Getting Started with Antibiotic Therapy for Arthritis

Educate yourself

1. The scientific evidence: 7 studies have been published in major medical journals since 1990 testing minocycline for rheumatoid arthritis; all seven have found it to be a safe and effective treatment. (A number of materials available from The Road Back Foundation website include a reference list of these studies.)

2. Obtaining the treatment: Any doctor who can prescribe antibiotics can provide this treatment. If your doctor is not familiar with antibiotic therapy, example protocols are available from The Road Back Foundation website. There are many ways to do this therapy and it must be tailored to the individual's needs.

3. Antibiotic response: Although tetracycline antibiotics have a number of medicinal properties, this therapy focuses on suppression of antigen caused by a microorganism. The paradigm used is that the antigen is largely responsible for causing your symptoms. This treatment has proven effective for a number of other forms of "arthritis" such as rheumatoid arthritis, scleroderma, lupus, juvenile rheumatoid arthritis, Reiter's syndrome, fibromyalgia, psoriatic arthritis, and ankylosing spondylitis.

Where can you find this educational information?

4. Selected past articles from our discontinued newsletter, The Intercessor, (no longer in hard copy) are available online.

5. Read the "brochures sheets" under the Education drop down for a general overview of antibiotic therapy.

6. Two important books: The NEW Arthritis Breakthrough is a detailed history of this treatment and provides an understanding of how it works. It is an excellent starting point for patients who want to know more about antibiotic therapy and includes the original book by Brown and Scammell, THE ROAD BACK, in its entirety. Scleroderma, The Proven Therapy Than Can Save Your Life, the first layman's account of this deadly disease, provides a unique view inside the lives of patients and researchers whose heroic partnership culminated in Harvard's Minocycline in Scleroderma Study and its promising outcome. However, for more information and greater perspective about the treatment, we recommend reading BOTH books if you have scleroderma

7. Researching a local medical library or the Internet for medical journal articles about your disease can be very helpful. Medical texts and journals are always your best source, use them whenever possible.

About the treatment

8. Treatment may consist of an antibiotic, an anti-inflammatory (NSAID) if necessary, and in some cases, an antihistamine.

9. Anti-inflammatory drugs (NSAIDs) are helpful in controlling inflammation which often accompanies arthritis. This inflammation can create a barrier around sites of activity which the antibiotic cannot penetrate. It is important to keep this inflammation at a minimum. An NSAID which works for one patient may not be effective for another; conversely, what worked at one stage of your disease may no longer work in a later stage. NSAIDs can be anything from over-the-counter aspirin or ibuprofens to longer acting prescription forms. In cases of severe or unresponsive inflammation, short courses of low dose cortisone (less than 10 mg) can be effective.

10. Antibiotics in the tetracycline family (inclluding doxycycline and minocycline) are effective against mycoplasmas and L forms of bacteria, believed to be involved in the disease process. Usually, the tetracycline family of antibiotics are prescribed for oral use.

Generic versions are available for all of these medications, but we have found some of generics are ineffective at the lower doses used in this treatment. They are less costly, but may result in a less complete response or no response at all. However, some patients report that they do well on particular generics in the doxycycline category and some using minocycline report success too. We have no way of knowing which generics are the most effective so many have stayed with the name brands for consistency.

11. You may have to try various dosages and frequencies to find what works best for you. Some patients start low and gradually increase; others start high and decrease. The long term rule is to use the lowest dose which will still provide improvement.

12. For long term or severe disease, a combination of antibiotics may be warranted, usually a tetracycline orally and historically clindamycin either intravenously or as an injection, as an effective boost to the treatment. Newer antibiotics have been substituted for the clindamycin in some cases. That is a decision for the physician to make. However, many if not most patients do not have easy access to IV therapy and can still have success with AP.

13. The mechanism of hypersensitivity must be accepted as a framework for treatment. Antihistamine provides relief of inflammatory process and the allergic response of the hypersensitivity state.

14. Tetracyclines (and clindamycin) are not only antibiotics which work for this therapy. The tetracyclines have the lowest incidence of side effects for long term use.

How long before I begin to see improvement?

15. This therapy is not a cure; it is, however, a highly effective treatment. Response varies and is affected by many factors: the strength of your immune system, what your previous medications have been, what medications you might still be using, how long you have had your disease, how severe it is, etc. Some people see almost instant improvement, others get worse before they get better (a reaction called a Jarisch-Herxheimer reaction). Usually improvement is slow and gradual, often even subtle, but eventual remissions are not uncommon with antibiotic therapy.

16. The Jarisch-Herxheimer reaction is a treatment induced flare reaction caused by the release of toxins into the body during the die-off of the organism. Increased soreness, swelling and/or pain are common symptoms of a Herxheimer. It is a temporary lasting from a few days to a few months. It can be treated by reducing, not stopping the antibiotic. Symptoms can be eased by hot soaks and whirlpool tubs. Pain can be alleviated with pain medications or just riding it out. Although not everyone experiences a Herxheimer reaction, it is best to be prepared by decreasing personal demands and discussing the possibilities with your doctor. Allow some "Herx time."

Exercise

17. The stronger you are going into a flare, the stronger you will be when you come out. Always tailor purposeful exercise, work or household chores to your disease. Don't quit; just go easier.

Keep a journal

18. The best way to understand your disease is to keep a record of your medications, your ups and downs, and anything that may be a factor in your response: stress, weather, activity, change in medication or supplements, illness etc. Providing accurate and complete information about changes in your disease is the best way to help your doctor help you. It can also provide you with guidance in scheduling activities.

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.