Antibiotics (General) - Road Back Foundation

While the cause and progression of rheumatoid arthritis (RA) continues to remain controversial, the potential remains for antibiotic therapy to be employed as a safe, effective treatment that has been borne out in numerous clinical trials. This research section provides a sampling of the various rationales offered by researchers and reviewers around the world for the effective use of antibiotic therapy for this painfully disabling, progressively destructive rheumatic disease.

Does the buck stop with the bugs?: an overview of microbial dysbiosis in rheumatoid arthritis. Int J Rheum Dis. 2016 Jan;19(1):8-20.

Researchers in India propose a comprehensive whole body mechanistic approach to the pathogenesis of rheumatoid arthritis (RA), which they assert is the result of a combination of host genetics, dietary factors, environmental cues, infections that originate in the lungs, mouth, gut and genitourinary tract, as well as direct microbial DNA evidence for infection translocation to the joints. The authors detail the antimicrobial effects of commonly used disease-modifying anti-rheumatic drugs (DMARDs), such as sulphasalazine and hydroxychloroquinine, as well as tetracycline antibiotics, macrolides, levofloxacin, dapsone, ceftriaxone and metronidazole, acknowledging their antimicrobial immune-modulatory effects. A prevention and treatment approach is outlined, employing antimicrobials, in addition to dietary modifications, probiotics, and DMARDs to modulate RA pathogenesis is described, in acknowledgment that gaps in understanding RA continue to be challenging.

Antibiotics for the treatment of rheumatoid arthritis. Int J Gen Med. 2013 Dec 27;7:43-7. doi: 10.2147/IJGM.S56957.

A Turkish researcher reviews the use and effects of antibiotic therapy for rheumatoid arthritis (RA) and its possible infectious causes from as early as the 1930s with the use of sulphasalzine and, followed soon after, with tetracyclines, through to the present day and the double-blind randomized, placebo-controlled studies for the therapeutic value of other antibiotics, such as levofloxacin and macrolide antibiotics (clarithromycin and roxithromycin).

Rheumatoid arthritis: proposal for the use of anti-microbial therapy in early cases. Scand J Rheumatol. 2003;32(1):2-11.

Researchers of the Infection and Immunity Group, at King’s College, in London, propose the use of antibiotic therapies in early rheumatoid arthritis (RA), in addition to high fluid intakes and fruit extracts, like cranberry juice. Based upon their extensive research, and the research of researchers from 14 other countries of 1,375 RA patients, it is their opinion that Proteus mirabilis, a causative pathogen of upper urinary tract infections, is a strong contender for the etiopathogenesis or RA.

Molecular mimicry between HLA-DR alleles associated with rheumatoid arthritis and Proteus mirabilis as the aetological basis for autoimmunity. Microbes Infect. 2000 Oct;2(12):1489-96.

Researchers within the Department of Rheumatology, at the UCL School of Medicine, Middlesex Hospital, London, recommend prospective antibiotic trials for the treatment of Proteus mirabilis, an upper urinary tract infection, which they consider to be a possible cause of rheumatoid arthritis. They also propose that this organism is capable of molecular mimicry, providing a rationale for an association of these microbes with rheumatic diseases.

Antibiotics for the treatment of rheumatologic syndromes. Rheumatic Disease Clinics; November 1, 1999, Volume 25, Issue 4, Pages 861–881.

In this review of the use of antibiotics for the treatment of rheumatologic diseases, this author discusses the many unknowns that remain open to inquiry regarding infectious causes for such diseases, but quantifies the value of antibiotics in terms of their immune-modulating effects in addition to their antimicrobial actions. To these ends, an examination of the success of clinical trials and experience with antimicrobials in rheumatic diseases is discussed, as well as the immune-modulatory and anti-inflammatory mechanisms of certain antibiotics and their role in altering disease pathogenesis.