Major Bacterial Involvement in Rheumatoid Arthritis

In a couple of recent articles, we saw that bacteria and iron are accelerants and likely causes of aging, and that the resultant hypercoagulation can be targeted. Etherisia Pretorius (a South African as the name implies) and Douglas Kell (British), two of the authors of the papers which went into those articles, along with colleagues, have recently written about major bacterial involvement in rheumatoid arthritis. This paper is worth bringing to your attention for a couple of reasons at least: 1) it suggests new ways to treat this condition, which is notoriously progressive and refractory to treatment; 2) it shows the involvement of iron.

What rheumatoid arthritis is

Rheumatoid arthritis (RA) is an autoimmune disorder characterized by inflammation, and while it most notably affects the joints, it can damage many other parts of the body. Signs and symptoms include:

  • Tender, warm, swollen joints
  • Joint stiffness that is usually worse in the mornings and after inactivity
  • Fatigue, fever and weight loss

RA affects up to 1% of the population, and is about 3 times as common in women as in men.

The authors of this paper write:

We discuss how the exposure of genetically susceptible individuals to environmental factors (1) that can act as triggers (2), cause an immunological reaction, followed by an autoimmune response (3), can result in RA (4). We review a plethora of evidence, collectively referred to as Ebringer’s theory (5), that points to the environmental trigger as microbial (particularly from e.g. urinary tract infections) (6). We then look at the role of LPS from these microbes (7) in causing an imbalance between pro- and anti-inflammatory cytokines, followed by systemic inflammation, and the effect on the cardiovascular and hematological health of the RA patient (8) (see Figure 1). Finally, recognizing the lack of easy and accessible biomarkers, we suggest that in a truly precision medicine approach, hypercoagulability and also microparticle presence, as well as LPS and β-amyloid analysis could play an important role in tracking the progression of the disease.

Bacteria and iron

A high fraction of those with RA had an infection before diagnosis. One reason that women may have a higher rate of RA is because they have a higher rate of urinary tract infections, especially from the bacteria Proteus.

Once infected, antibodies formed against the bacteria can cross-react with human antigens, such as in joints, and cause inflammatory reactions.

How do these bacteria get inside the body? As we’ve previously discussed, body sites that are normally considered sterile, such as the blood, may have quite a lot of bacteria in them.

These bacteria come from the normal flora of the oral cavity and the gut, as well as from infections. Periodontitis is significantly associated with RA, and gut dysbiosis is frequently found in RA patients. Cardiovascular complications are also common in RA.

One of the keys here is that iron dysregulation allows the bacteria to grow.

We all get some bacteria inside us regularly, but the body’s natural immunity prevents them from growing and reproducing. One of the most important aspects of this natural immunity is iron withholding. Bacteria require iron to grow, as do all living things, and the body tightly holds on to iron to keep bacteria from procuring it for their own uses. Iron is at the center of an evolutionary arms race between animals and microorganisms.

In iron dysregulation, iron escapes from the proteins that hold it, mainly ferritin and transferrin. The free iron is then available for bacteria to use.

An important point is that the more iron in storage, that is, in ferritin, the more there is available to escape and become free iron. Lower body iron stores can mitigate this. This is shown by the fact that in hemochromatosis, or iron hereditary overload, physiological damage occurs, despite the fact that most of the iron is bound by ferritin.

In RA, iron dysregulation and bacterial growth cause hypercoagulation and other damage.

So, would dumping iron via phlebotomy (bloodletting) help treat RA? I couldn’t find a reference to the effect that it’s been tried. But hemochromatosis can masquerade as RA, and iron is found in the joints in RA and other joint diseases.

I’m guessing that someone with RA would not be allowed to donate blood, however. Therapeutic phlebotomy, under a doctor’s care, could be an option.

In addition, attention to gut issues and/or periodontal disease should be of benefit.


Rheumatoid arthritis, a potentially crippling and painful disease, has no known cause. But bacteria are definitely involved, and they are spurred on by excess and free iron.

PS: Check out my book, Dumping Iron, which explains much more about the connection of iron to disease.

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Leave a Comment:

RH says February 3, 2017

Interesting. So what do you make of the menstrual loss of iron in women, yet higher rates of RA?

    P. D. Mangan says February 4, 2017

    RA is seen in mainly older women, so they have higher iron than younger, though not generally as high as men. So, genetic susceptibility, iron, exposure to pathogenic bacteria via urinary tract infections, etc. BTW, the prevalence of UTI in women compared to men must be 5 or 10 to 1.

Major Bacterial Involvement in Rheumatoid Arthritis says February 3, 2017

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