Archive of www,drmirkin.com before 2015
Gabe Mirkin
There are two major types of arthritis: osteoarthritis, also called degenerative arthritis, and reactive arthritis. Osteoarthritis means that cartilage wears away and doctors don’t have the foggiest idea why and therefore they have no effective treatment. Doctors usually prescribe non-steroidal pills that help to block pain but do not even slow down destruction of cartilage. Most serious scientists agree that an infection initiates the reactive arthritises and many think that the germ is often still there when symptoms start. Short-term antibiotics are ineffective, but if antibiotics are started before the joint is destroyed, they can prevent joint damage.
You are more likely to suffer reactive arthritis when you have:
I) positive blood tests for arthritis; all tests used to diagnose arthritis are measures of an overactive immunity;
II) swelling of the knuckles and middle joints of your fingers, causing them to look like cigars;
III) a history of a long-standing infection such as a chronic cough, burning on urination or pain when the bladder is full, chronic diarrhea and belching and burning in the stomach; and
IV) pain that starts at an age younger than 50.
Most rheumatologists refuse to treat their rheumatoid arthritis patients with antibiotics even though several controlled prospective studies show that minocycline drops the rheumatoid factor towards zero and helps to alleviate the pain and destruction of rheumatoid arthritis.
I treat my reactive arthritis patients with Minocycline 100 mg twice a day, (sometimes azithromycin 500 mg twice a week), but this must still be considered experimental because most doctors are not yet ready to accept antibiotics as a treatment. There is also possibility of a rare serious side effect of lupus. Many patients do not feel better for the first few weeks after they start taking minocycline. If a patient does not feel better after taking 100 mg of minocycline twice day for 2 months, I add Zithromax 500 mg twice a week. If the patient does not feel better after taking the two antibiotics for 6 months, I do add the immune suppressants that most rheumatologists prescribe. But as soon as they feel better, I stop the immune supppressants and continue the antibiotics.
Other papers show that even osteoarthritis may respond to antibiotics (27). People who have chlamydia in their joints usually have no antibodies to that germ in their bloodstream and therefore cannot cure it (30). Reactive arthritis is characterized by pain in many muscles and joints and is thought to be caused by a person’s own antibodies and cells attacking and destroying cartilage in joints. This type of arthritis may be triggered by infection and antibiotics may help to prevent and treat this joint destruction (1 to 10). Short-term antibiotics are ineffective (5). Doxycycline may prevent joint destruction by stabilizing cartilage (3) in addition to clearing the germ from the body.
How do germs cause arthritis? When a germ gets into your body, you manufacture cells and proteins called antibodies that attach to and kill that germ. Sometimes, the germ has a surface protein that is similar to the surface protein on your cells. Then, not only do the antibodies and cells attach to and kill the germ, they also attach to and kill your own cells that have the same surface membranes. Some people with arthritis have high antibody titre to E. Coli, a bacteria that lives normally in everyone’s intestines (15). It has the same surface protein as many cells in your body (15). Normal intestines do not permit E. Coli to get into your bloodstream. Some people who get reactive arthritis may have intestines that allow E. coli to pass into the bloodstream and cause the immune reaction that destroys muscles and joints. The same type of reaction applies to several other bacteria and viruses that can pass into your bloodstream (15A). Venereal diseases, such as gonorrhea, chlamydia and ureaplasma have been found in the joint fluids of many people with arthritis (16). People with reactive arthritis are more likely to have staph aureus in their noses (17) and carry higher antibody titre against that germ (18). Many people with reactive arthritis have had chronic lung infections, caused by mycoplasma and chlamydia, prior to getting joint pains(20,21). Mycoplasma has been found in joint fluid of people with arthritis (28,29). The treatment of arthritis with antibiotics is controversial and not accepted by many doctors; discuss this with your doctor.
26) JR Odell, CE Haire, W Palmer, W Drymalski, S Wees, K Blakely, M Churchill, PJ Eckhoff, A Weaver, D Doud, N Erikson, F Dietz, R Olson, P Maloley, LW Klassen, GF Moore. Treatment of early rheumatoid arthritis with minocycline or placebo: Results of a randomized, double-blind, placebo-controlled trial. Arthritis and Rheumatism 40: 5 (MAY 1997):842-848. In patients with early seropositive RA, therapy with minocycline is superior to placebo.
REACTIVE ARTHRITIS
2010
I am amazed that more doctors do not treat at least some of their arthritis patient with antibiotics because there are hundreds of papers showing that many different infections cause arthritis. Doctors do not have laboratory tests to diagnose all of the germs that cause arthritis. Failure to treat arthritis early can cause permanent cartilaginous damage so that no treatment can be effective later. The most common cause of arthritis, particularly in people under 50, is reactive arthritis that often follows an infection.
If you develop sudden unexplained pain in one or more joints, your doctor should check you for an infection. You should be asked if you have a urinary tract infection: burning on urination, discomfort when your bladder is full, a feeling that you have to urinate all the time, getting up in the middle of the night to urinate. Check for a stomach infection: belching and burning in stomach or chest. Check for a lung infection: chronic cough, shortness of breath, wheezing, burning in your nose or soreness in your throat. Check for intestinal infection: diarrhea, belly cramps or blood in stool. Also check for gum disease, chronic stuffy nose, chills or fever.
The following are just some of the infections that can cause reactive arthritis: Salmonella, mononucleosis, parvovirus, chronic hepatitis B virus and hepatitis C virus, retroviruses, chlamydia, mycoplasma, ureaplasma, gonorrhea, gardnerella, Human T Cell Leukemia Virus-1, many different intestinal infections, Lyme disease, cytomegalovirus, streptococcal sore throat, cat scratch disease, human herpes virus-6, hemophilus influenza bacteria, AIDS (HIV), and staph aureus. References are listed below.
I treat my reactive arthritis patients with Minocycline 100 mg twice a day, but this must still be considered experimental; many doctors are not yet ready to accept antibiotics as a treatment for reactive arthritis. Many patients with reactive arthritis do not feel better for the first few months after they start taking minocycline. If a patient does nor feel better after taking 100 mg of minocycline twice day for 2 months, I add Zithromax 500 mg twice a week. If the patient does not feel better after taking the two antibiotics for 6 months, I do add the immune suppressants that most rheumatologists prescribe. But as soon as they feel better, I stop the immune suppressants and continue the antibiotics. The treatment of reactive arthritis with antibiotics is controversial and not accepted by many doctors; discuss this with your doctor. More on treatment of arthritis
6)S Francois, G Guyadiersouquieres, C Marcelli. Reactive arthritis due to Gardnerella vaginalis – A case-report. Revue du Rhumatisme 64: 2 (FEB 1997):138-139.
29) MC Jendro, G Weber, T Brabant, H Zeidler, J Wollenhaupt. Reactive arthritis after cat bite: A rare manifestation of cat scratch disease – Case report and overview of the literature. Zeitschrift Fur Rheumatologie 57: 3 (JUN 1998):159-163.
Why I Prescribe Antibiotics
2005
I am often asked why I prescribe antibiotics to my patients with rheumatoid or reactive arthritis, late-onset asthma, Crohn’s disease, fibromyalgia and other so-called “autoimmune diseases”. Before I prescribe any medication, I ask myself whether it will help or hurt. All of the “auto-immune” diseases cause severe disability. Conventional medications neither cure these diseases nor stop the progressive destruction that they cause. Doctors prescribe immune suppressives that sometimes have deadly effects. Antibiotics are far safer than the drugs conventionally used to treat these diseases. So, if antibiotics can be shown to help control these diseases, they should be used long before a doctor thinks of using the conventional immune suppressives.
When a germ gets into your body, you are supposed to produce cells and proteins called antibodies that attach to and kill that germ. These diseases are felt by many doctors to be caused by your own immunity. Instead of doing its job of killing germs, your immunity attacks your own tissue. If it attacks your joints, it is called reactive arthritis; if it attacks your intestines, it’s called Crohn’s disease; your colon, it’s called ulcerative colitis; and if it fills your lungs with mucous, it’s called late-onset asthma. I do not believe that your immunity is that stupid. Accumulating data show that all of these conditions can be caused by infection. Many diseases that were thought to be autoimmune turn out to be infections: stomach ulcers are caused by bacterium, helicobacter pylori and others; multiple sclerosis may be caused by HHS-6 virus; rheumatic fever is caused by the bacterium, beta streptococcus, group A; Gillian-Barre syndrome may be caused by the bacterium, campylobacter; Crohn’s disease and ulcerative colitis by E. Coli, Klebsiella, Bacteroides or Mycobacterium avium paratuberculosis; and so forth.
Shouldn’t We Be Concerned About Resistant Bacteria?
The argument that giving antibiotics causes bacteria to be resistant to that antibiotic is reasonable, but it has no place in discouraging people with these diseases from taking them. First, these people have serious diseases that cause permanent damage and death. Second, the treatments that are available are toxic, shorten life, cause cancer, and have to be followed with frequent blood tests. On the other hand, I prescribe derivatives of tetracycline and erythromycin. These drugs are extraordinarily safe and do not require drawing frequent blood tests. If you were to become infected subsequently with bacteria that are resistant to these antibiotics, you would have lost nothing. No reasonable doctor would prescribe erythromycin or tetracycline for acute serious diseases, such as meningitis, pneumonia or an abscess, because tetracyclines and erythromycins do not kill germs, they only stop them from multiplying. Instead, doctors prescribe far more bacteriocidal antibiotics that kill bacteria.
Many doctors criticize my use of antibiotics, but antibiotics are far safer than conventional treatment, cost less, can be administered by a general practitioner, and often cure the condition, rather than just suppressing symptoms. I know that the most physicians who develop these conditions will treat themselves with antibiotics because they know that conventional treatments with prednisone, chloroquine, azathioprine and methotrexate are toxic, and treatment with erythromycins and tetracyclines is safe. However, treatment of many conditions with long term antibiotics is controversial and not accepted by most doctors; discuss your particular condition with your doctor.
How you can help to prevent antibiotic-resistant bacteria:
Suffer through short-term illnesses. Don’t ask your doctor for antibiotics when you have a cold, flu or other self-limiting illness. You may feel miserable, but antibiotics are useless against viruses.
Finish your prescription. If you stop taking a prescribed antibiotic as soon as you feel better, you encourage the development of resistant organisms.
Become a vegetarian. The bulk of antibiotics are given to animals raised for food. As long as humans demand huge amounts of meat, farmers will use whatever means they have to deliver their product economically.
Definitions:
Bacteriocidal Antibiotics, such as penicillins and cephalosporins, kill bacteria. They are used to combat most bacterial infections, particularly acute, serious diseases such as meningitis, pneumonia, a ruptured intestine or an abcess. However, most bacteriocidal antibiotics are not effective against chlamydia, mycoplasma or ureaplasma, bacteria that have no cell walls.
Bacteriostatic Antibiotics such as tetracyclines (including doxycycline and minocycline) and erythromycins (including Biaxin and Azithromycin) keep bacteria from multiplying. Your own immunity is then able to kill the bacteria and remove them from circulation.