The recent editorial by Dr. Paulus [1], although of great interest, was flawed by inaccurate and missing information.

Dr. Paulus stated that in 1968, Sanchez ... first reported the use of tetracycline to treat 14 patients with rheumatoid arthritis, with favorable results. Apparently, the author was unaware that Dr. Thomas McPherson Brown started to treat patients with rheumatoid arthritis 20 years earlier, in 1947, with aureomycin when the drug was first available and provided by Lederle Laboratories. Dr. Brown and colleagues first reported the beneficial effects of tetracyclines in 1949 at the Seventh International Congress on Rheumatic Diseases, the same meeting at which the benefits of cortisone treatment were introduced. The first results, with the use of large oral doses aimed at an infectious cause [2], were followed by a report that described the first effective intravenous tetracycline treatment for rheumatoid arthritis [3].

For unknown reasons, Dr. Paulus misnamed Dr. McPherson Brown and omitted my name as one of the coauthors of the study in his reference 4. This study was discounted by the author and others in favor of the statistically erroneous negative study in 1971. Dr. Paulus also failed to differentiate between the more active doxycycline and minocycline used in our study and the less effective oral tetracycline used in the negative study. Although the author discussed tetracycline's multiple actions (antimet-alloenzymes, anti-inflammatory, immunosuppressant, and so forth), he did not discuss the critical differences between the oral and intravenous administration of tetracyclines.

The results of the clinical trial of intravenous tetracycline therapy in patients with rheumatoid arthritis now under way at Duke University should concur with the effective control we found in the patients and gorillas [4]. A follow-up study was published in the Smithsonian Institution's National Zoo annual report in 1970.

Unfortunately, discounting these and other early observations, the editorial also failed to recognize the benefits of intermittent or combined oral and parenteral tetracycline therapy used by Dr. Brown in the rheumatoid immunologic disorders. For example, the effectiveness of routine tetracycline therapy seems to be lost in the late stages of atypical pneumonia as Mycoplasma pneumoniae continues to be shedded. As in Yorkshire swine, the mycoplasma antibody persists in patients with rheumatoid arthritis even though the antigen could not be cultured. As to the cause and mechanism of rheumatoid arthritis, there should be no question that some mycoplasma strains can cause arthritis in humans. Whether they are also a primary cause of the chronic rheumatoid arthritis, however, remains unknown.