Rheumatoid Arthritis and HRT

Women with rheumatoid arthritis more likely to achieve remission if they take sex hormones, finds research, by University of South Australia, in “Rheumatology” (2022). DOI: 10.1093/rheumatology/keac357

This paper appeared in my newsfeed today: I have paraphrased it for brevity.

Rheumatoid arthritis (RA)affects < 2% of the world’s population and is primarily genetic.
It mainly causes joint disease but can also affect the whole body, including organs.
At age less than 50 years of age, RA is 4x more prevalent in women than men.
It is more aggressive in women and the prognosis is worse.
It is twice as common in women over 60 years.
The peak age of onset of rheumatoid arthritis among females is 45-55 years, corresponding with a drop in estrogen. Furthermore, at the onset of menopause there is an increase in pro-inflammatory proteins.
Early menopause, or menopause under 45 years, increases the risk of developing rheumatoid arthritis and the incidence spikes sharply, post-menopause.
Conversely, younger women with rheumatoid arthritis who become pregnant experience a 50% decline in inflammatory activity.

In a study of 4474 women with rheumatoid arthritis, led by the University of South Australia, patients were treated with Tocilizumab and other immuno-suppressive medications:
– Pre-menopausal women had fewer symptoms than peri- or post-menopausal women.
– RA patients using HRT or oral contraceptives (OCs) had a better chance of remission.
– Post-menopausal women, comprised 63% of the participants (only 8% of them were on HRT). They were less likely to achieve remission, compared to pre-menopausal women .
– Post-menopausal women aged <45 years) made up 5% of the participants:
25% were pre-menopausal, 9% were peri-menopausal and 63% were post-menopausal.
– Remission rates were higher in those taking HRT or OCs while treating RA.
– RA remission was twice as high in peri-menopausal women.
– Women entering menopause without HRT or OCs were less likely to achieve remission.”

This is very interesting, in that it suggests that HRT should be used to treat RA.
However the study appears to have been undertaken without consideration of a prior (May, 2014) report and it seems that the authors did not investigate and/or treat, for Proteus Mirabilis.

Therefore, Vide Infra:

(1) Rheumatoid arthritis is caused by a Proteus urinary tract infection,
by Alan Ebringer  1 Taha Rashid
PMID: 23992372, DOI: 10.1111/apm.12154
2014 May;122(5):363-8. doi: 10.1111/apm.12154. Epub 2013 Aug 29.

Genetic, molecular and biological studies indicate that rheumatoid arthritis (RA), a severe arthritic disorder affecting approximately 1% of the population in developed countries, is caused by an upper urinary tract infection by the microbe, Proteus mirabilis.
Elevated levels of specific antibodies against Proteus bacteria have been reported from 16 different countries.
The pathogenetic mechanism involves six stages triggered by cross-reactive autoantibodies evoked by Proteus infection.
The causative amino acid sequences of Proteus namely, ESRRAL and IRRET, contain arginine doublets which can be acted on by peptidyl arginine deiminase, thus explaining the early appearance of anti-citrullinated protein antibodies in patients with RA.
Consequently, RA patients should be treated early with anti-Proteus antibiotics as well as biological agents to avoid irreversible joint damages.

(2) March 2006: the original article was published by a Ebringer and Rashid. titled “Rheumatoid arthritis is an autoimmune disease triggered by Proteus
urinary tract infection” , by ALAN EBRINGER & TAHA RASHID, in a report from the School of Biomedical and Health Sciences, Kings College London, London, UK
Rheumatoid arthritis (RA) is a chronic and disabling polyarthritic disease, which affects mainly women in middle and old age.
Extensive evidence based on the results of various microbial, immunological and molecular studies from different parts of the world, shows that a strong link exists between Proteus mirabilis microbes and RA. We propose that sub-clinical Proteus
urinary tract infections are the main triggering factors and that the presence of molecular mimicry and cross-reactivity between these bacteria and RA-targeted tissue antigens assists in the perpetuation of the disease process through production of
cytopathic auto-antibodies.
Patients with RA especially during the early stages of the disease could benefit from Proteus anti-bacterial measures involving the use of antibiotics, vegetarian diets and high intake of water and fruit juices such as cranberry juice in addition to the currently employed treatments.

(3) PubMed Central, 2016 Apr 1 Proteus mirabilis and Urinary Tract Infections, by Jessica N. Schaffer and Melanie M. Pearson , in (original article Microbiol Spectr. 2015 Oct; 3(5): 10.1128/microbiolspec.UTI-0017-2013, doi: 10.1128/microbiolspec.UTI-0017-2013 PMCID: PMC4638163 NIHMSID: NIHMS724705 PMID: 26542036

Proteus mirabilis is well-known, as the species that swarms across surfaces, overtaking any other species present in the process.
If you want to be a real expert on Proteus mirabilis, read this seminal article; but be warned – it is “the last word” on Proteus, written for microbiologists only!


I am a Toronto-trained Urologist. I practiced in downtown Toronto, from 1977 to 1997, when I went to Saudi Arabia as chief of Urology at the Armed Forces (teaching) hospital in Tabuk. Returning to Toronto in Y2000, I switched to family practice. In 2007, began to prescribe Hormone Restoration Therapy and in 2012, I became a member of the American Academy of Antiaging Medicine [A4M]. I successfully wrote the A4M's written examination in December, 2013 and In May, 2016 I passed the oral examination, for accreditation as a BHRT consultant. In 2014 I began BHRT practice in Collingwood, Ontario and in January, 2017, joined the Stone Tree Naturopathic Clinic. Now I am 82 and have retired, but it seems wasteful to jettison my learning and experience: the medical establishment knows nothing of BHRT / Functonal medicine and I feel obliged to offer my knowledge in the interest of those who are willing to think outside the box. MY QUALIFICATIONS: MB, BS, (from UWI), 1964. LMCC 1969. FRCSC (Urology), 1974. ECFMG 1984. Florida license 1998 [inactive], ABAARM Certification [A4M], 2016. I am a Member of CSAMM [the Canadian Society for Aging and Metabolic Medicine], the OMA&CMA, SUSO, CUA, RCP&S/C. PRACTICE TO DATE: Consultation in Functional Medicine, including assessment of Chronic Fatigue Syndrome, Fibromyalgia, Andropause, Menopause, Teenage and Postpartum Depression/Panic Attacks, Thyroid Hormone malfunction, Infertility, Sexual Dysfunction and “the Undiagnosable”. ALL ARE WELCOME to read, comment or question!

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