The Infectious Theory for Rheumatic Disease

The infectious theory for rheumatic disease is one of those old ideas whose time has come again. Up until the 1940s, it was taken for granted that most illnesses were caused by some kind of bug - although before electron microscopes, many germs had never been seen clearly enough to give them a name, and some, such as viruses, had not been seen at all. That difficulty in isolating and identifying a specific probable cause is one reason the infectious theory for rheumatic disease went out of vogue for several decades.

Another reason was the breakthrough in cortisone, a potent anti-inflammatory that was mistakenly thought to have the same role in rheumatic (inflammatory) disease as insulin has in diabetes. By the time it became obvious this was not the case - and that in heavy doses, cortisone could be extremely dangerous - the whole sub-specialty of rheumatology was firmly seated on the wrong horse, and the mistake had grown into an institutional tradition.

Today it is widely accepted that bacteria, mycoplasmas and viruses, all possibly aided and abetted by a genetic predisposition, are prime causative suspects in rheumatoid arthritis, scleroderma, lupus, fibromyalgia and related diseases of the connective tissue. In fact, the so-called New Germ Theory is finding support in a far wider medical arena, from Alzheimer's disease to MS, and from ulcers to asthma to cancer. And in every case, no matter how spectacular the evidence or how revolutionary the outcome, the initial response to this theory and related treatment for an infectious cause is strong resistance from an institution which sees as dangerous any challenge to the status quo.

The most likely infectious cause of most forms of rheumatic disease is a class of small organisms about halfway in size between a bacterium and a virus. Now called mycoplasmas, they were first isolated from arthritic joint fluid by Dr. Thomas McPherson Brown at the Rockefeller Institute more than 60 years ago. Assisted in that early work by polio pioneer Albert Sabin, Brown devoted the next half-century to research in the infectious etiology of rheumatic disease, and the use of safe, inexpensive antibiotic therapy for its control. Dr. Brown was the author, with Henry Scammell, of The Road Back, which first brought the case to the general public, and later gave the Foundation its name.

When Dr. Brown died in 1989, the number of doctors who offered antibiotic therapy for connective tissue diseases could be counted on one hand. Today they are numbered in the thousands. Just three years ago, only 14% of America's rheumatologists gave this treatment for rheumatoid arthritis. Although any medical specialty is often the most threatened and the least accepting of innovations in their market area, and there is still highly vocal resistance to change, today antibiotic therapy is prescribed by approximately half of all rheumatologists and the percentage is rising steadily.