One of the queries on my facebook page asked me for my opinion about AP therapy by Dr. McPherson Brown. Explaining everything in detail is quite a task on the post so I thought, I’d include this in my blog for the benefit of other patients.

First, let me give you a background of AP therapy. It is an antibiotic protocol therapy propagated on the premise that rheumatic diseases including Rheumatoid Arthritis (RA) results from mycoplasma infections and prolonged antibiotics can resolve the arthritis1. However, no live organism has ever been cultured from the joint cavity2. Prolonged antibiotic therapy with minocycline and doxycycline has played an adjunctive role in early disease not as an antibiotic but by inhibiting biosynthesis and activity of matrix metalloprotinases that have a principle role in degrading articular cartilage in RA. Mynocycline has mild but definite inhibitory effect on synovial T-cell proliferation and cytokine production3,4.

In all likelihood, mycoplasma like organisms, play the role of a triggering event leading to a self perpetuating mechanism for the causation of the disease. AP Therapy has not been accepted so far. Present therapy with DMARDS- disease modifying anti rheumatic drugs & biologics are proving better.

However, one should always look for any persistent infection anywhere in the body and its treatment may ameliorate the symptoms and signs of the arthritis like Poncet’s Disease, which is a RA like disease secondary to the active tubercular focus elsewhere in the body.

This reminds of an excerpt from a commentary on Dr. William Osler5 which provides a useful perspective on application of alternative medical paradigms. He would caution medical practitioners against the arrogance of believing that only our current medical practices can benefit the patient. He said that, new scientific insights might emerge from as yet unproved beliefs.

A recently published report in July 2009, showed that controlling dental infection by giving antibiotics in an active RA patients resolved most of the symptoms of RA as well. However, such cases are called reactive arthritis in which, if the primary infection is controlled in the body, it leads to resolution of arthritis symptoms also and that proves to be curative eg. Poncet’s Disease. If we treat the active tuberculosis by anti-tubercular therapy, symptoms of arthritis also get resolved.

Therefore, a doctor’s job is to do a thorough examination of the patient, research his/her medical history and other possible diseases he could be suffering from and then come up with his diagnosis and treatment. A patient’s job is of course, as I always say, to keep faith.

© 2010 Dr. (Col) OP Garg, VSM. All rights reserved.

References:

1Thomas McPherson Brown, M.D. Treatment of Rheumatoid Disease

2 Primer on the rheumatic diseases, 10th edition, Page 167

3 Yu LP Jr, Smith GN, Hasty KA, et al: Doxycycline inhibits type XI collagenolytic activity of extracts from human osteoarthritis cartilage and of gelatinase. J Rheumatol 18:1450, 1991

4 Smith GN Jr, Brandt KD, Hasty KA: Activation of recombinant human neutrophil procollagenase in the presence of doxycycline results in fragmentation of the enzyme and loss of enzyme activity. Arthritis Rheum 39:235, 1996

5 Dr. William Osler was a pre-eminent figure of his time (1849-1919). Many regard him as the consummate physician of modern times.

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