Are bacteria involved?

[Tonylynn]

According to an article in the New Scientist (10/8/19 No 3242) some scientists think Porphyromonas Gingivalis (a bacterium) may be partly to blame for a wide range of inflammatory diseases such as Altzheimer's and heart disease. P.gingivalis is present in gum tissue and passes from there into the blood stream. Once in the blood the p.gingivalis changes its surface proteins so it can hide inside white blood cells of the immune system and can also enter cells lining arteries.

Is it possible for this infection of the arterial wall to precipitate the formation of granulomatous tissue, such as the giant cells seen at biopsy? I am sure this has all been well researched but it's worth asking the question.

Some years ago I could hardly walk downstairs in the morning and was diagnosed with PMR and treated with prednisolone. A year later I was symptom free and no longer taking the steroids. Then the symptoms returned and this time I asked to be tested for Lyme, was found to be positive and two months of Doxycycline was the only treatment required. (My wife has GCA). The disease is caused by borrellia, a bacterium, but I find it interesting that it can mimic PMR.

Back in the 1980's a researcher by the name of Marshall infected himself with Helicobactor Pylori and was able to demonstrate that stomach ulcers were caused by bacteria as opposed to spicy foods and stress. Prior to that it was thought bacteria could not survive the acidity of the stomach and few people thought they could be associated with stomach ulcers.

Seemingly more and more illness, especially those affecting older people, are being investigated for a bacterial component. It just makes you wonder if bacteria, such as P.gingivalis could be associated with PMR and GCA. Unlikely, but ........ !!!!!

(Unfortunately p.gingivalis is not susceptible to antibiotic treatment but there are drugs being developed that may "deactivate" it).

[Hidden]

Interesting idea.

As an aside, when your PMR symptoms returned, what made you ask to be tested for Lyme Disease?

[Tonylynn in reply to Hidden]

I was sailing with a retired GP and told him my symptoms had returned. He went home and told his wife and SHE asked if I had been tested for Lyme. He passed this on to me. I owe her.

[Hidden in reply to Tonylynn]

It would be pretty unlucky to get PMR and then get Lyme Disease soon after ..... therefore:

(a) was your initial bout of PMR in fact Lyme disease, and maybe treatment for PMR somehow held back the Lyme disease symptoms.

or:

(b) was your Lyme disease in fact PMR, and maybe treatment for Lyme disease somehow held back the PMR symptoms.

Clever wife of GP

[Tonylynn in reply to Hidden]

I think it most probable that the initial diagnosis was incorrect. I was subsequently seen by a rheumatologist and she thought the diagnosis was more likely to be psoriatic arthritis (there being a family history) but she failed to test for lyme!

[Longtimer in reply to Tonylynn]

It has always puzzled me why doctors don`t test us for Lyme disease, but I have often read lately that our testing for it isn`t too accurate, but is in other countries.......so many people told negative may in fact have Lyme disease.....what a mess....and it clears up with antibiotics I believe....

[PMRpro Ambassador]

In the past they have looked to see if they could identify infective causes of PMR/GCA and nothing was found. Maybe , maybe not, but if there is it is probably only one component of a multifacetted cause.

[Tonylynn in reply to PMRpro]

I am aware that researchers have looked at a number of possible infecting agents but am unable to find any reference to p.gingivalis. Once cells, including those in the walls of arteries, become infected p.gingivalis remains dormant (bit like borrelia) occasionally waking to invade a new cell. Perhaps infections, stress etc could cause an increased secretion of gingipains from these infected cells which precipitates the cascade which results in the giant cell formation and the associated symptoms.

It seems many people have antibodies against p.gingivalis so one would expect to see them in those with GCA / PMR but if they were always present in GCA / PMR sufferers that would be something! Improbable, but who knows without testing.

[HeronNS]

It seems some of us can point to an illness marking the beginning of PMR, others to stress, whether physical or psychological. But no one illness is mentioned by everyone, no particular type of stress, so it seems PMR is most likely a breakdown or malfunction of the immune system, and no one yet knows how or why.

[Tonylynn in reply to HeronNS]

P.gingivalis enters the blood stream from the periodontal tissues even when periodontal disease is not obviously present. This would not give rise to an illness but could it not be that its presence in the walls of arteries could precipitate an inflammatory response with the formation of giant cells.

It would be interesting to know if there was a greater incidence of periodontal disease in those with PMR or GCA.

[Hidden in reply to Tonylynn]

I'm seeing my dental hygienist in a couple of weeks. I might ask her about this.

[Hidden in reply to Tonylynn]

I am not sure us always looking for the goose that laid the golden egg in terms of finding a "cause". Though it can impact patients attitude etc.

bmjopen.bmj.com/content/7/1...

[Devoid in reply to Tonylynn]

It’s very interesting when the number of vasculitis cases are increasing and the age getting younger at a time when access to a dentist is becoming increasingly difficult ??!!!

[HeronNS]

I have very healthy teeth and mouth. Pred has caused some gum recession not present when I became ill. I'm not saying what you say is wrong, only that it isn't the universal cause of PMR, which, if it exists, has not been discovered. PMR refers to a specific group of symptoms, but it doesn't seem to be like the flu or measles as its cause cannot be pinned on a specific pathogen.

[Orpheus82]

It is an interesting point though. I had had a tooth infection 3 months prior to the start of my PMR but had also had the stress of losing my brother to cancer 6 weeks before the PMR struck. So I had always put it down to the stress. Perhaps there is some merit to a dormancy theory similar to varicella zoster virus which is often awakened by stress to cause shingles. However that is a virus and not a bacteria. My tooth is still giving me trouble so I think it’s going to have to go. Wouldn’t it be wonderful if my PMR went at the same time!!

[HeronNS in reply to Orpheus82]

I believe there are lots of people who have found dealing with an underlying infection of some sort has indeed alleviated their PMR symptoms. Let us know how it is for you.

And many of us have suffered a combination of psychological stress and some kind of physical problem like an illness. In my case I had several years of various types of stress, but it all came to a head after I had a broken leg.