Rheumatoid Arthritis can be a debilitating autoimmune disease that progressively attacks the joints, heart, liver and kidneys, causing pain and permanent disability if left untreated.A visiting British researcher and medical professor believes that something as simple as water and cranberry juice may go a long way to preventing it from developing.Alan Ebringer is professor of immunology at King’s College London and honorary consultant rheumatologist at Middlesex Hospital in the UK.He has just released a book called ‘Rheumatoid Arthritis and Proteus’. Proteus is a germ that is the second most common cause of urinary tract infections. Dr Ebringer believes there is compelling evidence that there is a link between genetics, UTIs and RA. He was at King Edward VII Memorial Hospital to give a lecture for medical professionals as part of the Continuing Medical Education Programme.In the late 1980s Dr Ebringer was one of a handful of doctors here and in the UK researching the connection between Proteus and RA.“In the 1980s in London I had a very promising young doctoral student, Clyde Wilson from Bermuda,” said Dr Ebringer. “He is now a consultant microbiologist for the Bermuda Hospitals Board. He was then doing his PhD at King’s College, University of London. We decided to study RA. Dr Wilson contacted doctors on the Island to put together a group of patients with RA to be studied.”Dr Ebringer was put in contact with two local doctors — Henry Subair, a member of the American College of Rheumatology and the British Rheumatoid Arthritis Society and Keith Cunningham, the chief of pathology at BHB for several decades, until his retirement recently.“We needed 34 patients with inflamed RA and I didn’t have that number,” said Dr Subair. “So I put a call in to all the other doctors around the Island begging and pleading for patients. And we got enough people together. Blood tests were carried out at King Edward.”The study found antibodies to Proteus in the RA patients; the results closely mirrored that of similar studies conducted in the United Kingdom and other parts of the world. The paper was published in Canada in 1995 in ‘The Journal of Rheumatology’.“Americans published a similar result on antibodies to Proteus in RA patients in 2005, ten years after Bermuda,” said Dr Ebringer. “Bermuda was the first country in the western hemisphere to show that Proteus was present in patients with RA.”The Bermuda results form a chapter in Dr Ebringer’s book.RA is two to three times more common in women than men and this could be because of the link to UTIs. Women are more susceptible to UTIs because their urinary tract is shorter. Symptoms of a UTI include pain and burning upon urination and often pain in the lower abdomen. Not every person who develops a UTI will develop RA. According to Dr Ebringer, it is likely that the UTI caused by the Proteus combines with a genetic predisposition to RA.The results have not been without controversy. Other researchers believe that environmental factors or vitamin deficiencies may be the cause of RA. There is some evidence that while the overall incidence of RA is going down in recent years, the incidence of women with RA is actually increasing in the United States. About one percent of the world’s population suffer from RA and Bermuda’s incidence is on par with that.“RA can be a severe disease especially in women between the ages of 40 and 50,” said Dr Ebringer. “The results of our investigations have indicated that it is treatable. It is preventable. When a person is diagnosed with a UTI, they need to have a high fluid intake to flush the bacteria out. They need to drink cranberry juice and take antibiotics for the appropriate microbes.”Fruit juices such as cranberry juice and blueberry juice have been proven effective at reducing the effects of UTIs, because the fruit juice molecules stick to the walls of the urethra and bladder, in simple terms, giving the UTI germ fewer places to sit and take hold. A small bottle of pure blueberry juice in Bermuda stores can run as high as $15 a bottle. If you think that is high, Dr Ebringer said, just compare it to the cost of treating a patient with RA each year.“In the UK it is on average $15,000 a year,” he said. “You could buy a lot of blueberry juice with that.”“RA should be treated early so they don’t get the deformities,” said Dr Ebringer. “Once RA patients get the deformities it is irreversible.”Now Dr Ebringer said he would like to take the study further as he has seen anecdotal evidence that increasing fluid intake may help even RA sufferers with severe deformities.“One of the ways to treat it is by drinking four pints of water a day and drinking cranberry juice to flush out the Proteus,” he said. “One of my elderly patients said she had increased her fluid from four to six pints. I said, ‘oh, you must have been going to the toilet a lot’. She said ‘look young man, don’t worry about my problems going to the toilet. The reason I increased my fluid intake is that now I can open the door to the bathroom. I can now hold the wheel of the car and drive around which I couldn’t do before.”Dr Ebringer has also conducted extensive research into other autoimmune diseases such as Crohn’s Disease and Ankylosing Spondylitis. Crohn’s Disease is a form of inflammatory bowel disease that involves the intestines. Ankylosing Spondylitis involves the inflammation of bones in the spinal column.See Dr Ebringer’s book on www.googlebooks.com.