

EVIDENCE FOR ANTIBIOTIC THERAPY

The Netherlands first study: Half of the efficacy variables improved significantly after 4 weeks of therapy. At the end of the study, all variables were significantly changed compared to their pretreatment values. (Breedveld)

The Netherlands 2nd study: The efficacy of tetracyclines in arthritis and their limited toxicity, even when long courses are used, prompted consideration of these drugs as a possible new treatment for RA The trail was performed on patients with advanced, even intractable RA. Side effects may be considered mild in relation to other established DMARDS. Minocycline appears to have beneficial properties in RA, especially when laboratory parameters of disease activity are considered. (Kloppenburg et al)

Israeli study: Statistically significantly improvement was noted in almost all variables of disease activity. Of the 12 patients completing the study, 25% had complete remission, 25% had more than 50% improvement and the other 50% had moderate improvement (> 25%). (Langevitz et al)

United States NIH/ MIRA trial: Benefit became evident after 12 weeks of therapy, and the proportion of patients treated with minocycline showing improvement continued to increase through week 48 of the study.  Differences favoring minocycline over placebo were observed in the primary outcome measures. (Tilley)

Unites States Univ. of Nebraska: 18 of the 46 patients who were enrolled met the 50% improvement criteria at 3 months, and maintained at least 50% improvement for 6 month with no significant drug toxicity (5 out of 18 in remission after 1 year of minocycline therapy).  Investigators believe results are even more remarkable because the study design almost certainly decreased the chances of finding a positive effect.  Data from the study and others suggest that maximum benefit of minocycline does not occur until after 1 year of therapy. (O'Dell)

ANTIBIOTIC THERAPY

Developed and used successfully for over 50 years by the late rheumatologist Thomas McPherson Brown MD, antibiotic therapy is treatment aimed at the cause of arthritis, not just the symptoms. It is based on the belief that RA is triggered by a microorganism like mycoplasma, similar in some ways to both viruses and bacterium, but much smaller.

Treatment is primarily with tetracycline antibiotics which have generally proven to be safe over many years of use. Oral tetracycline, doxycycline, minocycline and clindamycin (intravenous or injections) are used although now there are additional options besides clindamycin.  As the antibiotics suppress and destroy the mycoplasma, the patient's own defense system, strengthened by the antibiotics, "kicks in" and disease activity decreases. A gradual improvement is often noticed and symptoms can begin to reverse. If treatment is begun early enough, patients are generally able to return to normal activity with little or no permanent damage.

Current research has shown minocycline to be both safe and effective For RA, validating Dr. Brown's findings. Antibiotic therapy has been used safely by decades by acne patients, as well as arthritis patients. Although some patients are able to discontinue the medication eventually, others must continue treatment to maintain remission. We know several patients who are in their third decade of successful treatment with no ill effects.

Although remissions are rare on traditional therapies, they are not unheard of, but with antibiotic therapy, reversals and remissions are not uncommon.

THOMAS MCPHERSON BROWN, MD

Dr. Thomas McPherson Brown was the founder and chairman of the Arthritis Institute. He was a world-renowned leader in arthritis research and treatment.

A Phi Beta Kappa graduate of Swarthmore College and Johns Hopkins Medical School, he served as chief resident in Medicine at Johns Hopkins. It was in 1939, while working at the Rockefeller Institute, that Dr. Brown discovered what he believed to be a link between rheumatoid arthritis and disease inducing agents later known as mycoplasmas. Mycoplasmas are directly affected by the tetracycline family of antibiotics.

Dr. Brown served as an assistant professor of medicine at Johns Hopkins School of Medicine, Director of Arthritis research at the Veterans Administration Hospital in Washington, DC and as professor of medicine and department chairman at George Washington School of Medicine in Washington DC. Dr. Brown was one of the founders of the American College of Rheumatology and was also a Trustee for the Arthritis Foundation.

In 1970, he left George Washington and founded the Arthritis Institute of the National Hospital for Orthopedics and Rehabilitation, where he continued both treatment and research for RA. During his career, he published approximately 100 papers in medical journals, detailing his research and his theory as to the mechanism of rheumatic disease. He wrote The Road Back in 1988.

Dr. Brown died in April 1989, and the Arthritis Institute close in 1996. Dr. Brown's legacy continues through The Road Back Foundation.

THE ROAD BACK FOUNDATION was founded by patients who have seen significant recovery from rheumatic diseases through the use of antibiotic therapy. It is because of remarkable improvements and a growing body of evidence that we are dedicated to spreading information about this treatment to patients, and encouraging the medical profession to offer antibiotics to their patients with rheumatic diseases. Based on over 50 years of anecdotal successes and now clinical trials, it is hoped that research and the considerable dollars involved will begin to channel into an area of investigation that will prove beneficial to the many patients and their friends and families who are devastated by rheumatic disease.

Although this treatment has met with controversy in some medical circles, an increasing volume of published research from around the world is appearing in medical journals which supports the theory that rheumatic diseases may be infectious in cause, and that antibiotics are the best treatment. The many patient stories on our web site lend further evidence to the effective use of antibiotic therapy.

Two books listed below are important resources for people who want to know more about antibiotic therapy used in the context of rheumatic disease.  These groundbreaking books have been very helpful in the treatment gaining interest among patients and physicians as the history and implementation of the therapy (as Dr. Brown and others used it) are clearly discussed.  There are other books now published that you might explore to further understand the implications of antibiotic therapy used as a first line treatment option or in conjunction with additional approaches.

1. The New Arthritis Breakthrough, by Henry Scammell, includes The Road Back with Thomas McPherson Brown, MD

2. Scleroderma The Proven Therapy That Can Save Your Life, by Henry Scammell

The Road Back Foundation does not engage in the practice of medicine. Consult with a physician to assess any medical treatment that is being considered. The Road Back Foundation encourages healthcare consumers to thoroughly investigate and understand all treatments and medications before proceeding. This material is for educational purposes only

The Road Back Foundation
P.O. Box 410184
Cambridge, MA 02141
614-227-1556
www.roadback.org