Antibiotics to Treat RA: What Is the Evidence?

Over the past 2 years I have successfully treated a number of patients with rheumatoid arthritis (RA) using a combination of gemifloxacin and doxycycline. A 1-month course of these antibiotics has resulted in a 50% to 90% long-lasting improvement in symptoms in about two-thirds of the patients treated. Many of these patients had received standard antirheumatological agents for years. Is antibiotic therapy for RA on anyone’s radar screen?

— Stephen Replogle, DO
     Yuma, Ariz

At least 2 double-blind, randomized, placebo-controlled trials have shown that minocycline(Drug information on minocycline) is superior to placebo for relief of signs and symptoms of RA.^1,2 In addition to their antibiotic activity, the tetracyclines are nonspecific inhibitors of matrix metalloproteinases, such as collagenase, and this is thought to be the mechanism of action responsible for their effect in RA. No data are available on the effectiveness of tetracyclines in preventing structural damage in RA.

The use of antibiotics in RA has been promoted by the Road Back Foundation,³ which has sought to disseminate the work of the late Thomas McPherson Brown, MD, a Johns Hopkins–trained rheumatologist who claimed to have isolated an infectious agent from the joint fluid of a patient with RA back in the 1930s and who spent the remainder of his professional career using an antibiotic protocol to treat RA.

Most rheumatologists do not favor the use of tetracyclines to treat RA because other agents are thought to be superior. In addition, most do not accept the hypothesis that RA should be treated as an infection.

—Richard Brasington, MD
   Professor of Medicine
   Director of Clinical Rheumatology
  Washington University School of Medicine
  St Louis