title: Rheumatoid arthritis: proposal for the use of anti-microbial therapy in early cases.
abstract: Rheumatoid arthritis (RA) is a chronic disease, affecting women more than men, especially in those possessing the "shared epitope" (EQK/RRAA) amino acid sequences present in HLA-DR1/4 molecules. Proteus mirabilis carries sequences showing molecular mimicry to the "shared epitope" and to type XI collagen of hyaline cartilage. Elevated levels of antibodies to P. mirabilis have been reported from 14 different countries involving 1375 RA patients and the microbe has been isolated from urine cultures of such patients. Our working hypothesis is that the disease develops as a result of repeated episodes of Proteus upper urinary tract infections. Prospective studies involving the trial of anti-Proteus measures in RA patients should be evaluated in the management of this disease. Antibiotics, high fluid intake, and fruit extracts, such as cranberry juice, have all been found to be effective in the treatment of urinary tract infections. Such measures could be used as possible additional adjuncts to the standard therapy with NSAIDs and DMARDs.
authors.affiliation: Division of Life Sciences, Infection and Immunity Group, King's College London, UK. alan.ebringer@kcl.ac.uk
authors.forename: Alan
authors.initials: A
authors.lastname: Ebringer
authors.forename: Taha
authors.initials: T
authors.lastname: Rashid
authors.forename: Clyde
authors.initials: C
authors.lastname: Wilson
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000209:etiology; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D011512:Proteus Infections / Q000150:complications* / Q000188:drug therapy* / Q000235:genetics; D011513:Proteus mirabilis / Q000235:genetics / Q000276:immunology / Q000472:pathogenicity*; D013997:Time Factors; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D000900:Anti-Bacterial Agents