Does anyone have an interest in infectious disease and how it might relate to autoimmune disease?

Yeah. Well, my rhumatologist describes autoimmune diseases as the body’s immune defenses ‘switching on’, and then not being able ‘switch off’, not just ‘randomly attacking for no apparent reason’.

Waiting for Dr. Shilolo.

I have several autoimmune conditions, for which the cause(s) are currently unknown. I would love to find the underlying reason for them, especially if it makes them ‘curable’.

Why yes, I do. What is your specific question?

Well, I will not go into specifics in this forum, but it would be nice to know a couple of things:

1. I understand that medical science likes for something to be PROVEN before it will accept a theory, but still why are doctors so resistant to this idea? There have been some small unstudies for schleroderma and RA that have respoded to antibiotics and the medical establishment seems to want to chalk it up to those antibiotics having anti-inflammatory properties…why not take the obvious assumption that there is a bacterial or mycoplasma causing this?

2. Do you know any doctors/researchers in the US who have a specific interest in this theory? The only one I know of Dr Terentham in Boston.

It relates to GYN problems and also Muscle problems. I realize you can’t probaby answer this without more specifics.

I doubt that is the case with autoimmune diseases. It would be a mistake to assume the immune system is infallible. Inflammation is often a sign that the body is fighting infections (think of the reddening around a healing wound), as the presence of white blood cells leads to destruction of many pathogens. If the inflammation makes the condition worse, then chances are it is an autoimmune disease.

But, my point is if antibiotics work, why resist the idea of infection? They use antibiotics now for Crohns disease, but most docs seem to want to not think that is an infection.

I should say here that I do not think all autoimmune is infectious…I think some might be environmental, and some could be the body going haywire like you say. Your inflammation example is valid in my opinion also.

@JLeslie There is no simple answer to your question, but, as an Infectious Diseases doctor with a PhD in Immunology, I feel that I can provide some insight. First of all, there are many doctors and scientists trying to link infection with autoimmunity (not just one). In fact, it is the “holy grail” of autoimmunity to ascribe an infectious cause to an autoimmune condition. However, decades of work on diseases like RA, lupus (SLE), Type I diabetes and multiple sclerosis (MS) have not yielded a smoking gun. So, it isn’t fair to say there is no research on this issue, because there most definitely is.

Second, while it may be that certain conditions, like rheumatic heart disease or post-infectious glomerulonephritis are associated with infections, they are delayed manifestations of autoimmunity, rather than indications of ongoing infection (in general). Thus, even if there were a bacterial cause for RA for example (which is unlikely), the likelihood that an antibiotic given years after the initial insult would help is extremely low. Another example is so-called chronic lyme disease. While antibiotics are helpful for acute lyme disease, and disseminated lyme disease, several well-conducted studies showed no benefit of long-term antibiotics for arthritis related to “chronic lyme” (and this for an arthritic disease closely associated with an infection; many autoimmune diseases have no such association). You mentioned Crohn’s disease, and I just want to say that antibiotics are used there because flares of frequently associated with true infection, rather than for the autoimmune component.

Not all the news is bad. Some chronic conditions, like tertiary syphilis and duodenal ulcer are treated with antibiotics (as you said), but these conditions have been verified as manifestations of ongoing infection. Thus, if a researcher did identify a bacterial cause for an autoimmune condition, you can be sure that doctors would jump at the chance to cure a chronic disease. In fact, as you alluded, minocycline is used for rheumatoid arthritis, although it remains entirely unclear if this is due to antibacterial properties. Most worrisome however is that minocycline use is associated with the development of autoimmune conditions itself. As a disease modifying agent for RA, minocycline has been supplanted by anti-TNF therapies, which are the mainstays of treatment these days.

Lastly, I would ask on open-ended question. How can we use antibiotics when we don’t know what we are treating? It isn’t like one antibiotic cures all infections (though we do have some really strong ones). Even so, antibiotics come with risks, like mild to severe allergic reactions, C. difficile colitis (from killing all the good bacteria), development of antibiotic resistance, and many others (depending on the antibiotic). What if the cause is a virus or fungus for which antibiotics are ineffective, a bug not treated with the randomly-chosen antibiotic, or not due to an active infection at all? Then, you are simply taking an unnecessary antibiotic, and getting all the harm with none of the benefit.

The horizon for autoimmunity is bright. Recent work has found a number of genetic mutations-polymorphisms that are linked to autoimmune conditions. Interestingly, many are in pathways involved in detecting bacterial-viral DNA, suggesting that individuals predisposed to autoimmunity have a more “primed” immune system, and that a small insult (like an innocuous infection) may trigger an autoimmune cascade in these individuals. Future work to modify these pathways may yield new therapies, which are sorely needed.

@shilolo Thank you so much for such a thorough response. I will send you a private message.

I lurve you shi.

@JLeslie As a student of the health sciences, I can tell you that very few ideas in modern medicine are accepted without rigorous research. If you want a reason to trust modern medicine, read through the criteria for a review to be published by the Cochrane Foundation. I’m not saying modern medicine is infallible, but to propose a theory such as you are, I would like to see a lot of studies.

@FireMadeFlesh I understand your point. If you look at my first post near the stop, not my original question, you will see that point 1 is that I understand things need to be PROVEN in science to be accepted. BUT, that does not mean a doctor cannot draw some logical conclusions from what is presented to them, even if a researcher has not proven it yet. That is my frustration. When you are sick, and a particular antibiotic is like magic for you, but when you stop you get sick again, maybe it is worth giving the drug longer or in a higher dose, even if science has not proven the connection yet. And, maybe, admitting, it could be an infection, we just don’t know, and working with the patient. I mean if it is a reasonable hypothesis, that is all I am saying.

@JLeslie You bring up a reasonable point. Doctors do have the leeway to go outside the boundaries of accepted practices, but it comes at a great risk to the patient and the doctor. If you as the patient get sick from the treatment (say you take antibiotics for 3 months and end up with C. difficile colitis) and the treatment has no basis in clinical experience, then both of you have suffered. You, for having the side effect, and your doctor for possibly participating in malpractice, which can get her license revoked and lead to a possible lawsuit. It is a very dicey proposition to ask a doctor to essentially “throw the kitchen sink” at your disease, with the hopes of treating it.

@shilolo I agree to the extreme you described. But if it is a regimen that is used freuqently for other diseases, and found to be relatively safe, why not try it if the patient understands the risk. For instance, if I take augmentin…again my magic pill…I feel better on day 5. Typically when taking this drug people start feeling relief within 72 hours, I think this is significant. So 7 days has not proven to be enough, maybe 10 or 14 days is. I am not talking about three months of medication.

@JLeslie I see your point, but I have also seen many patients who somehow become dependent on their unvetted treatment. For instance, as I mentioned above, antibiotics have been shown to be ineffective for treatment of “chronic lyme”. However, I’ve seen many patients who walk around with a PICC line (large IV) and take intravenous antibiotics for years.

Yes, I can understand in desperation how patients may WANT it to work and do extreme things. I am not asking for that, just a small extension :). Just a small logical leap of faith. I am lucky that I figured out a couple of drugs that give me relief, when all the ones GYN’s throw at you typically did not work.