HealthTalk.com transcript excerpt: Antibiotic Therapy & RA

[Guest guest]

Antibiotic Therapy & RA

October 16, 2002

:

I understand sometimes rheumatologists prescribe

antibiotics. Explain.

Dr. Schiff:

The antibiotics story is very interesting, and it's

very old. Many people who have rheumatoid arthritis, and I'm sure many

people listening to this who have arthritis, think of their arthritis

sort of like having a bad flu. They feel fluish all the time with

fatigue. They have aches and pains in their muscles and their joints,

and it just feels like you have the bad flu that just lasts the last ten

years. And it would suggest that maybe there's an infectious trigger.

Rheumatoid arthritis oftentimes, , will start acutely or suddenly,

and oftentimes will follow an infection so that there was a lot of

interest, and there has been for many, many years, looking for the

infectious cause or trigger of rheumatoid arthritis, and this has not

been found.

That's a backdrop to say that we do use an antibiotic

for rheumatoid arthritis, but not because it is an antibiotic that's

killing bugs in our system. It's because an antibiotic called

minocycline, which is a tetracycline derivative -- this is the

antibiotic that all of our teenage kids have taken for years for acne,

so it's a pretty safe antibiotic -- has been shown by a research group

headed by Dr. O'Dell at the University of Nebraska to improve

rheumatoid arthritis. We think it works not because it's an antibiotic

but because it inhibits a specific protein or enzyme which causes

inflammation and cartilage degradation or decrease in rheumatoid

arthritis.

So, personally, I use minocycline in very early

patients when I'm deciding whether they should be on methotrexate or a

biologic. I use it in patients with very mild arthritis. But if the

patients have more long-standing or severe rheumatoid arthritis, I skip

minocycline and either go to methotrexate or a biologic.

http://www.healthtalk.com/rheumatoidarthritis/talks/edition8/page11.cfm

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org