Talk:Rheumatoid arthritis
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Apparently, the disease is eased by pregnancy. This is probably because pregnancy induce higher concentration of female hormones in the body. "It is already known that female sex hormones play a large part in easing RA during pregnancy, but it is not known why." [1] Unsigned by User:Wk muriithi
- Ah, a news article. Many autoimmune disorders and some unsuspected others (multiple sclerosis, chronic fatigue syndrome) are eased by pregnancy. Sadly, they rebound mercilessly after parturition. Oddly, lupus erythematosus often develops during pregnancy. It is temping that fetal alloimmunisation is to blame, although nulliparous females and males also get lupus.
- This phenomenon has various explanations. Just "female hormones" does not explain this at all, because females are much more at risk for autoimmune disease than males (up to 10x in some diseases).
- It is actually more likely that the pregnant female auto-immunosuppresses to prevent immune rejection of the placenta and fetus, which are not necessarily HLA-identical.
- PMID 9500514 has a good review on this. It would be nice if the articles actually mentioned in which medical journal this research was going to get published. JFW | T@lk 20:14, 6 Feb 2005 (UTC)
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[edit] History
If somebody wants to expand the history section here is a link with good information: [2] --WS 10:39, 14 August 2005 (UTC) The Legacy of Thomas McPherson Brown, MD MIRA Therapy for Connective Tissue Disease by Henry Scammell
[edit] == A NEW APPROACH WITH A RICH HISTORY ==
THERE IS A CURE!
The Road Back and other web sites have very convincing evidence, including double blind clinical trials that demonstrate the efficacy of Antibiotic Therapy (AT) for the treatment of Rheumatoid Arthritis and other suppossed "autoimmune diseases". [3]and [4]
Nothing is likely to ruin a good reputation in medicine faster than being the first to come up with the right answer while the rest of the institution is comfortably bedded down with familiar folly. When the truth finally does come out, even after decades, that doesn't always mean the world immediately stops punishing the prophet. Heretics make great scapegoats, and the process often continues for a time even after they're safely dead.
Thomas McPherson Brown, MD, is a case in point. Working with Albert Sabin (later of polio vaccine fame) at the Rockefeller Institute just before World War II, Brown isolated a bacter ia-like agent from the joint fluid of an arthritic woman and speculated that it might be the infectious trigger for her disease. The bug in question, then generically classified as an L-form, was too small to identify precisely, but with the advent of electron microscopy it was shown to be a class of cell-wall-deficient organisms which scientists named mycoplasma, for watery fungus.
Mycoplasma is ubiquitous and not at all easy to get rid of, but Brown found that it usually could be controlled by long-term, low-level doses of tetracycline. As that class of antibiotic evolved, he got even better results with the second and third generation, doxycycline and minocycline. Up to then, the only treatments for the various forms of inflammatory arthritis were for the symptoms, and this was the first credible therapy aimed at a probable cause.
Of course, because Brown's treatment generally produced positive results, he became immensely popular with his patients, a vocal, partisan constituency eventually some 10,000 strong, which proudly referred to itself as "Doctor Brown's Army." But very possibly for these same reasons, among his peers and many of his colleagues he was variously dismissed as a misguided zealot, a benign eccentric, or a serious, boat-rocking troublemaker, and he found himself progressively cut off from the usual sources for the funding of research. As painful as this must have been, it hardly seemed to slow him down.
After the war Brown headed up arthritis research for the Veterans' Administration, and eventually became Dean of Medicine at George Washington University Medical School and a medical consultant to the White House. By the time I met him 1988, he had retired from GWU but still maintained a thriving clinical practice and directed the Arthritis Institute at the National Hospital just outside Washington. Although he depended on a cane, he still had the handshake of a lifelong tennis player, a warm, gentle laugh, and the smiling, caring attentiveness of a natural healer. It was easy to see why he was so widely loved.
The reason for our meeting was to collaborate on a book that set forth his theory and treatment for the inflammatory forms of arthritis. Our effort gained some poignant urgency from the fact that we both knew he was dying of cancer. Although he was the author of over 100 medical articles in prestigious peer-reviewed journals, the general public was still in the dark about the benefits and promise of antibiotic therapy. A book seemed the only way to continue Tom's lifelong battle against mankind's oldest and most widespread crippling disease, and to make the therapy available to the millions who would still need it when he was gone.
Although in many cases the therapy brought about remission or even reversal of rheumatoid arthritis, Dr. Brown cautioned me at our first meeting against presenting antibiotics as a cure. While they didn't work for everyone, he estimated his success rate at above 90 percent for those who stuck with the therapy (an estimate I have since heard from other physicians who treat large numbers of patients with his protocol.) The timetable and degree of response could vary for individual patients, Brown said, by such factors as how much time had elapsed since o nset of the disease, the severity of symptoms, age at diagnosis, family history, and not least, any damage that already may have been done to the patient's overall health and particularly to their immune systems by the more widely accepted therapies for a rthritis. Ironically, many doctors who dismissed minocycline as either unproven or unsafe for rheumatic disease were perfectly happy to prescribe a frightening pharmacopoeia of other "standard" therapies including the potent cancer drug methotrexate, or g old salts, possibly the most lethal prescription drug ever passed by the FDA. None of these other therapies had ever been proven to produce long-term benefits, and most let the disease worsen while masking symptoms.
Tom Brown lived just a year aft er the book's publication. That was plenty of time to experience the further slings and arrows of his peers ("I just hope he isn't hurting anybody," one of them observed piously for the cameras of 20/20), but not nearly long enough for vindication. The first serious study of his therapy didn't begin until nearly three years later.
The treatment described in our book is now widely referred to as MIRA therapy, from that landmark, NIH-sponsored study of Minocycline In Rheumatoid Arthritis. But the MIRA trials were hardly undertaken as a tardy attempt at salvaging Tom Brown's reputation; quite the contrary. As one of the principals recently told me, at the outset at least half of the six participating centers entered the study with open skepticism. For one thing, Brown's theory and treatment flew in the face of almost everything that was then held to be true of rheumatoid arthritis. For another, because the NIH appeared to be bending to pressure from Congress in the wake of our book, the study rekindled serious resentment against the persistence of his influence even from beyond the grave. Many expected the MIRA trials would simply drive Tom Brown's ghost from the stage, and rheumatology would be able to settle back into its familiar rut of empty hopes and unfilled promises.
That all began to change even before the MIRA trials were finished. Without decoding which patients were receiving placebo and which got minocycline, it was obvious that more of them were improving than would be expected for that size group. When the results were finally published in Annals of Internal Medicine in 1995, it was revealed that well over half of the minocycline patients had improved by at least 50% according to subjective criteria of joint tenderness and swelling. Even more experienced dramatic improvements in objective measurements of their blood work.
Not everyone was surprised. When Tom Brown had made his final television appearance on Good Morning America back in 1988, Joan Lunden said his approach to arthritis was "turning the medical world upside down." His answer was a quiet, "I'm trying to turn it rightside up." Seven years later, with the decoding of the MIRA study, for those who still remembered that exchange the words now rang like prophesy. It was only logical to the members of Dr. Brown's Army that the therapy that had turned around their diseases and given them back their lives would work as well for others. That was the whole point of the book.
An editorial accompanying the MIRA study described the outcome as "highly significant...with minimal adverse events." It said that together with similar results from a smaller study in the Netherlands, the results "could be submitted to the Food and Drug Administration as the two positive 'pivotal' controlled clinical trials required for approval of a new drug application."
What are those 'minimal adverse events' sometimes associated with minocycline? The best known is sun sensitivity, which is easily avoided by a good blocker and the proper clothing. While none of the MIRA patients showed serious toxicity, seven dropped out of the study, most commonly for dizziness. This is a known problem with minocycline, but apparently not with doxycycline, which Tom Brown would often use as an alternative. Another adverse reaction, so infrequent that it was not reported in the MIRA study, can be hyperpigmentation, a darkening of the skin in patches, usually on the hands and forearms, which disappears when the therapy is stopped. It also can discolor teeth of small children. The most serious-sounding objection to minocycline is that it is an antibiotic, a class of pharmaceuticals under considerable - and legitimate - criticism for wide scale overuse, particularly in diseases where it encourages resistant forms of the organisms it attacks. But that argument ignores the benign profile of antibiotics in the tetracycline family, proven least prone to this disadvantage in literally billions of doses for conditions no more serious than teenage acne. And it also overlooks the special nature of mycoplasmas. When most bacteria are attacked by an antibiotic, they immediately put up a defense in the form of mutation, based on a decision formed at the point of impact in the cell wall. But because mycoplasmas are cell-wall-deficient organisms (toroidal in shape, they look like partially nibbled donuts), the antibiotic action takes place primarily in the cell's core, where no such response occurs. I have met several of Tom Brown's patients who have controlled their connective tissue disease with minocycline for decades, and the only other effect they ever noticed was that they almost never were bothered by the common cold.
There now have been at least seven major studies of Tom Brown's theory and treatment, including publication of O'Dell's landmark trials in Nebraska where one-third of the patients who had improved on minocycline in the first year achieved remission by the end of three years. The results were even better for year four. In 1998, The Lancet published a small, open study of usually fatal systemic scleroderma at Harvard Medical School, sponsored by The Road Back Foundation and the National Institutes of Health; two-thirds of the completers were in remission after 48 weeks of this therapy. Today, minocycline and doxycycline are widely prescribed for the various inflammatory forms of arthritis and other connective tissue diseases such as scleroderma, lupus and fibromyalgia. Minocycline is now listed as a standard treatment for both rheumatoid arthritis and Lyme disease by the Arthritis Foundation and the USP.
But at the same time Tom Brown's safe, inexpensive and highly effective therapy is becoming the new standard treatment for many of those diseases, the paradox remains. Even though the specialty of rheumatology proved the treatment works, many practitioners in that field still resent the way the MIRA study happened, and either refuse to give it or they limit its availability to those fortunate few patients who are informed enough to ask for it. Along the way, perhaps because the institution has lost the capacity for change and renewal, rheumatology has become the fastest declining specialty in medicine.
Meanwhile, the rehabilitation of Tom Brown's reputation is progressing nicely, as they like to say in medicine, with full recovery just around the corner. When he and I set out to preserve his theory and treatment for those who would live after him, we had no idea our effort would prove so durable. But the new edition of our book is updated with results of the latest clinical trials and illustrated with new case histories and pictures of recovered patients doing the most improbable things such as rock-climbing and scuba diving. Ten years after we wrote the first version and nine years since his death, Tom Brown's legacy, updated and reissued as The New Arthritis Breakthrough, was ranked by Library Journal as the #1 best-selling health book in America. I can hear Tom's warm, familiar chuckle at how it's turning out.
- Effect, mechanism & cause are quiet distinct features. The fact that a tetracycline antibiotic may help does not prove that the demonstrated benefit is due to antibiotic action and thus a causation by bacteria. You will note from some of the articles in the PubMed Search criteria given that minocycline in particular seems to be more helpful than other tetracyclines:
- It seems likely that the tetracyclines have direct immuno-modifying activity, quite separate from any antibacterial action: "The present study thus shows that Minocycline and tetracycline exhibit immunomodulatory properties, which may contribute significantly to their beneficial effects in rheumatoid arthritis.
" - Reeta K, Mediratta P, Mahajan P, Sharma K (2002). "Effect of minocycline and tetracycline on immunological responses in experimental animals.". Indian J Med Sci 56 (11): 553-9. PMID 14510338.
- Similarly much of the benefit of tetracycline in rosacea may be anti-inflammatory in nature rather than any killing of bacteria on/in the skin.
- The article already mentions that a number of bacterial triggers have been previously considered - so it is not Rheumatologists being blind to a visionary colleague, but a number of suggestions that have been made and , to date, found wanting as a full explanation.
- These ideas are not currently accepted by mainstream medicine and are de facto therefore the minority viewpoint. NPOV requires mentioning of the opinion. It is not trivial minority I grant (which need not be mention at all in wikipedia), but nor does NPOV grant comparable coverage.
- Merely providing a search list of 'Minocycline in Rheumatoid Arthritis' to PubMed is not citing evidence for a position (all the 102 found papers could be refuting the idea) - so some selectivity as to which of these is to be used to support a claim needs be made. The other 2 links given [5] is a personal website (and fails meet WP:Reliable source criteria) and [6] is a campaigning patient group - again this would constitute a tertiary source rather than appropriate peer reviewed primary source studies.
- The information may or may not have good evidence behind it, but for now none of the present links acts to WP:Verify the claims made, and as such the claim does not deserve to stay in the article (remember wikipedia is not a soap box, however passionate about a topic one is) - but with suitable rewrite and a change in citation/reference approach there is clearly lots of interesting stuff to add (even if just that tetracyclines useful immunomodifiers that are less toxic than other agents)...
- For now, I shall have a go a writing/phrasing some of the additional material, applying wikistyling and moving non-mainstream ideas out from the main flow - this is "controversy" in the normal scientific meaning (i.e. a range of differing ideas and debate rather than necessarily accusations of pseudoscience) and research, rather than established/accepted knowledge. David Ruben Talk 21:29, 10 July 2006 (UTC)
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- I have just revert Selfhelp's POV recent edits in which it was stated that "complete remission" was shown by the papers cited - this was unfounded - the www.annals.org link concludes "modest" improvements & "neither ...study addressed possible mechanisms of action". Adding 2 additional links to Roadback seems to be spamming/POV pushing. I agree the studies are interesting and worthy further research, likewise that Minocycline seems a nicer drug than many others used in RhA (not least, given my dislike of phlebotomy, the lack of any requirement for monthly blood testing as with methotrexate). But studies, as indicated in the www.annals.org citation given, have not consistently supported benefits of tetracycline - although latest 2 studies are helping to suggest a research trend. Certainly there is no medical consensus (yet) on their overall role: ?useful just for mild disease, ?usefulness exceeds that of current treatments or ? useful for all degrees of severity and might help reduce dosages of more side-effect prone DMARDs ? But all this amounts to speculation (albeit likely quite positive), that should not be included in wikipedia as an encyclopaedia of established knowledge. David Ruben Talk 00:33, 15 July 2006 (UTC)
[edit] Eastern philosophies
This section REALLY needs some information backing it up its claims... even if there's no actual scientific backing, some citation of books or websites promoting an "Eastern" approach to RA would be good. Elfbabe 06:20, 20 March 2006 (UTC)
I changed a statement in the diagnostic criteria so that it reflects the actual one. Jfmarchini 17:17, 9 September 2006 (UTC)
[edit] Features
The person who wrote some of these dreadful symptoms must have the most depressing life. Dry eyes = leaking of eye contents? Good grief. Could you be a little less dramatic and just talk about major symptoms rather than freak occurrences? Cyborg Ninja 01:48, 29 October 2006 (UTC)
[edit] Gold as a cure
I heard that in the 1940's (US) that RA was treated with gold which was injected into the bloodstream, and apparently was quite popular and effective. But now one knows how or why it works. —The preceding unsigned comment was added by 208.22.79.8 (talk) 19:27, 5 February 2007 (UTC).
Might be interesting to note that R. A. is a disease not a product of old age.
[edit] Juvenile version
The article lacks a discussion of the juvenile version of RA. Might put some info in this week. Novickas 18:57, 12 March 2007 (UTC)
Hi everyone. Is it possible to condense some of the material on this article to make it more concise?
Rowan 15:07, 24 March 2007 (UTC)Rowan
