A Harvard Article (10/05) about Arthritis being INFECTIVE!

[amyid]

Hello, I hope everyone is having a  wonderful  weekend! (Happy 4th to my American friends!)

I am preparing to go to Iowa to see Dr. S and hopefully give my AP a boost.  In preparing for our consult, I thought it would be a good idea for me to make copies of my medical records.  Specifically, my many culture results from my frequent sinus infections over the last 2 1/2 years as there have been a lot of strep bacterial infections.  One culture result in particular got my attention.  It was a bacterium called Moraxella Catarrhalis.  (I remember both my ENT and Immunologist were particularly concerned about me culturing out this bug, as I had just followed treatment for another bacterial infection (yes, a strep) and then was treated for 2 months for a severe rebound fungal infection.) 

Copying records today and  remembering this concern-and now piecing it together with the infectious theory on RA,-I did a google.  I was looking up the specifics about this bacteria on emedicine when I saw it was a common cause of septic arthritis!   Septic Arthritis was highlighted, so I followed the link and it took me to an article by John L Brusch, MD, FACP, Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance.  The article is dated October 18, 2005. 

I am pasting the very first part of the first page of this article below.  I am not in the medical profession, and being new to AP, I am not as versed on the particulars of mycoplasma, cell walls, etc.  Yet, I found this article to be very solid in demonstrating that arthritis can be caused by organisms, not just “…your immune system going awry.”  as I was told by my docs. 

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Background
Infective arthritis may represent a direct invasion of joint space by various microorganisms, including bacteria, viruses, mycobacteria, and fungi. Reactive arthritis, a sterile inflammatory process, may be the consequence of an infectious process located elsewhere in the body. Although any infectious agent may cause arthritis, bacterial pathogens are the most significant because of their rapidly destructive nature. For this reason, the current discussion concentrates on bacterial septic arthritides. Failure to recognize and to appropriately treat septic arthritis results in significant rates of morbidity and may even lead to death.

Because of the increasing use of prosthetic joints, infection associated with these devices may be the most common and challenging type of septic arthritis encountered by most clinicians.

Approximately 20,000 cases of suppurative arthritis occur in the United States each year. The 2 major classes of bacterial/suppurative arthritis are gonococcal and nongonococcal. Overall, although Neisseria gonorrhoeae remains the most frequent pathogen (75% of cases) among younger sexually active individuals, Staphylococcus aureus is the most common cause of the vast majority of cases of acute bacterial arthritis in adults and in children older than 2 years. This pathogen is the cause in 80% of infected joints affected by rheumatoid arthritis. Streptococcal species, such as Streptococcus viridans, Streptococcus pneumoniae, and group B streptococci, account for 20% of cases. Aerobic gram-negative rods are involved in 20-25% of cases. Most of these infections occur in people who are very young, who are very old, who are immunosuppressed, and who abuse intravenous drugs.

Polymicrobial joint infections (5-10% of cases) and infection with anaerobic organisms (5% of cases) usually are a consequence of trauma or of abdominal infection. The organism of Lyme disease (ie, Borrelia burgdorferi), a large variety of viruses (eg, HIV, lymphocytic choriomeningitis virus, hepatitis B virus, rubella virus), mycobacteria, fungi (eg, Histoplasma species, Sporothrix schenckii, Coccidioides immitis, Blastomyces species), and other pathogens may produce nonsuppurative joint infection.

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I was particularly taken with the statement in the first paragraph “Although any infectious agent may cause arthritis, bacterial pathogens are the most significant because of their rapidly destructive nature. For this reason, the current discussion concentrates on bacterial septic arthritides.”  To me, this gives credence to AP in that for the article he was focusing on septic (immediate, devastating infection) arthritis, but acknowledged that bacterial pathogens are indeed a cause, and are rapid in their destructions.

Also, the second paragraph where they discuss the septic issue in greater depth and how it is most common in the very young, old & immunodeficient individuals, made me wonder…for those of us who weren't compromised prior to infection/initial onset did the bacterium just have to “build up”, or was it a physiological trauma that brought upon our body's inability to fight it and that brought out our disease?  Did we not get “septic arthritis” because we had some immune strength initially and rather than sepsis it is “slower” in the form of RA?  (John M, or others in the science field, I may be interpreting this incorrectly.  If I am, please help!  My degree is in Sociology; I am not used to all this :P. )

Staphylococcus aureus is the most common cause of the vast majority of cases of acute bacterial arthritis in adults and in children older than 2 years. This pathogen is the cause in 80% of infected joints affected by rheumatoid arthritis.   I realize “acute” is not to be ignored in this statement.  But isn't RA acute and chronic?  It comes on rather acutley in some…but just continues on chronically.  Unless treated with an antibiotic.  Could this be why some respond better when Zithromax or other strep fighter is added to AP?  I plan on asking Dr. S!!

For Maz, Lynnie in Syndey, the last paragraph really caught my attention (for the gut and Lyme).  It states clearly that Lyme, and other infections (the fungus common in gut issues)  can cause “nonsuppurative” joint infection.  [/color]

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These are just my opinions.  I hope this article will provide something for the rest of you, too.  I was getting a bit nervous for my IV treatments in IA.  I am more determined than ever that AP is the right path!  I will try and post from Iowa, and let you all know how my IV treatment is going.

Wishing you all peace and health!

:dude:Amy

Here is the link to the entire article http://www.emedicine.com/med/TOPIC3394.HTM

DX Rheumatoid Arthritis- 3/2008, Began AP 8/2008-continued various forms of AP through present. It's long and complicated- have a question re: my protocol, just ask 🙂

[Rose66]

Hi Amy

What an interesting article, and one that can be reasonably grasped by those of us without a scientific background.

I think I may have originally been attracted to AP by blind desperation rather than a balanced consideration of the merits of the treatment, and also a vague diagnosis that didn't seem to leave me with any sense of why this condition had erupted.  The rheumatogist suspected it might be psoriatic arthritis due to psoriasis (but not arthrits) running in my mother's family, although only mildly.  I have as yet no other symptoms of psoriasis (although sometimes the skin lesions came later apparently).  Although it is of course highly possible that I have PsA at some level I'm not convinced, at least not while I have no other indicators at all.

But what may be of interest to others in trying to make the link with bacterial infection is my own health history.  It's not at all like yours but perhaps shows how different experiences could lead to a similar outcome.   Until the last year or so I have been blessed with remarkably good health all my my life. Only the most minor childhood illnesses and nothing other than a cold one or twice a year as an adult.  Pretty lucky huh? 

However, one episode sticks out.  About 8 years ago, shortly after the birth of my son, I had a horrendous bout of some type of gastro bug, truly awful for about 10 days with everying just ripped out of my guts.  Well, it resolved and I picked up and continued on quite happily but with mysterious days that would randomly occur over the next 6 months when I could scarcely get out of bed, less violent symptoms than the originaly attack but of the same nature, a strange but profound malaise.  It seemed so peculiar, after a few hours it would evaporate and I would bounce up and get on with the day.  After months these attacks began of ease off but left me with a sense of having been really quite ill over that period of time.   Once it was past I was fully back to my old self –  but about a year later my foot started hurting …..  I wonder if those bugs were lying low in my system and waiting to emerge.  Also, since the arthritic symptoms started to really made themselves known over the last 18 months I've had continual bowel problems, something that has never been an issue for me before.

Just another anecdote of course, but infectious theory sounds credible to me.   

Best of luck with the trip to Iowa, sounds exciting.  I'm about 8 weeks into AP and still very much having ups and downs.   I do hope the IVs give the the kickstart you need and that you can keep us posted while there.

Best wishes to all

Roisin

 

 

 

[Kim]

Thanks, Amy.  Great information and sure a lot to chew on.  Sure fits my history pattern — strep every year, bad case of bacterial pneumonia, knee replacement that never healed, etc.

Wishing you all the best on your trip to Iowa.  Please keep us posted…….kim

[Silvia]

Hello Amy:

I am a new member here, and I do have a background in Microbiology, so I'm familiar with Moraxella catarrhalis.  This is a common organism found in the respiratory tract of patients with recurrent respiratory infections, sinusitis, bronchitis, etc. 

The article you quote has a focus of infectious (septic) arthritis, which has always been recognized, and is quite different from RA and the mycoplasma/strep theory.  You can recover the causative organisms from joint fluid quite readily in this type of infection. Infectious arthritis is a well recognized entity, and can be caused by a variety of organisms.  They can gain entry into joint spaces either by trauma or systemically from a remote infection.  Most organisms produce a variety of toxins that can wreak havoc on the infected areas.  The organisms cited in the article are classical septic arthritis bugs.  They may destroy the joint and will make the patient acutely ill, but don't follow the same disease progression that typical RA will.  I believe the infectious theory of RA is valid and true (otherwise I wouldn't be following its recommedations myself!), but I think the disease process is distinctly different, and has  to do with a combination of mycoplasmas and the involvement of T cells in the destruction of the joints.  Hope this makes sense to you, and like you, I expect to beat this with AP!  All the best to you… Silvia

[amyid]

Silvia,

Thank you!  What a valuable asset you will be to this board with your microbiology background.  Sociologists like myself aren't great at deciphering the material:P.  None the less, I keep researching.

I appreciate your insight and knowledge.  I did realize they were talking about acute sepsis.  (I was septic after a surgery 4 years ago:sick:, so I know how “acute” and serious it is!).  I just wondered (in my unscientific mind ;))  if it could be how the L-forms made their way to the joints?  Like I said, I am always searching for information, but not always sure of it's interpretation.  I am looking forward to reading more of your posts and learning more from you (correct interpretations) !

Welcome and best wishes on your road back!

Amy

DX Rheumatoid Arthritis- 3/2008, Began AP 8/2008-continued various forms of AP through present. It's long and complicated- have a question re: my protocol, just ask 🙂

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