For many years I have had fatigue and tender, weak, sore muscles, particularly in my forearms, biceps, thighs, calves, abdomen and lower back. Along with the pain and fatigue, I have annoying twitching that comes and goes. Sometimes this twitching is mild, and other times it is quite annoying. While my symptoms have been mild for many years, in the last two years they have become more and more intense and severe. I now have almost constant joint pain in my shoulders and more and more my hands are affected, while occasionally I will also have pain in my knees, wrists and ankles.  Another of my most annoying symptoms is the feeling of burning in my eyes and that they feel they are dry.  Light sensitivity at times is severe, however this seems to fluctuate between non existent to quite intrusive.   I have been to my doctor and had several tests, none of which have pointed out any reasons for my condition. I am being treated for hypothyroidism with 0.88mcg of Thyroxine, and I am also on CPAP for mild sleep apnea. I have seen a neurologist for the twitching and was deemed to have nothing wrong. I was referred to two rheumatologists, neither of whom said there was anything wrong with me and said I most likely had Fibromyalgia. I began doing some research on the condition and the description and symptoms do fit , however many of the symptoms are shared with chronic fatigue syndrome (CFS) . The unfortunate part of this, is most of the treatments for this are for the symptoms. Nothing truly looks at the possible causes. The more and more I read, the more times it was suggested that a possible infection could be the cause. I started to capture some of this information, and I have organized it here. There appears to be a several tests for this and I am going to persue this with my doctor.

Fibromyalgia – Is There an Infectious Connection?

The connection of FM to infections is well documented in the literature, especially in relation to Lyme disease, mycoplasma, Chlamydia pneumoniae., Hepatitis C, Parvovirus B19, HIV, and Epstein-Barr.

The identification of mycoplasma infections in the leukocyte blood fractions of a rather large subset of CFS, FMS and arthritis patients suggests that mycoplasmas, and probably other chronic infections as well, may be an important source of morbidity in these patients. If such infections are important in these disorders, then appropriate treatment with antibiotics should result in improvement and even recovery. This is exactly what has been found.(Nicholson JAMA 1995).”

Fibromyalgia – thearthritiscenter.com

The fibromyalgia syndrome (FMS) is the most common rheumatic cause of chronic diffuse pain. The most important clinical features of FMS are symptoms of diffuse aching, stiffness, and fatigue coupled with a physical examination that demonstrates multiple tender points in specific areas.

Mycoplasma

Mycoplasmas: Sophisticated, Reemerging, and Burdened by Their Notoriety – Joel B. Baseman and Joseph G. Tully

Extensive clinical and microbiological evidence indicates that mycoplasmas alone can elicit a spectrum of illness for which no other agents are incriminated. The eradication of these pathogenic mycoplasmas from various tissue sites requires an intact and functional immune system, although persons with fully competent immune systems may have difficulty eliminating mycoplasmas, even with recommended prolonged drug therapy.

Mycoplasmas – rain-tree.com

A review of the clinical documentation being performed around the world on mycoplasmas indicate that scientists are hypothesizing them to be cofactors or actual causes of many human diseases, including: chronic fatigue immune dysfunction syndrome, auto-immune disorders (lupus, multiple sclerosis and Lou Gehrig’s Disease/ALS), arthritis, fibromyalgia, acquired immune deficiency syndrome, “idiopathic” cd4 positive t-lymphocytopenia (aka HIV-negative AIDS), psoriasis, scleroderma, Crohn’s disease, cancers, lymphoma, leukemia, pelvic inflammatory disease, asthma, atypical pneumonia, Sjogren’s syndrome, interstitial cytitis, and Alzheimer’s disease.

Mycoplasmas - Shmuel Razin

Mycoplasmas are the smallest and simplest self-replicating bacteria. The mycoplasma cell contains the minimum set of organelles essential for growth and replication: a plasma membrane, ribosomes, and a genome consisting of a double-stranded circular DNA molecule ( Fig. 37-1). Unlike all other prokaryotes, the mycoplasmas have no cell walls, and they are consequently placed in a separate class Mollicutes (mollis, soft; cutis, skin).

Mycoplasmas – shasta.com

Autoimmune conditions associated with Mycoplasmas include arthritis, Fibromyalgia, myositis, thyroid dysfunction (Hashimoto’s or Grave’s Diseases), and adrenal dysfunction, signs and symptoms of Lupus, Multiple Sclerosis, and Lou Gehrig’s Disease. (12)

Mycoplasma infection can trigger inflammatory cytokine over-production that is commonly seen in CFS/FMS. With the induction of CD-4+ helper cells of the immune system, an over production of cytokines such as Interleukin-1, Interleukin-6 and Tumor Necrosis Factor-alpha occurs. (15)(16)(17) These elevated cytokines have been implicated in the development of many of the CFS/FMS symptoms, including neurological involvement. (19)(20) They can have specific or nonspecific stimulatory or suppressive effects on lymphocytes, as measured by B and T cell activation. (18) In addition, the Mycoplasma infection has immunomodulating effects, activating the hypothalmic-pituitary-adrenal axis. This can cause a cascade of limbic system symptoms characteristic of CFS/FMS. (19)

Articles

Multiplex PCR for the Detection of Mycoplasma fermentans, M. hominism, and M. penetrans in Patients with Chronic Fatigue Syndrom, Fibromyalgia, Rheumatoid Arthritis, and Gulf War Syndrome. – Aristo Vojdani, PhD, MT and Al Robert Franco

It is well documented that CFS, FMS, RA, and GWS share many common symptoms. Prior to this study there have been studies reporting on only the relationships of each of these illnesses individually. The present study suggests that mycoplasma infection may be the common link between these illnesses responsible in some degree for the similarities in symptoms experienced in each condition.

It has been well documented that people who suffer from fibromyalgia exhibit many of the same symptoms found in CFS (6,7). These two illnesses are so similar that for years many medical practitioners have considered them as the same condition. They are still regarded as closely associated in the scientific literature with only the exception of a few distinction criteria. Other research has stated the uncanny similarities between chronic fatigue syndrome and gulf war syndrome (8). Patients suffering from rheumatoid arthritis also exhibit certain symptoms characteristic to each illness (9). Although RA exhibits a narrower spectrum of clinical symptoms than CFS, FMS, and GWS, it does exhibit a significant overlap of symptoms found in each condition. The fact that these four illnesses have such a high degree of similarities led us to investigate the possibility that mycoplasma infection may be a common link to each condition.

Why I Prescribe Antibiotics to Patients with Chronic Fatigue Syndrome, Fibromyalgia, Multiple Chemical Sensitivity, and Other Autoimmune Diseases – Gabe Mirkin M.D.

If you feel sick and your doctor is unable to make a diagnosis because all laboratory tests and cultures fail to reveal a cause, you could be infected with one or more of these bacteria. The only way that you will be cured is for your doctor to suspect an infection with these germs and for you to take long-acting erythromycin or tetracyclines for several weeks, months or years.

Fibromyalgia usually means that muscle and joint pains are major symptoms, but muscle biopsies are normal, pressure points are not reproducible and ultra sound is normal. Multiple chemical sensitivities mean that patients think that their symptoms are caused by factors in their environment or they consult doctors who think the same thing. Untreated, the symptoms that that lead to any of these diagnoses will usually continue in adults for the rest of their lives. I have prescribed doxycycline 100-mg twice a day for several months, and sometimes azithromycin 500-mg twice a week, and some of my patients get better.

Fibromyalgia – By Al Robert Franco, M

We at the Arthritis Center of Riverside as well as others have found that a great number of patients who have fibromyalgia show evidence of mycoplasma infection. These small, cell-wall-deficient organisms hide inside the cells of the host, and our studies have shown they can be innocent bystanders in 10% to 15% of the normal population.

Chronic Infections in Fibromyalgia Syndrome: Sources of Morbidity and Illness Progression. by Prof. Garth Nicolson, Fibromyalgia Survivor 2000

We have found that ~70% of FMS, ~60% of CFS and ~50% of RA and Gulf War Illness patients have mycoplasmal blood infections that can explain many of the chronic signs and symptoms found in these patients. In the majority of FMS and CFS patients we have found multiple pathogenic mycoplasmas in their white blood cells but these infections are only found in 0-9% of controls [1, 4]. Interestingly, the majority of CFS and FMS patients had multiple mycoplasmal infections but none were found in controls [4]; however, single infections are found in some nonsymptomatic subjects (0-9%). The tests that we use to identify mycoplasmal infections, Forensic Polymerase Chain Reaction, are very sensitive and highly specific.

Common Mycoplasmas -Now Weaponized, Pathogenic & Deadly – By Donald W. Scott, MA, MSc

Dr Charles Engel, who is with the US National Institutes of Health, Bethesda, Maryland, stated the following at an NIH meeting on February 7, 2000: “I am now of the view that the probable cause of chronic fatigue syndrome and fibromyalgia is the mycoplasma…“

In the early stages of a disease, doxycycline may reverse that disease process. It is one of the tetracycline antibiotics, but it is not bactericidal; it is bacteriostatic–it stops the growth of the mycoplasma.

Several other publications from www.immed.org linking infection to Fibromyalgia, Chronic Fatigue and Gulf War Sickness are located here.

Studies

Multiple mycoplasmal infections detected in blood of patients with chronic fatigue syndrome and/or fibromyalgia syndrome.

Previously, more than 60% of patients with chronic fatigue syndrome/fibromyalgia syndrome were found to have mycoplasmal blood infections, such as Mycoplasma fermentans infection.

Mycoplasma blood infection in chronic fatigue and fibromyalgia syndromes.

Chronic fatigue syndrome (CFS) and fibromyalgia syndrome (FMS) are characterised by a lack of consistent laboratory and clinical abnormalities. Although they are distinguishable as separate syndromes based on established criteria, a great number of patients are diagnosed with both. In studies using polymerase chain reaction methods, mycoplasma blood infection has been detected in about 50% of patients with CFS and/or FMS, including patients with Gulf War illnesses and symptoms that overlap with one or both syndromes. Such infection is detected in only about 10% of healthy individuals, significantly less than in patients. Most patients with CFS/FMS who have mycoplasma infection appear to recover and reach their pre-illness state after long-term antibiotic therapy with doxycycline, and the infection can not be detected after recovery. By means of causation and therapy, mycoplasma blood infection may permit a further subclassification of CFS and FMS.

Arthritis and Mycoplasma

Here are a few interesting studies done using antibiotics and Rheumatoid Arthritis.

Minocycline in Rheumatoid Arthritis: A 48-Week, Double-Blind, Placebo-Controlled Trial

CONCLUSION: Minocycline is an effective DMARD in patients with early seropositive RA. Patients treated with minocycline were more likely to achieve an ACR50 response and did so while receiving less prednisone. In addition, minocycline-treated patients were more likely to have discontinued treatment with prednisone at 2 years.

Treatment of early seropositive rheumatoid arthritis with minocycline: four-year followup of a double-blind, placebo-controlled trial.

At followup, RA was in remission (American College of Rheumatology criteria) without disease-modifying antirheumatic drug (DMARD) or steroid therapy in 8 of the patients originally treated with minocycline compared with 1 patient in the placebo group (P = 0.02). Ten patients in the minocycline group versus 16 in the original placebo group currently require DMARD therapy (P = 0.02). CONCLUSION: Among patients with seropositive RA, remissions are more frequent and the need for DMARD therapy is less in those treated early in the disease course with minocycline compared with those treated with conventional therapy delayed by an average of only 3 months. Minocycline appears to be an effective therapy for early RA; further investigation into its mechanism of action is needed.

Benefits and risks of minocycline in rheumatoid arthritis

The same authors later reported that about half of these patients were in or near remission after 3 years of follow up. No adverse effects were reported in this study. Summarising the data of these 3 double-blind studies, we may conclude that minocycline may be beneficial in patients with rheumatoid arthritis, especially when given early in the disease course or in patients with a mild disease.

Testing

I have yet to find any Canadian labs that will do either the ELISA (Enzyme- Linked Immuno-Sorbent Assay) or PCR method, however there are several in the USA.

The first link has told me that they will perform tests with the authorization of a Canadian doctor.

http://www.mdlab.com/html/home.html

http://www.tarci.net/services.html

http://www.mycoplasma.uab.edu/intro.htm

http://www.clongen.com/mycoplasma_testing_services.php

http://www.thepowerhour.com/news/mycoplasma_testing.htm

Treatment

New Treatments for Chronic Infections Found in CFS, Fibromyalgia Syndrome and Gulf War Illnesses, by Prof. Garth Nicolson, American Academy of Environmental Medicine Newsletter (Winter 1997)

The recommended treatments for mycoplasmal blood infections require long-term antibiotic therapy, usually multiple 6-week cycles of doxycycline (200-300 mg/d), ciprofloxacin or Cipro (1,500 mg/d), azithromycin or Zithromax (500 mg/d) and clarithromycin or Biaxin (500 mg/d).  Multiple cycles are required, because few patients recover after only a few cycles [4], possibly because of the intracellular locations of mycoplasmas like M. fermentans and M. penetrans, and the slow-growing nature of these microorganisms.

Role of Mycoplasmal Infections in Fatigue Illnesses: Chronic Fatigue and Fibromyalgia Syndromes, Gulf War Illness and Rheumatoid Arthritis, by G.L. Nicolson et al.,  J. Chronic Fatigue Syndr. 2000

We now recommend that patients be placed on antibiotics (doxycycline or minocycline, 200-300 mg/day; ciprofloxacin, 1,500 mg/day or sparfloxacin, 400 mg/day; azithromycin, 500 mg/day; clarithromycin, 750-1,000 mg/day) for at least 6 months before using the 6-week on, 2-week off regimen.21,22 This is because few patients recover after only a few 6-week cycles, and it does not make sense to have patients repeatedly relapsing during therapy. CFS, FMS and GWI patients slowly recover on the antibiotics, and their environmental sensitivities slowly return to preillness states, suggesting that their immune systems are slowly recovering.

Antibiotic Protocol for Rheumatic Disease FAQ

Patients begin oral therapy – minocycline (Minocin) or doxycycline 100 mg. once or twice daily, or tetracycline 250 mg. to 500 mg. twice daily Monday, Wednesday and Friday. Tetracycline is more apt to react with food and must be taken on an empty stomach. The antibiotic and calcium supplements (including dairy products) should not be taken at the same time. This dosage is effective for most patients. However, five or even seven-day a week doses may be necessary in some cases. Patients with mild to moderate disease are started with this same oral therapy.

Books

Here are some excellent books

Del.Icio.Us

Here are my links.