Mycoplasma’s
Role in Rheumatoid Arthritis (RA) and Other Autoimmune Disorders
© 2004 Katherine Poehlmann, Ph.D.
The Inflammation Process
Symptoms of pain, swelling, warmth, and redness associated
with impact trauma or muscle damage are usually beneficial. Cells of the immune
system are attracted to the injured area where they fight any infection, then
clear away the debris in preparation for tissue regrowth and repair.
Chemicals such as cytokines and prostaglandins work in
concert to control the infection process, and are released in an orderly and
self-limiting manner. When the process does not stop at the appropriate time,
the immune system continues to fight in an active and destructive state. The
constant activity leads to chronic fatigue, a diminished energy level,
curtailed oxygen transport, increased interferon activity, and an overworked
thyroid leading to exhaustion. Mycoplasma grows best when the thyroid is in
hypo state, i.e., when it is minimally active.
Many of the natural chemicals and destructive enzymes
generated by the immune system can, over time, cause damage to cartilage. The
drugs prescribed to relieve RA pain are in fact trying to inhibit this natural
chemical overproduction but they do not remove the root cause of the
inflammation.
Autoimmune Reaction
All RA forms have an inflammatory
component and show evidence of connective/synovial tissue damage. These are
indicators of a process resembling the autoimmune reaction where the
body inexplicably attacks its own cells. In RA, the reaction is actually the body’s natural
allergic response to an infection in the connective tissues. This battle is the
cause of the inflammation, pain, and disfiguring effects of RA since the
disease agent is connected to the cell by various forms of comingling of
foreign and host DNA. When the disease agent is
removed, the attack stops.
The autoimmune theory has become so entrenched in American medical school teaching that other options have not been considered until very recently.[1] With PCR analysis of synovial fluid it is possible to detect the genetic material of the mycoplasmal microorganisms, L-forms, and other agents triggering rheumatoid arthritis and reactive arthritis. Much of the research is originating outside the United States, but American scientists are now starting to explore the possibility of bacterial infection in RA, confirming the findings of Dr. Thomas McPherson Brown.[2]
Mere fragments of mycoplasma are sufficient
to create a powerful antigenic reaction in the joints that causes the body to
produce antibodies to counter it. The antibody reaction may be mainly against a
“host antigen” carried on the mycoplasmal membrane. It may be a reaction to a
hybrid antigenic molecule formed by a comingling of invader surface shape with
toxins or food molecule shapes.
Patients with other diagnoses,
such as Lyme Disease or Fibromyalgia, who test positive for Mycoplasma
or Chlamydia strains or other bacteria and nanobacteria also
exhibit RA indicators and symptoms.
Mycoplasma’s Role in
Autoimmune Disorders
Mycoplasmas and bacterial L-forms are resident, in vivo
parasitic “invaders” that become active from time to time to obtain nutrients,
expel wastes, breed, and migrate in and out of the body to form new colonies.
These actions precipitate an allergic reaction that appears to be an autoimmune
disorder since no external cause for the reaction is detected by routine
testing methods. In vitro cultures are slow and usually fail to detect
mycoplasmas and L-forms.
Mycoplasmas exhibit cloaking behavior in several ways: cell
shape modification, infiltration of T-cells, and mimicry of normal cells.
Mycoplasmas and L-Forms
We carry mycoplasmas and L-forms with us as remnants of
childhood infections such as pneumonia, strep throat, bronchitis, rheumatic
fever, or other early illnesses. Microorganisms such as mycoplasmas often lie
dormant, waiting for conditions to be favorable for propagation. This could
explain conditions such as rheumatoid arthritis, Chronic Fatigue Syndrome
(CFS), or Gulf War Illness, which seem to strike suddenly. There are possible viral
co-factors such as herpes simplex or strep pneumonia that can form deadly
combinations.
Chronic pneumonia is a good prototype for what happens when
a mycoplasma infection becomes fixed around a certain area. Nodules of
granulation material—inflamed tissues that surround the infectious organism for
months—produce the characteristic cough of the disease. A similar phenomenon
happens around the RA sufferer’s joints.
During the inflammation reaction, the body responds by moving calcium to
the site, forming nodules—dry, gritty, calcium hydroxyapatite crystals—that
clump around the invading microbes.
The body must be trained to defend itself with minimal help
from external agents such as antibiotics. This is the reason for very low
antibiotic dosage over a period of weeks or months recommended by Dr. Brown. In
parallel, one must take steps to strengthen the immune system through diet,
exercise, and other healthy lifestyle changes.
Other contributing factors to poor health can
be traced to specific systems: e.g., diabetes to the circulatory system,
thyroid problems to the endocrine system, and so forth. Working together with a
specialist in these areas will hasten recovery.
In time, it is possible to wean oneself away from
antibiotics.
The Puzzle of RA Flare-Ups
One of the enduring puzzles of
so-called autoimmune disorders is that they all go through cycles of
exacerbation and remission. Hundreds of experiments on animals have proved that
mycoplasmas are important cofactors in arthritis and other chronic rheumatic
disorders and that the tetracycline family of antibiotics suppresses
mycoplasmal infections. Immune system control mechanisms appear to be cyclic in
nature due to time lags in other regulatory processes (digestion, sleep cycle,
etc.)
Mycoplasmas are capable of
long-term intercellular in vivo survival and slow, intracellular
replication, so they may be resident and waiting for some trauma or barometric
pressure changes to activate them when the host’s immune system has moderated
its operation. Thus the progression of the infection is cyclical, with waves of
reemergence followed by withdrawal to less detectable forms.
Therefore, when mycoplasmas act
as antigenic substances, triggering internal allergic responses, they release
toxins intermittently to a sensitized area, subsiding and then reappearing.
Antibodies move through the body via white blood cells and platelets, and it is
through this means that RA migrates from shoulder to hand to knee as the
antibodies launch counterattacks against local antigens and toxins. The
antibodies move on to new battlefields whenever migrating pathogens like
mycoplasmas flare up.
This type of ebb and flow
explains the types of flare-ups that RA sufferers describe.
RA Triggers
The apparent causal relationship between changes in the
weather and RA pain can be explained. Clinical evidence shows that two
environmental factors can cause flare-ups: (1) a sudden drop in barometric
pressure and (2) the presence of high humidity in conjunction with this drop.
The aches and pains correspond to a sudden release of antigens to a sensitized
area, confirming Dr. Brown’s theory that migrating or shape-changing
mycoplasmas act as antigenic triggers.
As the microorganisms migrate out of the body they stimulate respiratory
distress, thus broadcasting their seeds via effluvia (e.g., sneezing) to other
mammalian hosts.
Trauma to joints and tendons may cause structural changes,
further reducing oxygen transport and limiting removal of fluids and wastes in
the region of the injury. The lack of oxygen in the traumatized area increases
pressure and swelling. The usual
treatment is anti-inflammatory drugs. For the COX-2 enzyme to work, the body
needs sufficient copper and zinc. Hyaluronidase enzymes are destructive and
facilitate bacterial reproduction. Vitamin C thwarts hyaluronidase
Mycoplasma are borderline anaerobes. That is, they are
sensitive to changes in barometric pressure. They move about the body in search
of more comfortable places to reside. This movement triggers the inflammation response
from the immune system. Hyperbaric oxygen treatments force oxygen into
compromised cells and tissue, thus allowing the infection-fighting function of
white blood cells to proceed.
Aerobic exercise, deep breathing,
use of a slant board are recommended. DMSO and other topical salves help
improve circulation to the affected areas. Coenzyme Q10 and anti-oxidant vitamins are worthwhile supplements.
RA Treatment
Dr. Brown’s research showed that
when tetracycline is used to suppress the defensive envelope the organism
builds around itself, the body’s own disease-fighting capability can combat it
effectively and the RA is eventually driven into remission. Tetracycline
antibiotics are among the few that are effective against virtually all species
of mycoplasmas, with relatively low toxicity and few side effects. Physicians
have used oxytetracycline long term for decades to treat adolescent acne with
minimal adverse effects.
Test results from individuals
suffering from arthritis who participate in double-blind tests with
tetracyclines are not typically interpreted correctly because these tests are
designed to look for a rapid linear response within a six-month period. Some
chronic disease conditions do not react to a long-term, low-dose antibiotic
treatment in such a short amount of time. Some conditions may require years,
often because other co-factors are present and not corrected.
These antibiotics are so
effective in suppressing mycoplasmas in RA that a reaction called the
Jarisch-Herxheimer effect develops on initial use.
The Jarisch-Herxheimer
Reaction
The fact that tetracycline causes the Jarisch-Herxheimer
reaction demonstrates the presence of infection. There may be more to it than
that. The reaction manifests itself as a worsening of existing symptoms. It is
caused by the rapid death of a colony of parasitic microorganisms releasing
their internal toxic contents in situ. With precise testing for
mycoplasmal microorganisms and L-forms, perhaps by PCR or biochip methods, it
may be possible to trace the origin of the infection and to see the
relationship, for instance, between folic acid and fat-molecule destruction.
According to Dr. Brown, with a bacterial allergy the
mycoplasma creates a barrier around itself that keeps the immune system’s
natural disease-fighting antibodies at bay. Tetracycline works by suppressing
this barrier, the mycoplasma’s means of defense. Research is underway to
determine exactly what consitutes this barrier: toxins, lipids, or enzymes.
Natural antibiotic or antibacterial substances such as
immune system-enhancing herbs and tonics may also produce a Jarisch-Herxheimer
effect. As soon as this “allergic reaction” is noted, the individual should
stop intake of the substance because the body’s immune system needs time to
train itself to deal with the infection and become stronger.
Dr. Mercola has found that those of his patients who follow
strictly prescribed nutritional guidelines rarely experience a
Jarisch-Herxheimer reaction. Supplements of vitamins C and B6 are
helpful in countering the body’s excessive histamine production during the
course of the reaction.
This treatment method may seem counterintuitive, but it
follows standard allergen immunization principles. The Jarisch-Herxheimer
effect to some extent indicates success, but it cannot be endured for long
without considerable discomfort, so treatment should be temporarily suspended
or dosage reduced. Periodic resumption should be tried until the person
gradually becomes immunized to the allergy trigger. The allergic reaction
diminishes as the population of the invading organism is driven to manageable
levels.
Cortisone or other corticosteroids or antihistamines may be
used in conjunction with tetracyclines to permit higher doses of the antibiotic
with acceptable levels of allergic reaction.
Some RA Success Stories
Test results from individuals suffering from
arthritis who participate in double-blind tests with tetracyclines are not
typically interpreted correctly because these tests are designed to look for a
rapid linear response within a six-month period. Some chronic disease
conditions do not react to a long-term, low-dose antibiotic treatment in such a
short amount of time. Some conditions may require years. When the treatment is
discontinued, a relapse occurs. These antibiotics are so effective in
suppressing mycoplasmas that a reaction called the Jarisch-Herxheimer effect
develops.
One 1995 study[3] showed that RA may be
caused by, exacerbated by, or have relapses triggered by a persistent infection
of Mycoplasma or Chlamydia. Treatments with minocycline have shown positive results.
This study is significant because it was conducted over the course of nearly a
year. Some of the 219 participants were as young as 18 years of age. The
improvement associated with the minocycline treatment suggests that a longer,
protracted infection such as that caused by mycoplasmas contributes to RA.
Another minocycline study showed as much as 50 percent improvement for 65
percent of the test subjects.[4]
Dr. Gabe Mirkin notes that five significant
controlled studies show that minocycline drops the rheumatoid factor towards
zero and helps both to alleviate pain and to retard cartilage destruction in
rheumatoid arthritis patients.[5] In his August 1999
newsletter[6], Dr. Mirkin cites a study[7] showing that more than half
of RA sufferers are infected with mycoplasma. He has treated his patients
successfully with minocycline.
Dr. A. Robert Franco, head of the Arthritis
Center of Riverside, CA, has treated over 1,000 RA patients successfully with
Dr. Brown’s antibiotic regimen since 1988.[8]
A summary of reported statistics shows 30-40%
probability of complete remission using Dr. Brown’s treatment, and 70-80%
probability of significant reduction of symptoms. That’s the good news.
The Bad News
The featured presentation at the American
Academy of Rheumatology in 1997 demonstrated that minocycline is the safest and
least costly drug for RA, and is also the most effective when given prior to
extensive cartilage damage has occurred.[9] Dr. Mirkin deplores the
fact that despite hundreds of papers showing that hundreds of different
infections cause arthritis, most rheumatologists continue to treat RA with
immunosuppressing drugs because they consider RA to be an autoimmune disease.
According to Dr. Mirkin, these dangerously toxic drugs shorten the patient’s
life by an estimated ten years and increase cancer risk six fold.[10] The drugs are highly
expensive, and merely dull pain rather than target the infection.[11]
Trapped Toxins
When antigens and antibodies
clash, the result is destruction of cells and a sudden release of toxins, which
are composed of a variety of diverse components—proteolytic enzymes, kinins,
kallikreins, histamines, hydrogen peroxide, and other irritants. The result of
the struggle is pain and inflammation.
As the mycoplasma antigen
migrates to a new area, the antibodies follow it to this new combat zone,
leaving the former battlefield to rest and heal, but the toxins released by the
antigen-antibody conflict are often trapped in pockets of the bursa and are not
promptly expelled through the various elimination organs of the body.
These trapped toxins can create a
mass of fluid or scar tissue that can bring pressure to bear upon the joints
when blood vessels expand. Gravity assists in trapping toxins in the
lower-extremity joints of the knees and feet. Excess weight and ill-fitting
shoes, especially high heels, will exacerbate the pressure and pain on these
swollen, irritated tissues.
Clearance of bacteria from soft tissues
appears to be of low priority importance as a host-defense mechanism during
soft-tissue infection. It may be that this is the reason mycoplasmas are able
to establish a foothold early and have time to adapt to later assault by
antibiotics.
Neutralizing Harmful Toxins
and Enzymes
In those cases where the particular pathogen is unknown or
in doubt, it is more effective to target and neutralize the irritants as a
first step, without identifying the organism producing them.
OTC anti-inflammatories and antihistamines can help. Sports
doctors treat injured athletes with beneficial enzymes like bromelain and
papain.
Other benign ways to expel these accumulated toxins are
localized massage, herbs that stimulate circulation and eliminate toxins,
increased water intake, and daily low-impact aerobic exercise followed by
elevation of the lower legs to above-heart level several times per day using a
slant board. The toxins will be loosened and drain into the bloodstream to be
eliminated by the kidneys, skin, and lymphatic system.
Topical application of DMSO may also be helpful in reducing
pain and swelling, in combination with topical oil of wintergreen (methyl
salicylate) -- like liquid aspirin.
One aspect of RA allergic flare-up appears to be related to
certain toxins, for example, salmonella toxin, where studies have found
arthritis-causing genetic marker HLA-B27. In some instances, a defective
HLA-B27 gene generates a molecule with a structural weakness causing it to fold
up and become useless.
HLA-B27 is found on the surface of white blood cells of
about eight percent of the population. More than 50 percent of adults who have
rheumatoid arthritis also have the inherited marker HLA-DR4. Having this marker
increases one's risk of developing RA four fold. Furthermore, research indicates that these genetic markers may
predispose individuals to contract arthritis after particular infections, such
as gastrointestinal infections, urinary tract infections, or diarrheal food
poisoning. The linked cluster of genes, HLA-D4, occurs more frequently in
people with RA
Clues might be found in the toxin or enzyme
generated by the microbe, e.g., the correlations listed in the IBM
Bio-Dictionary Annotation between Mycoplasma pneumonia and the
COX-2 enzyme. Some of these destructive enzymes are collagenase, hyaluronidase,
and penicillinase.
Allergic reactions
An allergic response, whether to an internal or external
substance, is really a stimulation of the immune system to develop a specific
antibody, immunoglobulin E (IgE). The IgE antibodies attach themselves to mast
cells to prepare to ward off the invaders. As the offending substance (e.g.,
ragweed pollen) enters the body, it bumps against these primed mast cells and
sets off their histamine chemicals. Destructive H2O2 is
also released.
Mycoplasmas’ behavior is cyclic in nature. They often
persist in metabolically inactive states where a few are released from cells,
followed by more active states where many are released. Whatever the trigger,
over a period of months or years the body creates fixed-tissue antibodies that
are poised and ready to react to the released toxins whenever and wherever they
appear. The body thus learns to react to mycoplasmas in the same way it learns
to react to a substance like poison ivy. Antibody reactions alone cannot
suppress mycoplasmal infections. This may be why efforts to develop vaccines
against mycoplasmas have not been successful.
Over-the-counter (OTC) antihistamines such as
chlorophineramine maleate have been shown to reduce the severity of rheumatoid
arthritis attacks by mitigating joint pain.
However, one should not rush to swallow antihistamines at
the first sign of sneezing. Instead, one should find ways to avoid allergens
from animals, dust mites, molds, grasses, detergents, and foods by identifying
the circumstances under which allergies strike, then removing the offending
agent. The process may be as simple as cleaning furnace filters or installing
electrostatic air cleaners in the home or office to keep dust levels to a
minimum.
Food allergies are especially important. Reactions can be
delayed as long as 72 hours. Testing can be a worthwhile investment. RA
symptoms can result from Candida overgrowth. Bacteria thrive in a sugary
environment. Diabetics are at risk to developing infections, and people with
bacterial infections are at risk for diabetes.
Thyroid Health is Vital
Many of these symptoms apply to
MS in particular, but some are experienced in a wide variety of autoimmune
disorders. They are the classic set of symptoms for thyroid dysfunction, which
has been shown to be linked to mycoplasma infection.
One of two types of
antibodies—thyroperoxidase or thyroglobulin—is found in nearly all
patients with hypothyroidism (Hashimoto’s thyroiditis) and in approximately 50
percent of those with hyperthyroidism (Grave’s Disease).
According to the Thyroid Society,
twenty million Americans have some form of thyroid dysfunction but many are
undiagnosed or misdiagnosed. The thyroid gland controls the body’s metabolism
by producing hormones that regulate energy, control heart rate and body weight,
and determine how the body uses nutrients. Thyroid test results, therefore, can
be a valuable indicator of nutritional balance and efficient use of hormones.
An endocrinologist should be consulted.
Since disease often begins when
the immune system is dysfunctional or weakened, a nutritional analysis should
be a starting point.
Tests for Microbial
Infection
The principal tests helpful in diagnosing
microbial infections are: Polymerase Chain Reaction (PCR), Tetracycline (as a
probe), Erythrocyte Sedimentation Rate (ESR), Interferons, Rheumatoid Factor
(R-factor), Neutrophil Testing, Joint Scan, Genetic Markers, Antibody tests.[12]
All laboratory test results must
of course be interpreted in the context of the patient’s overall health. Other
factors influencing test results may be drugs the patient is taking, foods
ingested before the test, how strictly the patient followed pretest
instructions (e.g., fasting), and variations in laboratory procedures and
techniques.
Some fundamental questions arise
concerning the reliability of any diagnostic test involving organic samples,
which may be collected exactly according to procedure at the doctor’s office,
but may suffer damage in transit to the lab. Sensitivity to time, temperature,
humidity, altitude, and other factors may influence test results by altering
the sample before the lab technician begins to examine it. False positives or
out-of-range values may result. Several tests may be required to obtain an
average. Internet resources can help interpret test results and augment the
physician’s assessment.
Many CFS and Fibromyalgia
patients have a systemic cytomeglovirus infection. Dr. Garth Nicolson
recommends testing for this infection in any instance of autoimmune illness.
Conclusion
Dr. Brown and his associates
accumulated significant evidence that mycoplasmas and their L-forms were at the
root of RA. They discovered that tetracyclines were a group of antibiotics that
could kill or radically suppress mycoplasma and L-form growth. They also found
that tetracyclines could help RA conditions to improve when administered in a
low, controlled dose over a long period (months to years), depending on the
severity of the condition and whether there were other bacterial complications
adding to the sensitizing process. In these cases other antibiotics could treat
the other bacteria. This approach will gradually bring the infection(s) to
within manageable bounds.
Large doses of Vitamin C (3-5 grams daily) will thwart
destructive enzymes like hyaluronidase that destroy connective tissue
Gentle aerobic exercise daily will oxygenate cells and
flush toxins from the body. Use a slant board (ten minutes twice per day).
Drink 8 glasses of pure water daily (2 sports bottles)
The right nutrition is essential for a healthy body. “We
are what we assimilate.” Cells take in useful nutrients and begin the
repair process, then discharge waste chemicals. Toxins are naturally excreted
if circulation is good (blood and lymph), immune system in strong, endocrine
functions are working effectively.
*******30*******
Dr.
Poehlmann is the author of Rheumatoid Arthritis: The Infection Connection,
available on Amazon.com and at major bookstores, or click here to order now.
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[1] The autoimmune theory is underscored repeatedly in immunology textbooks and also in the publication of the Arthritis Foundation. E.g., Purpura, Mary, “One Person’s Stress is Another Person’s Challenge.” Arthritis Today, March/April 1997, and also Dinsmoor, Robert and Kahn, Cynthia, “Smart Drugs.” Arthritis Today, January/February 1996.
[2] See www.rheumatic.org for paper citations, case studies, laboratory results, abstracts, and so forth. An impressive paper by Dr. Joseph M. Mercola, “Protocol for Using Antibiotics in the Treatment of Rheumatic Diseases,” can be found at www.mercola.com. The paper was presented at the 31st Annual Meeting of the American Academy of Environmental Medicine in Boston, MA in October 1996. Dr. Mercola lauds Dr. Brown’s pioneering work in mycoplasma research and tetracycline treatment.
[3] Tilly, B.C.; Alarcon, G.S.; Heyse, S.P.; et al “Minocycline in Rheumatoid Arthritis: a 48-week, Double-Blind, Placebo-Controlled Trial.” Ann Int Med 1995;122:147-148.
[4] O’Dell, J.R.; Paulsen, G.; Haire, C.E.; et al. “Treatment of Early Seropositive Rheumatoid Arthritis with Minocycline: Four-year Followup of a Double-blind, Placebo-controlled Trial.” Arthritis and Rheumatology 1999;42:1691-1695.
[6] Mirkin, Dr. Gabe. “Mirkin Report for Healthier Living.” August 1999.
[7] Rheumatology 1999;38(6): 504-509
[8] See www.thearthritiscenter.com/arthritis_info.htm#Anchor-Infections-11481. This is an excellent and comprehensive website. The Arthritis Center is located at 4000 14th Street, Suite 511, Riverside, CA 92501. Phone: (909) 788-0850.
[9] O’Dell, et al. “Minocycline Therapy for Early Rheumatoid Arthritis Continued Efficacy at Three Years.” Annual meeting of the American College of Rheumatology. November 9, 1997.
[10] Mirkin, Dr. Gabe. “Mirkin Report for Healthier Living.” August 1999.
[11] Mirkin, Dr. Gabe. “Reactive Arthritis.” June 3, 1999. From the Internet at www.drmirkin.com/joints/J159.htm.
[12] These and other tests are described in detail in chapter 6 of Rheumatoid Arthritis: The Infection Connection by Katherine M. Poehlmann, Ph.D. Satori Press, 2002.