The History of the Search for Cause and Cure
With no known cure for the more than 100 types of arthritis, treating and coping with the painful symptoms have become the core of concern for patients and physicians.
In the 1930's, a bacterial cause for rheumatoid arthritis was investigated but the research was short-lived except for distinct cases of acute infectious or septic arthritis. In 1939, the first real lead regarding an infectious cause for rheumatoid arthritis arose when mycoplasma, an atypical viral-like bacteria, was isolated from the exudate and tissue of rheumatic patients.
Investigators had already shown that mycoplasmas cause arthritis in mice, rats, chickens, goats, and cows. They had found mycoplasmas in the genitourinary tracts of humans too, especially females.
In 1949 at the International Congress on Rheumatic Diseases the possible relationship between mycoplasmas and joint disease was reported. After obtaining one of the first National Institutes of Health (NIH) research grants in 1950, Thomas McPherson Brown, M.D. and colleagues at the arthritis research unit reported the following year that the rheumatoid disease mechanism was more of an immunologic reaction of antigen and antibody (with mycoplasma as the suspected antigen) rather than the infectious and transmissible type.
In 1955, the research unit reported that mycoplasmas, unlike bacteria and viruses could live in tissue cell cultures without destroying the tissue cells. To further support mycoplasmas as a causative agent/antigen, in 1964 a high incidence of mycoplasma antibodies in the blood of rheumatoid arthritis patients and lupus patients was found, indicating current or previous infection.
Also recognized was a 4:1 higher incidence of mycoplasma antibodies in females suggesting a correlation with the higher incidences of rheumatoid arthritis in females.
Efforts to demonstrate the effectiveness of tetracycline therapy were initiated and first reported over 40 years ago by Thomas McPherson Brown, M.D. Two weeks after Brown's death in 1989, NIH requested grant applications for the controlled clinical trials of tetracycline therapy for rheumatoid arthritis which he had been seeking. The preliminary results of the clinical trials, known now as MIRA or Minocycline in Rheumatoid Arthritis, were promising and the NIH requested grant applications for studies of mycoplasma and other infectious agents as causes for rheumatoid diseases in 1993, and a pilot study for intravenous antibiotics for rheumatoid arthritis in 1994.
The result of the MIRA clinical trial stated, "Patients who suffer from mild to moderate RA now have the choice of another therapeutic agent. Not only did the antibiotic significantly reduce symptoms, but side effects were minimal and less severe than observed for most other common rheumatoid treatments".
Throughout the years, the theories that focus on mycoplasma as the responsible infectious agent and on tetracycline as the antibiotic treatment of choice have been hampered by lack of adequate funding for more research and from politics. "Why Arthritis?" by Harold W. Clark, Ph.D., one of Brown's colleagues, assesses the rheumatoid diseases, decades of research, the search for a cure, and the frustration of researchers whose case for anti-mycoplasma therapy was overlooked for 40 years by the government and various arthritis organizations. Clark believes efforts were impeded because a safe, simple treatment threatens the medical establishment since patients would then require less medical intervention.
Many physicians remain skeptical and still do not suggest antibiotic treatment to their patients. The Arthritis Foundation was seemingly unimpressed even after antibiotic therapy was deemed as safe and effective. The foundation's medical director reportedly said he did not view the treatment as a breakthrough and more study of dosages and long-term use of minocycline is needed.
According to the American College of Rheumatology, "Minocycline is prescribed for patients with symptoms of mild rheumatoid arthritis. It is sometimes combined with other medications to treat patients with persistent symptoms of this form of arthritis."