A new study adds support to the idea that rheumatoid arthritis (RA) is triggered by the immune system battling an infection. This support surprisingly comes from a study showing that antibiotics were not helpful for treating symptoms of the more common “wear and tear” arthritis (called osteoarthritis)1.
Why is This Important?
Earlier research showed that tetracycline antibiotics (e.g., minocycline or doxycycline 100 mg twice daily) had a marked effect on decreasing the symptoms in rheumatoid arthritis. Unfortunately, because these antibiotics are dirt cheap ― about $5 per month (they are no longer under patent) ― as compared to newer treatments which often cost about $1,500 per month, there is little financial motivation to get the information to physicians about the use of antibiotics for rheumatoid arthritis. When the studies first came out, many physicians ignored it by saying they thought it was because of the antibiotics having an anti-inflammatory effect instead of there being an infection (who cares — it helped and was safe!). As is often the case when a treatment used by holistic doctors is shown to work, the research is simply ignored.
The Standard Approach to RA Treatment
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Judicious use of glucocorticoids (Prednisone)
- Early use of disease-modifying anti-rheumatic drugs (DMARDs) such as the chemotherapy drug methotrexate
- Biologic Response Modifiers such as the Enbrel family medications
Often people continue to have problems despite these aggressive therapies.
Natural and Holistic Medicine Alternatives
Many natural remedies are very helpful for rheumatoid arthritis, including adopting a vegetarian or Mediterranean diet, cutting down on sugar intake, exercising (as approved by your physician), taking ginger and taking a good multivitamin.
In this article, however, I'll look at antibiotics ― which holistic physicians have recommended for RA for over 40 years. This work was largely advanced by the late Dr. Thomas McPherson Brown and The Road Back, a book about Brown’s lifetime of research.
Let’s look at a few studies using antibiotics for RA:
1. Let’s begin with information from a 1995 NIH press release on the "Minocycline in Rheumatoid Arthritis (MIRA) Trial"2: “Results of a 48-week multicenter clinical study of 219 adults with rheumatoid arthritis show that the drug minocycline reduces joint pain and swelling and is safe in patients with mild to moderate disease. Findings of the minocycline in Rheumatoid Arthritis (MIRA) Trial are reported in the January 15  issue of Annals in Internal Medicine… 'Minocycline is another drug to add to the armamentarium of treatments for rheumatoid arthritis,' said Michael D. Lockshin, M.D., acting director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The MIRA Trial was conducted at six clinical centers across the United States and supported by research contracts from the NIAMS, a component of the National Institutes of Health (NIH)… At the end of the 48 weeks, 54 percent of patients taking minocycline and 39 percent of patients taking the placebo had at least a 50 percent improvement in the number of swollen joints. In terms of joint tenderness, 56 percent of the minocycline group and 41 percent of the placebo group had at least a 50 percent improvement"2.
2. In a 1997 study, 65% of the RA patients treated with minocycline met the 50% improvement criteria at 3 months, and maintained at least a 50% improvement for 6 months with no significant drug toxicity, vs. only 13% of those treated with placebo (P < 0.001)3.
3. By 2001, 4 double-blind studies showed doxycycline to be effective in RA (and it is remarkable that these studies were able to be done without drug company funding). In a 2001 study4, the authors concluded “Four double-blind clinical trials have now clearly established the efficacy of minocycline in the treatment of RA. The mechanisms of action of almost all therapies for RA are poorly or incompletely understood; tetracyclines are no exception...Whether RA is caused, triggered, or perpetuated by an infectious agent or agents is still not delineated... it is possible, perhaps even likely, that suppression of infections in a nonspecific manner, thus decreasing the stimuli for TNFα production, may play a role in the treatment of RA. Indeed, the current study and all 3 of the above-mentioned previous studies have shown that minocycline therapy is a potent suppressor of the erythrocyte sedimentation rate and C-reactive protein levels in RA... The MIRA data suggest that patients with more severe disease, i.e., epitope-positive patients, might benefit the most from minocycline therapy... Minocycline therapy can now be added to the list of viable options available as initial therapy for patients with RA” 4.
A few cautions with treatment:
- When initially killing off a chronic reaction, patients sometimes feel worse the first 2-6 weeks (called a Herxheimer or “die-off “ reaction) as the infection dies off. This is annoying, but usually a good sign and passes.
- Give 3-12 months to see the benefits. It can be taken with the other medications (except not with iron). The Minocin (minocycline) 100 mg 2x day is usually taken long term.
- The Minocin may cause sun sensitivity or increased skin pigmentation.
- Avoid sugar and move toward a vegetarian or Mediterranean diet.
Unfortunately, many physicians (including many rheumatologists) are not familiar with these studies, and may still look at you cross-eyed if you bring up antibiotics for RA. It seems ironic that long term doxycycline is readily prescribed for children with acne (which is not my first choice — I think many would have the acne clear a lot by cutting out sugar and milk products), but not for people with crippling RA. In my RA patients, I recommend doxycycline or Minocin early on in their treatment — along with a regimen of natural therapies. It is worth being aggressive in RA though, as early treatment improves long-term outcomes. It is good to know that the antibiotics minocycline and doxycycline add another helpful and low cost treatment for RA that you can ask your holistic physician about.
(1) "Extended report: The effects of doxycycline on reducing symptoms in knee osteoarthritis: Results from a triple-blind, randomized controlled trial." Ann Rheum Dis 2011. Published online first: 8 May 2011 doi:10.1136/ard.2010.147967.
(2) "Clinical Trial Shows Minocycline is Safe and Effective for Rheumatoid Arthritis." National Institutes of Health, January 14, 1995.
(3) "Treatment of early rheumatoid arthritis with minocycline or placebo: Results of a randomized, double-blind, placebo-controlled trial." J. R. O'Dell et al.
(4) "Treatment of early seropositive rheumatoid arthritis: A two-year, double-blind comparison of minocycline and hydroxychloroquine." Arthritis & Rheumatism. Volume 44, Issue 10, pages 2235–2241, October 2001.