Arthritis and Colon Bacteria (Long)

Several recent research papers show that inflammatory types of arthritis such as rheumatoid arthritis, psoriatic arthritis and reactive arthritis may be caused by harmful bacteria in your colon. Your colon is full of more than 100 trillion bacteria. Some are good and some are bad. The good bacteria are happy with what you eat and do not try to enter your colon cells, while the harmful colon bacteria are not happy with what you eat, so they try to enter the cells lining your colon. Your immune system responds by sending out large numbers of cells (lymphocytes), chemicals (cytokines) and antibodies to attack and kill the invading colon bacteria. This is called inflammation. If the harmful colon bacteria continue to penetrate your colon cells, your immune system stays active all the time and uses the same cells and chemicals to attack your body. Doctors call this activity “auto-immune diseases,” which can affect your joints (rheumatoid arthritis), intestines (inflammatory bowel disease), lungs (rheumatoid lung disease) and just about every other tissue in your body.
• Newly discovered species of gut bacteria may cause some cases of rheumatoid arthritis (Science Translational Medicine, Jan 5, 2023).
• People who are susceptible to rheumatoid arthritis have a bacterial colon composition that may cause their immune system to mount an attack on these bacteria, triggering arthritis (Arthritis Rheumatol, May 23, 2023).
• Similar changes in colon bacteria occur in people who have rheumatoid arthritis (Science Translational Medicine, Jul 26, 2023;15(706)).
• Probiotics may help to treat and reduce harmful colon bacteria and intestinal permeability as a cause of rheumatoid arthritis (Am Nutr Assoc, 2023 Jun 9:1-18).

Rheumatoid Arthritis and Colon Bacteria
Analysis of the bacteria in your colon can predict susceptibility to developing rheumatoid arthritis (Genome Medicine, 2016;8(1)). Treating arthritis-susceptible mice with the healthful Provatella histicola bacteria decreased frequency and severity of arthritis, and they had fewer inflammatory conditions associated with rheumatoid arthritis (Arthritis Rheumatol, Dec 2016;68(12):2878-2888). Many papers have reported improvement in rheumatoid arthritis symptoms with the prescription of antibiotics (Klin Med, 2010;89(4):45-8; J Rheumatol, 2008;35(8):1500-5; Ann Rheum Dis, 2003;62(9):807-11; Elife, 2013;2:e01202).

Antibiotics do affect the makeup of colon bacteria in humans, but at this time we do not know enough to suggest that patients with rheumatoid arthritis should be treated with antibiotics to change colon bacteria. A more conservative approach would be to encourage a healthful change in colon bacteria using an anti-inflammatory diet and other lifestyle changes (diet, exercise, weight loss if indicated, avoiding smoke and alcohol, and so forth).

Earlier Research on Rheumatoid Arthritis, Gut Bacteria and Antibiotics
• Collagen injections can cause changes in colon bacteria in rats that go on to develop arthritis (Front Cell Infect Microbiol, 2019 Jun 12;9:204).
• Fecal bacterial transplants from healthy mice reduce intestinal cell damage in mice likely to develop intestinal cell damage (M Systems, Oct 9, 2018;3(5):e00137-18).
• Similar changes in colon bacterial composition in people who suffer from inflammatory bowel disease (Nature, 569, 655–662 (2019).
• Similar changes in colon bacteria in people who suffer from colon cancer (Nat Commun, 2015;6:8727).
• Changes in colon bacteria as a person develops type I diabetes (Cell Host Microbe, 2015;17:260–273).
• Changes in colon bacteria as people develop obesity and a fatty liver (Nature, 2012;482:179–185).
• Mice and humans who have early stages of rheumatoid arthritis both have a newly discovered species of Subdoligranulum bacteria in their colons that trigger autoantibodies that may cause rheumatoid arthritis (Science Translational Medicine, October 26, 2022).
• A study of 1,388 women with hand arthritis, average age 61, showed that they had higher levels in their colons of the bacteria Bilophila and Desulfovibrio that try to invade their colon cells, as well as a lower level of the genus Roseburia that do not invade colon cells (Arthritis Rheumatol, published online March 24, 2021).
• Colon bacteria may cause rheumatoid arthritis (Front Immunol, 2022 Sep 8;13:1007165).

History of Antibiotics to Treat Rheumatoid Arthritis
Most doctors do not believe that antibiotics help to treat inflammatory types of arthritis such as rheumatoid, psoriatic or reactive arthritis, even though there are a large number of papers showing that antibiotics may help (Int J Gen Med, 2014; 7: 43–47), at least for a short time (Hosp Pharm, 2016 Jul; 51(7): 535–538). After a few months or a year, they often stop working. Once the cartilage in your joints is damaged, it will never heal. In 1939, more than 83 years ago, Thomas MacPherson Brown isolated a bacteria called mycoplasma from the joint fluid of person with rheumatoid arthritis and he spent the rest of his life trying to prove that mycoplasma caused rheumatoid arthritis.

In the 1940s, some doctors treated rheumatoid arthritis with the antibiotic sulfasalazine. Later, doctors used tetracycline, clarithromycin and roxithromycin. Several reports blame dental bacteria as a cause of rheumatoid arthritis. Six prospective double blind studies show that minocycline helps to treat rheumatoid arthritis, provided the antibiotic is started within the first few months of the disease. There are no prospective double-blind studies showing that minocycline is not effective. Many doctors who treat rheumatoid arthritis are unfamiliar with this literature and have no clinical experience in prescribing antibiotics to treat rheumatoid arthritis.

Doctors at the University of Nebraska treated people in the first year that they were diagnosed with rheumatoid arthritis (Arthritis and Rheumatism, 1999;42(8):1691-1695). Half were given conventional treatment with pain medications, such as ibuprofen, and the standard immune suppressants, prednisone, Plaquenil, and so forth. Half were given only the antibiotic, minocycline. Then the patients stopped taking minocycline and all were treated in the same way for the next three years. Four years later, almost all the patients who were not treated with minocycline were taking immune suppressants and had significant joint damage, while 50 percent of those given the minocycline did not need immune suppressants. All six prospective studies showed that rheumatoid arthritis patients who were given minocycline had far fewer symptoms and lower rheumatoid factors than those who did not take minocycline.

Anti-Inflammatory Lifestyle to Treat Rheumatoid Arthritis
An anti-inflammatory lifestyle has been shown to help grow healthful bacteria in your colon, which can help to treat rheumatoid arthritis (J Rheumatol, 2008;35(8):1477-9). If you have rheumatoid arthritis or any other type of arthritis, anti-inflammatory lifestyle habits should be an important part of your treatment program. For many years, exercise has been recommended as part of the treatment for rheumatoid arthritis, and a summary of studies confirms that exercise is beneficial (Arthritis & Rheumatology, published online April 01, 2019). An anti-inflammatory diet high in plants and low in meat and sugar (Rheum Dis, 2017;76(8):1357-64), and weight control (Arthritis Res Ther, 2015;17:86), also reduce symptoms of rheumatoid arthritis.

Rheumatoid arthritis is a disease in which your own immune system attacks and damages your joints. Nobody knows why some people develop rheumatoid arthritis, while others do not. However, we do know that the joint damage is caused by exactly the same cells and chemicals called cytokines that your body uses to kill germs when they try to invade your body. When your immune system stays active all the time, it is called inflammation (Curr Opin Rheumatol, 2014 Jan;26(1):101-7). Everything that turns on your immune system is called pro-inflammatory and everything that dampens down your immune system is called anti-inflammatory.

Studies on Diet to Treat Rheumatoid Arthritis
People who eat a healthful high-plant diet are at reduced risk for developing rheumatoid arthritis (Nutritional Outlook, Mar 20, 2019;22(2)). Previous studies have shown that a vegan diet is associated with reduced symptoms and reduced progression of the disease (Clin Rheumatol, 1994;13(3):475–82; Rheumatology, 2001;40(10):1175–9; J Altern Complement Med, 2002;8(1):71–5). An excellent review of dietary factors that can increase or decrease joint destruction in rheumatoid arthritis can be found in Frontiers of Nutrition (Nov 8, 2017;4:52). Rheumatoid arthritis patients who ate:
• a healthy plant-based diet had reduced markers of inflammation (CRP and sed rate) and reduced progression of disease compared to those with less healthy diets (Nutrients, Oct 18, 2018;10(10):1535).
• more vegetables, greens, beans, whole grains, dairy and seafood, and less refined grains, salt, and empty calories had less severe symptoms than those who ate less healthful diets (Nutrition and Health, 2017; 23(1):17-24).
• more milk, fried foods, butter and solid oils had more severe symptoms (Clin Rheumatol, Oct 2018;37(10):2643-2648).
• a Mediterranean diet, with lots of fiber, had reduced inflammation and pain (Ann Rheum Dis, 2003;62(3):208–14).

My Recommendations
Symptoms of rheumatoid arthritis can improve with lifestyle changes to increase healthful bacteria and decrease harmful bacteria in your colon. At this time, there is still uncertainty about how effective an anti-inflammatory lifestyle is in treating rheumatoid arthritis, but I recommend that people who suffer from any type of arthritis should include the following lifestyle habits with your other treatments (check with your doctor):
• A diet that is high in vegetables, unground whole grains, beans, fruits, nuts and other seeds, and low in red meat, processed meats, fried foods, sugared drinks and foods with added sugars
• A regular exercise program (with your doctor’s approval)
• Maintenance of a healthful weight
• Avoidance or restriction of alcohol
• Avoidance of smoking and second-hand smoke
• Avoidance of other toxic substances and pollutants

ARCHIVED articles on my Treatment of Rheumatoid Arthritis with Antibiotics from my medical practice and website before 2015  are available here.  Many of these references, and my opinions expressed in the articles, date back to before 2005, so use with caution.