Tetracyclines and Antibiotics

 

Theory / hypothesis: The Tetracyclines and hypothesis of RA - by drdoc on-line

I see the minocycline as having a mild to medium disease modifying activity in RA.
The early work by Thomas McPherson Brown - in advocating tetracyclines in RA was based on studies that were potentially flawed...with lack of controls etc..
I recommend that people read the history behind this as described in "Antibiotic therapy for RA - Trentham et al in Rheumatic disease clinics of N.America August 1995 page 817-834.

IN ALL only one GOOD PLACEBO CONTROLLED trial exists to suggest that minocycline is efficacious in RA.

However most people would say it has a mild effect... but FOR SOME PATIENTS it is highly effective.

It would seem that

It has some effect in 1/3 of patients.
It is ineffective in 1/3 of patients.
It is not tolerated because of side effect in 1/3 of patients

Therefore I see it as having a place in patients who haven't responded to standard DMARDS. It would be nice to see a trial in patients early in their disease- i.e. the first few months.

The Disease I feel is a multifactorial problem.
I hypothesise a genetically prone individual, whose immune system renders one unable to clear an infective organism adequately.
The organism may be INTRACELLULAR within the macrophages and hence shielded from most of the bodies defense mechanisms.
The agent may then display some of its particles on the macrophage or cell surface.
Therefore the body sees the presence of the agent and tries to mount an ineffective but aggressive immune response. Therefore the continued exposure of the antigen from such an organism ( which I think is more likely to be viral based) results in a autoimmune problem by molecular mimicry, rather than direct infection.
i.e. - the particles of the agent (the antigens )-RESEMBLE the tissue of the host, and therefore the host turns his/her immune system against itself.

Antibiotics don't treat viruses too effectively, but tetracyclines have a antiinflammatory, and an anticollaganase and an immunosuppressive role. This may explain its effect. I am unaware of any specific articles showing antiviral activity.

That's the theory of drdoc.

For an update on the use of minocycline in RA go to my minocycline page

 

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drdoc on-line
Rheumatologist
Cape Town
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