Which infectious agents may cause rheumatoid arthritis (RA)?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

For many decades, numerous infectious agents have been suggested as potential causes of RA, including Mycoplasma organisms, Epstein-Barr virus (EBV), and rubella virus. This suggestion is indirectly supported by the following evidence:

  • Occasional reports of flulike disorders preceding the start of arthritis

  • The inducibility of arthritis in experimental animals with different bacteria or bacterial products (eg, streptococcal cell walls)

  • The presence of bacterial products, including bacterial RNA, in patients’ joints

  • The disease-modifying activity of several agents that have antimicrobial effects (eg, gold salts, antimalarial agents, minocycline)

Emerging evidence also points to an association between RA and periodontopathic bacteria. For example, the synovial fluid of RA patients has been found to contain high levels of antibodies to anaerobic bacteria that commonly cause periodontal infection, including Porphyromonas gingivalis. [20, 21]


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