More inflammatory autoimmune info

[Starr]

As a response to Lynnie's remarks in an earlier post, I've tried to represent some prevailing opinions in the medical community (not my personal opinion).

“I think it's pretty well accepted by most rheumatologists that there is some kind of environmental (often infectious) trigger for these diseases. I've only heard one rheumatologist say this in 21 years. And in the 5 years I've been on this Board, the story that is most frequently cited by people posting here is that their rheumatologists say the opposite (an idiopathic disease, immune system attacking itself for no identifiable reason etc).”

***An environmental or infectious trigger means that something like a toxin or pathogen is what starts an autoimmune process, which can turn into a chronic condition or disease. Just like the trigger of a gun, the trigger doesn't actually kill people but it's the first event in a sequence. Once an autoimmune process is set in motion, other related stimuli can perpetuate it. Antibiotics help partly by ridding the body of any pathogen load, by suppressing some kinds of inflammation, and also by helping the immune system remodel itself. The immune system is incredibly adaptive and is always changing. Young people have especially adaptive immune systems but as we age, we lose some of that vigor. Thymic exhaustion, in particular, might be a major factor in why older people are slower to respond or sometimes don't respond to immune stimuli….or why sometimes an extremely stressful event can start an autoimmune process. If an autoimmune disease is set off by an infection, clearing the infection will certainly help relieve symptoms of the autoimmune process but it's unlikely that it will change the immune system back to what it was previously. Genetic research has shown that people with certain genes have propensities to develop certain diseases. Sometimes people are born with those diseases and sometimes something triggers them. Often, there are a whole cluster of traits that are associated with certain genes. A lot of people with RA also have a gene that predisposes them to celiac disease. For these people, eating certain foods will result in production of antigliadin and avoidance of gluten-containing foods will relieve many/most of the RA symptoms. People who think they have leaky gut probably have increased levels of intestinal IgA antibodies and symptoms can usually be relieved by eliminating the offending foods. This explains how some people are “cured” of their RA only by dietary changes. Testing is available to let you know if you have this problem or propensity. Some people, especially for what's termed reactive RA, can be cured when a pathogenic gut bug is eliminated. In this case, an autoimmune sequence has not yet been established. Maz posted an abstract recently that noted the detection of an antigen for mycoplasma in RA synovial tissue which has been observed previously, and demonstrates how difficult it is to avoid RA flares if the RA was initially triggered by an autogenic response to a mycoplasma infection. Even if the original infection is totally cleared from the body, it would be almost impossible to avoid triggering subsequent flares because simply another exposure to the mycoplasma would set off a dysfunctional immune response and mycoplasma are everywhere. So even if the immune system fought off an infection by the invading mycoplasma, the RA flare caused by the mycoplasma antigen would also occur. If the body develops an autoimmune response to mycoplasma, repeated flares are inevitable because mycoplasma are encountered so frequently. But there are MANY triggers for “autoimmune” or “dysfunctional” immune system diseases and eliminating the trigger doesn't always eliminate the disease.

“minocycline, which has been shown to be an extremely powerful anti-inflammatory and immune modulator (both stimulates and suppresses parts of the immune system). I would love it if you could provide some documentation for that. As far as I am aware, minocycline is considered by the ACR as a mild DMARD, a weak immuno-modulator that should only be used in mild to moderate RA. That is the story most people tend to get from rheumies (and only those who have heard about minocycline as a DMARD). If there is research to support its 'extremely powerful inflammatory and immune modulating' properties, that would be a very powerful new weapon for lots of people to present to their doctors as a good case for its prescription. And I'm sure alot of people here would very much appreciate you posting it. Lynnie”

*** I responded to the request for documentation about mino's antiinflammatory properties in the original thread (please see, “AP, Just treating inflammation not the Auto Immune side?”) but would like to clarify one additional point. Lynnie, you are correct that the ACR's official position, based on the MIRA trials, is that mino is a weak DMARD. The fact that mino has been shown to have powerful antiinflammatory properties does not necessarily mean that it's a powerful DMARD. The fact that minocycline is listed as a valid treatment by the ACR should be enough to convince a doctor to let a patient who requests it to try it. The ACR, American College of Rheumatology, is the professional group that, using a process of consensus, establishes guidelines and standards of care in that field, so the ACR guidelines should reassure a physician who is concerned about using a drug for off-label use altho it is specifically contraindicated for some people (hepatitis, pregnancy,etc). Minocycline is relatively cheap (tetracycline is cheaper), relatively safe, and can be very effective. Actually, all antibiotics have immuno-modulatory effects but have not been tested in clinical trials for applications related to those properties. Because RA is complex and diverse in triggers, a specific immunomodulatory drug won't work for all. That's why certain biologics only work for some people. Methotrexate is a bit broader in it's reach and is relatively cheap, so it's often used as an early approach.

I hope that people will take an active role in their wellness and make informed decisions about their health choices. I also hope people don't consider any information to be a very powerful new weapon because our healthcare providers should be team members with whom we have a good rapport, not our adversaries.

Here is a quote from an article referenced below,
“Another indication from these results is that immune stimuli are implicated in the initiation of autoimmune diseases, supporting the hypothesis that infectious diseases or other inflammatory events may be temporally linked to the initiation of autoimmune disease.”

http://genomebiology.com/2007/8/10/317

another:
http://autoimmune.pathology.jhmi.edu/whatisautoimmunity.html

more info:
http://www.brighamandwomens.org/Research/rheumatology/

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