Can Antibiotics Treat Rheumatoid Arthritis?
When your doctor presents you with treatment options for rheumatoid arthritis (RA), it’s natural to feel more than a bit overwhelmed. That’s when many of us start consulting the deep recesses of a search engine. And that’s where you might find information about using antibiotics, particularly minocycline, for RA. Can this work?
The theory behind using antibiotics for RA
Antibiotics have been used for RA for almost 100 years. It started in the 1930s, when Dr. Thomas McPherson Brown posited that RA was caused by an infection.
Certain types of arthritis can be related to infection. This includes reactive arthritis, called Reiter’s Syndrome in the past, which is caused by a reaction to an infection, particularly in the genitals or bowel. As well, septic arthritis happens when a bacteria causes an infection in a joint. In both these cases, antibiotics may play a role in resolving the condition.
There is, however, not a lot of evidence to support the theory that RA is related to an infection. In fact, we have evidence to suggest that it isn’t. Biologics, which are immunosuppressants, are considered the most effective treatment for RA. If RA was related to an infection, suppressing the immune system would make it worse instead of better.
Do antibiotics control RA?
In 1995, a comprehensive study of the effect of minocycline on RA was performed. The double-blind and placebo-controlled study showed that the drug was effective and safe for people with mild to moderate RA. However: “There are limited data to demonstrate that minocycline prevents the development of bone erosions or otherwise reduces joint injury,” said Rajat Bhatt, M.D., a physician at Kadlec Rheumatology in Kennewick, Washington. In addition: “Minocycline has not been directly compared with sulfasalazine, methotrexate, or other major DMARDs in common use since the 1990s.”
Some people do report feeling better after a course of antibiotics. The tetracycline class of antibiotics in particular may have a temporary beneficial effect on RA as it inhibits enzymes that break down cartilage.
Should you take antibiotics for RA?
The American College of Rheumatology recommends that minocycline be used only “for patients without poor prognostic features, with low disease activity, and with short disease duration.” This represents a very small group of people with RA.
Even if you do fall within that group, there are added cautions in using antibiotics to treat RA.
“Rheumatoid arthritis is a chronic disease and we try to avoid antibiotics long-term, due to high chances of inducing drug resistance,” said Dr. Bhatt, further stating that doctors “always try to avoid chronic antibiotic use in any patient.”
Long antibiotic use can also lead to some unpleasant side effects. These include an alteration in the bacteria in the gut, leading other bacteria to take over, such as in the cases of C. difficile. As well: “Minocycline can occasionally induce lupus and can cause hyperpigmentation skin as well, thus can itself cause autoimmune disease,” explained Dr. Bhatt.
The reasons minocycline isn’t used very much to treat RA don’t stop with the concern about drug resistance and side effects. The best chance of inducing RA remission is to treat the condition early and aggressively to minimize damage to joints and other systems in the body. As mentioned above, minocycline is not enough for most people who have RA. Dr. Bhatt explained that: “Usually the patient will require other DMARD therapy to stop X-ray progression of joint damage.” A number of other DMARD medications have demonstrated their effectiveness in controlling RA and are therefor considered better options.
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