Page 3 - Antibiotic Therapy for Rheumatic Disease

The author’s opinion stems from an extremely small further assess claims of a few experienced antibiotic
1-year uncontrolled trial published in the Lancet therapy rheumatologists, chiefly Thomas McPherson
in 1998. Both patients and investigators reported Brown that this therapy worked. And this proved
improvement. But was the benefit truly drug-related to be the case in two animal models of arthritis. It
or merely reflected the hope and optimism presented also engendered the role of my center in the MIRA
by any therapeutic trial? study. For me extension of the use of minocycline
into my day-to-day practice then followed. In the last
The clinical situation in scleroderma remains decade of the 20th century this evolutionary path
desperate! No consensus exists that any was a template that I had followed in the 1980s for
approach works. The author’s prior experience methotrexate where involvement in the placebo-
with penicillamine and an array of so-called controlled trial of methotrexate published in The
immunosuppressive drugs has been dismal. This New England Journal of Medicine in 1985 led to its
outcome applies to cyclophosphamide as well where wide-spread clinical use. The contrast however, has
the intervention can be as bad as or even worse than been the markedly more favorable safety profile of
the disease itself. So why not consider the unproven minocycline versus methotrexate.
and experimental but safe approach and
try using minocycline? Now approaching the “sunset” of my career, I
hope that this retrospective review can be useful
Currently patient testimonials appear to be the for patients and their physicians—at least in the
only tangible clue of whether minocycline works immediate future. Perhaps it can be conveyed to your
in scleroderma. These experiences can be found on doctor along with the question: “Doctor, is it worth
the Internet or in lay books (‘Scleroderma’ by Henry a try?”
Scammell). So far I trust implicitly those testimonials
submitted by patients under, at least in part, my care. Acknowledgements:
Also persuasive for me are comments of surprise and This author wishes to thank his patients, The Road
pleasure by co-involved physicians. The Hippocratic Back Foundation for its informational achievements
Oath I took exactly 40 years ago when graduating and his supportive wife, Rosie.
from medical school was a pledge to try to help and
not to RBF Editor’s Notes:
harm. Except for research support provided by the Patient experience reported to the foundation has
NIH or the Road Back Foundation, I’ve never made demonstrated that:
a nickel prescribing minocycline. So why do I and *Doxycycline has proven to be successful for many patients
others continue doing it? who cannot tolerate minocycline.
**Dose levels of antibiotics may need to be titrated to
If started in scleroderma, extreme patience is individual tolerance.
required. Raynaud’s, extreme hand contractures,
and perhaps internal organ involvement do not
appear to respond.

PATIENT RECOMMENDATIONS

The intent of this review is to provide patients with
a currently up-to-date conclusion of the role of
minocycline in the treatment of RA and scleroderma.
It cannot dismiss potential criticism that it reflects
bias on the part of the author. In defense, I would
point out that my conclusions are based on several
science-based events. I was awarded a research grant
from the NIH to study minocycline in animal
models of RA in the 1980s. Its purpose was to