Decrease in anti-Proteus mirabilis but not anti-Escherichia coli antibody levels in rheumatoid arthritis patients treated with fasting and a one year vegetarian diet.

Abstract

Objective-To measure Proteus mirabilis and Escherichia coli antibody levels in patients with rheumatoid arthritis (RA) during treatment by vegetarian diet. Methods-Sera were collected from 53 RA patients who took part in a controlled clinical trial of fasting and a one year vegetarian diet. P mirabilis and E coli antibody levels were measured by an indirect immunofluorescence technique and an enzyme immunoassay, respectively. Results-The patients on the vegetarian diet had a significant reduction in the mean anti-proteus titres at all time points during the study, compared with baseline values (all p < 0.05). No significant change in titre was observed in patients who followed an omnivorous diet. The decrease in anti-proteus titre was greater in the patients who responded well to the vegetarian diet compared with diet nonresponders and omnivores. The total IgG concentration and levels of antibody against E coli, however, were almost unchanged in all patient groups during the trial. The decrease from baseline in proteus antibody levels correlated significantdy (p < 0.001) with the decrease in a modified Stoke disease activity index. Conclusion-The decrease in P mirabilis antibody levels in the diet responders and the correlation between the decrease in proteus antibody level and decrease in disease activity supports the suggestion of an aetiopathogenetic role for P mirabilis in RA.(Ann Rheum Dis 1995; 54: 221-224) Proteus mirabilis, a common cause of urinary tract infection, has been suggested to be of importance in RA.' Increased proteus antibody levels have been found in patients with RA compared with healthy controls and patients with ankylosing spondylitis, sarcoidosis, and systemic lupus erythematosus,'-3 although one study found no correlation between levels of antibodies to Proteus and the Stoke disease activity index.4In the present study we have examined the association between disease activity and proteus antibodies in RA patients during a controlled clinical trial of fasting and a one year vegetarian diet.5 We also measured IgG antibodies to Escherichia coli, and total IgG concentration, to test the species specificity of any changes in antibody titres. Patients and methods PATIENT POPULATION AND STUDY DESIGNDetails of the RA patients who took part in this controlled clinical trial of fasting and a one year vegetarian diet have been given elsewhere.5 Briefly, 53 patients were allocated randomly to a treatment group (n = 27) or a control group (n = 26). The patients in the treatment group were sent to a health farm for a period of four weeks. During the first seven to 10 days at the health farm the patients fasted; during the subsequent 3-5 months the patients followed a gluten free vegan diet (a vegetarian diet without milk and dairy products), followed by a lactovegetarian diet during the remaining nine months of the study period.5 The patients in the control group had a four week stay at a convalescent home, and they continued to follow their normal omnivorous diet throughout the whole study ...

Changes of Intestinal Microflora in Patients with Rheumatoid Arthritis during Fasting or a Mediterranean Diet

“…To date, various bacterial species, e.g. Proteus mirabilis and Escherichia coli, are discussed to play an important role in the pathogenesis of RA [35,36]. Otherwise, evaluation of dietary-induced changes in the intestinal microflora in patients with RA with conventional culture methods such as isolation, identification, and enumeration during therapeutic dietary interventions has been reported to be very difficult [10,11].…”

Mediterranean dietary intervention study of patients with rheumatoid arthritis

“…In the study by Kjeldsen-Kragh et al, the changes in disease activity were associated with the antibody activity against P. mirabilis (29), which has been suggested to be linked to the etiopathogenesis of RA (30). Also changes in the faecal flora were associated with disease activity (31).…”

Postulated Vasoactive Neuropeptide Autoimmunity in Fatigue‐Related Conditions: A Brief Review and Hypothesis

“…RA patients had higher levels of antibodies against Proteus in their urine when compared to those of healthy subjects (Senior et al 1999) and significant correlation was detected between serum anti-Proteus antibodies and Proteus urinary isolation rates in RA patients when compared to healthy controls . Furthermore, RA patients group who were receiving a vegetarian diet had a drop in the levels of antibodies against P. mirabilis but not E. coli, when compared to those patients who were omnivores (Kjeldsen-Kragh et al 1995). This dietary treatment may have exerted its specific anti-microbial effect via the actions of lignans and phytoestrogen metabolites (Adlercreutz et al Senior et al (1999) Sub clinical Proteus bacteriuria and elevated levels of anti-Proteus antibodies in urine and serum of patients with RA when compared to HCs.…”

“…This new treatment includes anti-Proteus measures involving the use of Proteus-sensitive antibiotics with dietary manipulations in the forms of vegetarian diet (Kjeldsen-Kragh et al 1995) and high daily intake of water and fruit juices containing fructose such as cranberry juice (Rashid et al 2001). This new treatment includes anti-Proteus measures involving the use of Proteus-sensitive antibiotics with dietary manipulations in the forms of vegetarian diet (Kjeldsen-Kragh et al 1995) and high daily intake of water and fruit juices containing fructose such as cranberry juice (Rashid et al 2001).…”