Posts Tagged ‘bacteria’

A visit to my rheumatologist on Friday turned from a routine 15 minute visit into a 45 minute triage session. At the end, the rheumy mentioned that sometimes things can seem to swirl out of control and it certainly feels that way right now.

We discussed neck/shoulder/arm pain and muscle atrophy which increased over the past few months. My neurologist ran a large battery of tests including MRIs of the chest and brain, nerve conduction and EMG tests, and numerous blood tests. The only issue found of note was muscle dysfunction on the EMG. A myelogram/CT scan two month ago showed some nerve compression in the neck but the surgeon said it did not warrant intervention. My rheumy argued that a second opinion was now in order and said that they would contact two neurosurgeons for ideas about what to do.

I received a steroid injection into my right shoulder. Both shoulders have been crunchy and painful for over two years but have kicked up a notch lately to the point of being quite distracting during both the day and night. My rheumy is requesting that a radiologist reread a recent MRI of my chest to examine potential joint damage to shoulder joints. The MRI was originally ordered to look for potential inflammation in the brachial plexus nerves but caught images of each shoulder joint.

Blood tests were ordered and included routine complete blood count (CBC), metabolic panel, and inflammation measures. But immunoglobulin (Ig) tests were also ordered for the first time. Immunoglobulins are immune antibodies which may be indicative of fighting infections. These were seen by the rheumy as important given my long term battle with meningitis and now C diff bacteria. I just finished a second antibiotic for C diff, a particularly problematic gut bacteria that causes severe diarrhea and toxin-induced ulcers in the colon. I started on the antibiotic vancomycin for 14 days but it did not control the infection as another positive C diff test came back. My infectious disease doctor said that the bacteria was not likely antibiotic resistant but that my compromised immune system from RA and Rituxan was making it difficult for me to fight the infection. I was scheduled to receive the next Rituxan infusion in a couple of weeks but my rheumy suggested putting it off until the infection gets under control. The infectious disease doc put me on a new antibiotic called Dificid or fidaxomicin. It was recently approved for treating C diff infections. It cost $1,400 for 20 pills! I just finished that 10 day course but the symptoms persist. My rheumy asked me to contact the infectious disease doctor Monday and I also started the process of setting up an appointment to see my gastroenterologist who will want to do a colonoscopy to check on the physical status of the colon. In the meantime, the rheumy set me up with an immunologist to check my immune system particularly IgG antibodies which is involved in fighting infections. The rheumy told me that IgG infusions may be a possibility to help boost the immune system and help me fight the C diff infection.

All told including office visits, ER visits and hospitalization, the following specialists will have been seen over the past two months: emergency room, internist/hospitalist, radiologist, neurosurgeon, neurologist, immunologist, infectious disease, rheumatologist, and gastroenterologist. Trying to keep up with all of these issues and specialists is almost a full time job. I appreciate that my rheumatologist serves as the central care giver who really knows all of my conditions and treatments. Hopefully some relief will be forthcoming soon.


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Ever since the H1N1 swine flu scare a few years ago, I make it a point to get a flu vaccine every autumn. When receiving a regular physical exam from my general practitioner last week, the doctor suggested that a pneumococcal polysaccharide vaccine be added…

To check out the rest of this post, go to the newly launched website rheumatoidarthritis.net. I will be writing posts for this site periodically as a Patient Advocate and will continue to make regular posts at this personal blog.

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Using the Germ Theory of Disease (discussed in my previous post), microorganisms such as bacteria have been suspected for many years as being the cause of RA. But a direct link has never been found. Lately, some researchers found evidence that common bacteria found in the gut, along with genetics, may serve as triggers of autoimmune diseases. [i]

Another small group of primitive bacteria called mycoplasmas have also been implicated as a causative agent of various diseases generally[ii] and RA specifically.[iii] These bacteria don’t have cell walls and only live inside the body of another organism as a parasite (plant, animal, etc.). They are extremely hard to isolate in people but one set of researchers examining mycoplasmas stated,

The results suggest that a high percentage of RA patients have systemic mycoplasmal infections. [iv]

While mycoplasmas may be present in patients, this does not prove a direct cause and effect link between these bacteria and RA. Never the less, some researchers state that,

“Further study is necessary to prove that M. fermentans is a causative microorganism of RA; however, the new mechanisms of disease pathogenesis provides hope for the development of effective and safe immunotherapeutic strategies…”[v]

If bacteria are linked to RA, then antibiotic therapy would logically follow suit. The tetracycline family of antibiotics, which is effective in treating mycoplasmas, is proposed for antibiotic protocol therapy. The most commonly used tetracycline antibiotic used in treating RA is minocycline.

Some studies show that patients given antibiotic protocol did not show benefit.[vi] [vii] [viii] Other studies demonstrate a reduction in RA symptoms. [ix] [x] Two fairly recent reviews of controlled experimental studies on the efficacy of the antibiotic tetracycline family revealed mixed results leading to insufficient conclusions.[xi] [xii] The exact reason why antibiotics may impact RA is not fully understood but it may include antibiotics killing off bacteria that are causing RA or it may simply be that antibiotics cause a reduction of inflammatory cytokines.[xiii] The scientific evidence for the use of at least the tetracycline family of antibiotics is unclear at this time.

Antibiotic protocols (AP) are not widely espoused by official medical rheumatology societies and non-profit arthritis organizations. In spite of this, there are several groups devoted to antibiotic treatments for autoimmune diseases and some rheumatologists will prescribe AP (see http://www.roadback.org/, http://rheumatic.org/, http://www.rheumaticsupport.net/index.php).

In conclusion,

  1. Bacteria are not yet clearly linked as a direct cause of RA. Mycoplasmas may be one group of bacteria eventually implicated in autoimmune diseases.
  2. Bacteria in the gut, along with genetics, may serve as a trigger for autoimmune diseases.
  3. The efficacy of antibiotic treatments for RA is unclear at this time.
  4. More research is needed to pinpoint the cause(s) of RA. All possible causes, including bacteria, should continue to be investigated.

The gut bacteria/genetics combination recently discovered shows the most promise. But I suspect that any resultant treatments from this line of research (many years down the line) are not likely to be generic, whole body administration of antibiotics. They are more likely to be genetic-based treatments designed to impact some biochemical process connected with bacteria’s impact on the immune system.

Personally, if I ever get to the spot where the spectrum of biologic and other current RA treatments don’t work for me, I will definitely raise the topic of antibiotic protocol with my rheumatologist. In the meantime, you can read about one person’s experience with antibiotic protocol at her blog http://rheumforgod.wordpress.com/ap-diary/.

Disclaimer: This short post is not meant to serve as an exhaustive review of the topic and related studies. My personal goal is to learn a little, share information with others, and keep discussions ongoing. I am neither promoting nor refuting the use antibiotic treatments for RA.

[i] http://cbdm.hms.harvard.edu/assets/Publications/2010/JoyceWImmunity.pdf

[ii] http://microbewiki.kenyon.edu/index.php/Mycoplasma

[iii] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2433307/


[v] http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WBK-4RXK6BC-3&_user=10&_coverDate=05%2F02%2F2008&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1444535875&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=40fa71c12bc87f80e946de33d9b718d2&searchtype=a

[vi] http://onlinelibrary.wiley.com/doi/10.1002/art.1780140607/abstract

[vii] http://www.jrheum.org/content/28/9/1967.short

[viii] http://www.ncbi.nlm.nih.gov/pubmed/8434246

[ix] http://www.annals.org/content/122/2/81.full

[x] http://www.okmicro.co.jp/Abt/MinocyclineERA1.pdf

[xi] http://www.formularymonographs.com/PDF/fandc-olf5026.pdf

[xii] http://www.jrheum.org/content/30/10/2112.abstract

[xiii] http://www.formularymonographs.com/PDF/fandc-olf5026.pdf

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There is no cure for rheumatoid arthritis or for most autoimmune diseases for that matter. This is primarily because the specific underlying causes of autoimmune diseases are unknown.

The germ theory of disease, the idea that diseases are caused by microorganisms such as bacteria and viruses, was hypothesized by Louis Pasteur[i] and further described by Robert Koch via his Postulates.[ii] While not applicable to all diseases, the theory has been successfully applied to a myriad of diseases leading to amazing treatments, cures, and vaccines.


Microorganisms, primarily bacteria, have been hypothesized as a cause of rheumatoid arthritis for years. In fact, some early treatments of RA included antibiotics and similar drugs like sulphasalazine (still prescribed today). But, using Koch’s Postulates, no germ could be isolated or identified as triggering the disease. Some still propose using antibiotic protocol to treat RA (see http://www.roadback.org/). I’m curious about this approach and plan to write about it in the future. Now bacteria, as a possible trigger of RA, are back in the scientific news.

As I wrote about in an earlier post, researchers taking a systems approach hypothesize that there are three possible triggers of autoimmune diseases – genetics, bacteria, and a “leaky gut” (proteins from food leaking through intestinal wall and causing an immune response). This work is primarily directed by Dr. Fasano at the University of Maryland.[iii] Now researchers from Harvard University and New York University report research on mice that demonstrated a relationship between the presence of a common bacteria found in the gut and an immune response leading to arthritis.[iv] [v] Mice genetically susceptible to autoimmune arthritis were raised in germ-free environments. They demonstrated a lack of arthritic symptoms. The mice were then exposed to a single type of gut bacterium and they immediately began to show symptoms of arthritis. They also found that a certain type of T cell connected to the production of arthritis-causing antibodies was connected to the presence of bacteria. The researchers argued that the mice didn’t “catch” arthritis from bacteria, but that there’s an interaction between the genetic make-up of the mouse and the autoimmune response to bacteria. This finding supports Fasano’s work and also lends evidence to the genetic link due to the fact that all people don’t get autoimmune diseases when exposed to certain bacteria.

What does this mean for those of us with RA? Probably nothing for the immediate future. We can’t live in germ-free environments like the mice in the study. A general wiping out of bacteria in the gut would wreck havoc on the digestive system and current antibiotic treatments don’t work for everyone with RA. But perhaps this research will spark more attention and funding on these issues leading to potential discoveries of causes of autoimmune diseases leading to the development of effective treatments.

[i] http://www.accessexcellence.org/RC/AB/BC/Louis_Pasteur.php

[ii] http://www.medterms.com/script/main/art.asp?articlekey=7105

[iii] http://somvweb.som.umaryland.edu/absolutenm/templates/?a=837&z=2

[iv] http://www.focushms.com/?p=206

[v] http://cbdm.hms.harvard.edu/assets/Publications/2010/JoyceWImmunity.pdf

Photo Credit: Creative Commons License http://www.flickr.com/photos/worldworldworld/

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