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Parasitic Infections and Arthritis: The Dark Side

Sanux Team

Sanux Team

— 11 min read
Parasitic Infections and Arthritis: The Dark Side
Photo by Michael Schiffer / Unsplash

I was introduced into the world of parasites by Dr. Evan Hirsch, a functional medicine specialist with over 19 years of experience in the medical field. He is the founder of The EnergyMD, a program that helps people improve their energy levels and overcome fatigue.

My interested sparked when i found a relationship between parasites and arthritis, since i am finishing writing a book on arthritis.

There is some evidence and research on the relationship between parasites and arthritis, and found a few studies supporting not only a risk factor but also some benefits.

Rheumatoid Arthritis (RA):

Some studies have suggested that chronic parasitic infections may modulate the immune system in a way that could affect the development of autoimmune diseases like rheumatoid arthritis. For example, the hygiene hypothesis suggests that the reduced exposure to parasites and other infections in developed countries may contribute to the increased incidence of autoimmune diseases.

Entamoeba histolytica and Reactive Arthritis:

There is evidence that certain parasitic infections, such as those caused by Entamoeba histolytica, can trigger reactive arthritis in some individuals. Reactive arthritis is a form of inflammatory arthritis that can develop in response to certain infections, including bacterial and parasitic ones.

Entamoeba histolytica is a protozoan parasite responsible for amoebiasis, a disease with a high prevalence in developing countries. Recent reports have identified this parasite as a rare potential cause for reactive arthritis, which is the likely scenario in some cases.

These are the top 10 countries in order of prevalence where Entamoeba histolytica is endemic: Indonesia, Mexico, Brazil,South Asia, Middle East, South America, Taiwan, Iran, Saudi Arabia, Vietnam

Key points:

Symptoms of Reactive Arthritis:

  • Reactive arthritis is a form of autoimmune arthritis or joint inflammation that occurs as a “reaction” to an infection elsewhere in the body[5].
  • Reactive arthritis typically affects the joints, eyes, and urinary tract[5].
  • Symptoms of reactive arthritis include joint pain, swelling, stiffness, and redness, as well as eye inflammation, urinary tract symptoms, and skin rashes[5].

Entamoeba histolytica and Reactive Arthritis:

  • Entamoeba histolytica is a protozoan parasite and the causative agent of amoebiasis[4].
  • Recent reports have identified Entamoeba histolytica as a rare potential cause for reactive arthritis[1].
  • Parasitic rheumatism was diagnosed in 16% of patients with reactive arthritis, and Entamoeba histolytica was identified in 8% of cases[2].
  • The immune response to Entamoeba histolytica involves the activation of innate and adaptive immune cells, which can lead to inflammation and tissue damage[3].
  • The immune response of Entamoeba histolytica and immune evasion by the parasite are complex and not fully understood[4].

Treatment of Reactive Arthritis:

  • Treatment of reactive arthritis typically involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve joint pain and inflammation[5].
  • In some cases, disease-modifying antirheumatic drugs (DMARDs) or biologic agents may be used to treat more severe cases of reactive arthritis[5].
  • Treatment of Entamoeba histolytica infection typically involves the use of antiparasitic medications, such as metronidazole or tinidazole[4].

Citations:

Filariasis and Joint Symptoms

Filariasis is an infectious disease caused by filarial parasites that can lead to inflammation, swelling, fever and can lead to joint symptoms resembling arthritis in some cases. The disease is transmitted by different types of mosquitoes, such as the Culex mosquito, Anopheles, and Aedes. While lymphatic filariasis is endemic in many countries, there are efforts to eliminate the disease through mass treatment programs and surveillance.

Here are the top 10 countries where lymphatic filariasis is endemic, according to the World Health Organization: India, Indonesia, Nigeria, Bangladesh, Pakistan, Tanzania, Mozambique, Myanmar, Egypt, Ethiopia.

Key points:

Symptoms of Filariasis:

  • Some people have no symptoms, while others may have inflammation, swelling, or fever[1].
  • Filariasis can lead to lymphedema (fluid retention) or hydrocele[1].
  • Over time, damage to the lymphatic system may make it difficult for the body to fight infections, leading to frequent bacterial infections, elephantiasis, and other complications[1].
  • Symptoms of filariasis vary depending on the type of filarial infection. Onchocercal dermatitis is the most common sign/symptom of onchoceriasis. The skin becomes very itchy, and a red spotty rash is often present. Scratching often leads to bleeding, ulcers, and secondary infections. The lower trunk, pelvis, buttocks, thighs, and legs appear to be the most affected. Microfilariae are the main cause of this dermatitis[5].

Joint Symptoms of Filariasis:

  • In the subcutaneous form of filariasis, symptoms include itching, urticaria, skin rashes, and joint involvement or arthritis[6].
  • Chronic infection can lead to swelling of the extremities, hydroceles, and testicular masses[2].
  • Filariasis may cause joint symptoms such as painful lymphadenopathy and retrograde lymphangitis that most often affect the inguinal nodes, genitalia, and other areas[4].

Treatment of Filariasis:

  • Anti-parasitic medications can lead to severe side effects such as dizziness, fever, headache, muscle or joint pain, and nausea[1].
  • Even if medication kills the filarial worms, lymphedema can still develop. To manage lymphedema symptoms, disinfect and cover any wounds, elevate swollen arms or legs, and use compression garments[1].
  • Filariasis may develop into chronic conditions such as lymphedema or elephantiasis. These conditions have no cure, although you can manage them and reduce symptoms[1].

Citations:

Helminthic Therapy

Some experimental treatments, known as helminthic therapy, involve intentionally infecting individuals with certain parasitic worms (helminths) to modulate their immune response. This has been explored as a potential treatment for autoimmune conditions, including various forms of arthritis.

Helminthic therapy is a type of immunotherapy that involves the treatment of autoimmune diseases and immune disorders by means of deliberate infestation with a helminth or with the eggs of a helminth. Helminths are parasitic worms that have evolved to manipulate the host immune system to avoid attack and induce immune tolerance. Helminthic therapy aims to restore the balance of the immune system by introducing helminths into the body, which can modulate the immune response and reduce inflammation.

Key points:

Advantages of Helminthic Therapy:

  • Helminths are central to correcting immune dysregulation, and their replenishment may prevent disease[3].
  • Helminths have anti-inflammatory effects on both protozoan parasites and rheumatoid arthritis[1].
  • Helminth therapy has been suggested as a possible treatment method for autoimmune and other inflammatory disorders in humans[4].
  • Helminth therapy focuses on advantageous results that have been obtained[2].
  • Helminths are extremely successful parasites capable of establishing long-lasting infections within a host[3].

Limitations of Helminthic Therapy:

  • The number of organisms hosted by individuals undergoing helminthic therapy is very small and any side effects are typically only encountered in the first three months of infection[3].
  • It is currently unknown which clinical dose or species of helminth is the most effective method of treatment[3].
  • The appropriateness of the species of helminths used, whether infections should be systemic or localized, whether the dose should be light or heavy, of acute or chronic duration, and the role of host genetics are still being investigated[4].
  • Helminth infection is not an appropriate treatment direction due to the complex immunoregulation and safety concerns[5].

Citations:

It's essential to emphasize that the relationships between parasitic infections and arthritis are not straightforward, and the immune system's response to parasites is complex and can vary from person to person. Furthermore, the development of arthritis is influenced by a combination of genetic, environmental, and immunological factors.

Here are some less known facts about the relationship between arthritis and parasites:

  • Phenolic compounds, such as flavonoids, have anti-inflammatory effects on both protozoan parasites and rheumatoid arthritis[1]. This suggests that there could be a potential link between the treatment of parasitic infections and the treatment of rheumatoid arthritis.
  • Infection with toxoplasmosis, a parasitic disease caused by the protozoan Toxoplasma gondii, could be a risk factor for rheumatoid arthritis[3]. This suggests that parasitic infections could be a potential risk factor for the development of rheumatoid arthritis.
  • Reactive arthritis is classically seen following infection with enteric pathogens such as Yersinia sp., Salmonella sp., Campylobacter jejuni, and Shigella sp., but inflammatory arthritis has also been described following enteric infections with other organisms such as Clostridium difficile, Brucella sp., and Giardia sp.[4]. This suggests that parasitic infections could be a potential cause of reactive arthritis.
  • Infection by intestinal protozoa was associated with increased intestinal permeability and increased serum levels of IFABP2 and TNF-α in patients with rheumatoid arthritis[2]. This suggests that parasitic infections could be associated with increased inflammation in patients with rheumatoid arthritis.
  • Little is known of the pathogenesis of arthritis in parasitic infections[4]. This suggests that further research is needed to better understand the relationship between parasitic infections and arthritis.

Citations:

The following are are some key studies published that have looked at the relationship between arthritis and parasites.

A study published in 2017 suggests that infection with helminths can minimize the occurrence and severity of rheumatoid arthritis.

  • The study was published in 2013 in the journal Clinical and Experimental Immunology[1].
  • The authors of the study reviewed the anti-inflammatory effects of a specific immunomodulator called ES-62 on innate and adaptive immune responses and the potential for ES-62 to be used as a therapeutic agent for rheumatoid arthritis[1].
  • ES-62 is a molecule produced by the filarial nematode Acanthocheilonema viteae, which is a type of helminth[1].
  • The authors found that ES-62 has potent anti-inflammatory effects on both innate and adaptive immune responses, and that it can suppress the development of rheumatoid arthritis in animal models[1].
  • The authors suggest that ES-62 could be used as a therapeutic agent for rheumatoid arthritis, and that further research is needed to determine the safety and efficacy of ES-62 in humans[1].

Citations:

A study published in 1981 reports that arthritis developed in two patients during the course of parasite infestation with Strongyloides stercoralis and Taenia saginata, respectively /

  • The study was published in 1981 in the journal Annals of the Rheumatic Diseases[1].
  • The authors of the study reported on two cases of reactive arthritis induced by parasitic infestation[1].
  • The first case involved a 28-year-old man who developed arthritis during the course of a Strongyloides stercoralis infestation[1].
  • The second case involved a 30-year-old man who developed arthritis during the course of a Taenia saginata infestation[1].
  • Both patients had symptoms of arthritis, including joint pain, swelling, and stiffness, and both had positive serologic tests for rheumatoid factor[1].
  • The authors suggest that parasitic infestation could induce reactive arthritis, and that further research is needed to better understand the relationship between parasitic infestation and arthritis[1].

Citations:

A review article published in Trends in Parasitology suggests that parasitic worms could be a potential answer to conquering rheumatic diseases, as the global incidence of autoimmune and rheumatic diseases shows an inverse correlation with parasitic helminth endemicity.

  • The article was published in 2023 in the journal Trends in Parasitology[1].
  • The authors of the article reviewed the epidemiological data that support the inverse correlation between parasitic helminth endemicity and the prevalence of autoimmune and rheumatic diseases[1].
  • The authors suggest that parasitic worms could be a potential answer to conquering rheumatic diseases, as they have evolved to manipulate the host immune system to avoid attack and induce immune tolerance[1].
  • The authors also suggest that parasitic worms could provide broad-spectrum protection against age-related diseases, including rheumatic diseases, by modulating the immune system and reducing inflammation[1].
  • The authors note that improvements in hygiene and elimination of helminth parasites have been of incalculable benefit to humanity, but that the cost coupled with this benefit is abnormalities of immune function that may contribute to the development of autoimmune and rheumatic diseases[1].
  • The authors suggest that restorative helminth therapy, which involves the controlled infection of patients with parasitic worms, could be a potential treatment for autoimmune and rheumatic diseases, and that further research is needed to determine the safety and efficacy of this approach[1].

Citations:

A study published in Frontiers in Medicine suggests that infection by intestinal parasites could increase the serum levels of IFABP2 and TNF-α in patients with rheumatoid arthritis. https://www.frontiersin.org/articles/10.3389/fmed.2022.846934

  • The study was published in 2022 in the journal Frontiers in Medicine[1].
  • The authors of the study conducted a cross-sectional study in 18 women diagnosed with rheumatoid arthritis to determine the frequency of infection by intestinal parasites and its relation with inflammation and intestinal permeability markers[1].
  • A fecal sample of each participant was analyzed for parasitic identification, and serum levels of IFABP2 and TNF-α were measured[1].
  • The authors found that infection by intestinal protozoa was associated with increased intestinal permeability and increased serum levels of IFABP2 and TNF-α in patients with rheumatoid arthritis[1].
  • The authors suggest that infection, coinfection, and abundance of intestinal protozoa should be clinically screened because they could be an associated factor to the clinical variability of the disease[1].

Citations:

A case report published in Rheumatology describes a patient with early-onset polyarthritis as a presenting feature of intestinal infection with Strongyloides stercoralis. https://academic.oup.com/rheumatology/article/42/11/1419/1788272

  • The case report was published in 2003 in the journal Rheumatology[1].
  • The authors of the case report describe a 54-year-old woman who presented with early-onset polyarthritis, which was later found to be associated with an intestinal infection with Strongyloides stercoralis[1].
  • The patient had a history of travel to Africa and South America, and had been treated with nonsteroidal anti-inflammatory drugs and methotrexate for her arthritis symptoms[1].
  • The authors suggest that the patient's arthritis symptoms were likely due to the parasitic infection, and that the case highlights the importance of considering parasitic infections in patients with arthritis symptoms, especially those with a history of travel to endemic areas[1].

Citations:

A systematic review and meta-analysis published in PLOS Neglected Tropical Diseases reports that toxoplasmosis infection can be a risk factor for rheumatoid arthritis. https://journals.plos.org/plosntds/article?id=10.1371%2Fjournal.pntd.0006545

  • The study was published in 2018 in the journal PLOS Neglected Tropical Diseases[2].
  • The authors of the study conducted a systematic review and meta-analysis of studies that investigated the association between toxoplasmosis infection and rheumatoid arthritis[2].
  • The authors found that toxoplasmosis infection was associated with an increased risk of rheumatoid arthritis, and that the association was stronger in studies that used serological tests to detect toxoplasmosis infection[2].
  • The authors suggest that toxoplasmosis infection could be a risk factor for rheumatoid arthritis, and that further research is needed to better understand the relationship between toxoplasmosis infection and rheumatoid arthritis[2].

Citations:

Dr. Evan Hirsch has extensive knowledge and expertise in parasites.

In a podcast episode with Cassie Bjork, he discussed how mold, parasites, Lyme, and toxins could be blocking energy levels. In another podcast episode with Dr. Doni, he mentioned that parasites could be one of the underlying causes of fatigue.

He is an expert in detoxing the environment to treat fatigue, and getting rid of toxins as a critical step to having more energy. Furthermore he discussed how insect-borne parasites could be triggering panic attacks. His EnergyMD program addresses parasites as one of the heavy metals, chemicals, molds, infections, and trauma that need to be addressed to enable lasting healing.

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