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| Medical School: | Universidad Nacional Mayor de San Marcos, Lima, Peru |
| Medical Internship: | Hospital Central Del Seguro Social del Empleado, Lima, Peru |
| Medical Residency: | Union Memorial Hospital, Baltimore Maryland |
| Rheumatology Fellowship: | Catholic Medical Center of Brooklyn and Queens at Queens Center, Jamaica, New York |
| Medical Practice: | Kaiser Permanente Medical Group, Group Practice-Fontana, California Medical Director - Arthritis Center of Riverside-Riverside, California Laboratory Director-Arthritis Center of Riverside-Riverside, California |
| Affiliations: |
American College of Rheumatology California Medical Association Riverside County Medical Association The Road Back Foundation, Advisory Board |
| Appointments: | Clinical Assistant Professor of Internal Medicine/Rheumatology College of Osteopathic Medicine of the Pacific Western University of Health Sciences-Pomona, California |
| Personal Information: | Dr. Franco is married and has four children. He is fluent in English, Spanish, French and Italian. |
Dr. Franco and Antibiotic treatment
The idea that rheumatic arthritis might be caused by an infection first occurred to Dr. Franco when he was still in medical school. While learning about tropical medicine, he studied patients with tropical infectious diseases such as typhoid fever, brucellosis and shigellosis. Along with fever and gastrointestinal distress, these patients also exhibited symptoms of joint involvement. This piqued Dr. Franco's curiosity because the joint involvement was to a degree that it resembled other arthritic ailments.
For instance, patients with typhoid had many joints involved and reminded Dr. Franco of early rheumatoid arthritis or systemic lupus erythmatosus while patients with brucellosis had spine and other joint involvement similar to that of ankylosing spondylitis. Patients with shigellosis had inflammation of the sacroiliac joints. Since there were those similarities and since no bacterial culprit could be isolated from patients with rheumatoid arthritis, Dr. Franco reasoned that perhaps R. A. was caused by a viral infection. It wasn't until years later that he would find out how close he was to the truth.
Throughout his rheumatology fellowship in New York during the late '70s, Dr. Franco continued asking questions and searching for answers. He scoured the medical literature for all that was written about the interrelationship between infections and rheumatic diseases. He learned everything he could about the microorganisms that cause bone and joint disease, namely bacteria, viruses, fungi, parasites and Mycoplasmas.
Bacterial infections were known to cause septic and reactive arthritis. Multiple viruses were implicated in arthritis while some frequently caused it. Species of fungi were known to be pathogens that could lead to arthritis and parasites had been associated with joint and bone lesions. The role Mycoplasma played in arthritis, however, had been debated for years.
Mycoplasma species differ from bacteria in that they are very small and lack a cell wall. They are the smallest organism able to survive outside of cells. They enter the tissue in different areas and cause injury to the cell mucosa. Once damage to the body occurs, the body frequently is unable to clear the Mycoplasma from the site of infection without antimicrobial treatment.
With all that was known about the causes of rheumatalogic diseases, Dr. Franco was frustrated and baffled that the treatments for these ailments were not more effective. While practicing rheumatology in the '80s, he had seen some success with the disease-modifying antirheumatic drugs (DMARDs). Ever curious, he wanted to know why. What did they have in common? He soon discovered that the common thread in DMARDs is the fact that they all possess antimicrobial properties. That observation led him to presume there must be something to the connection between DMARDs antimicrobial properties and their success against rheumatic arthritis and the effectiveness of antimicrobial treatment on ridding the body of Mycoplasma.
Then, in 1988, he read, "The Road Back" by Dr. Thomas M. Brown and Henry Scammell. In their book they theorized that Mycoplasma was a bacteria that behaved as a virus. When Dr. Franco read that, it took him all the way back to his med school days. That would explain why no bacterial culprit could be detected in patients with rheumatoid arthritis. The bacteria were camouflaged, hiding if you will. They couldn't be isolated because they were residing intracellularly, like a virus.
Dr. Franco realized the implications of this. He knew they were very close to a breakthrough in understanding how Mycoplasma may cause rheumatoid arthritis. If the theory proved correct, then perhaps a better, more effective way to treat R. A., maybe even reverse it, was just around the corner. He was very anxious to meet with Dr. Brown and discuss the possibilities so he called the Arthritis Institute.
Unfortunately, he was too late. Dr. Brown had recently passed away.
Dr. Franco was stunned. He fully recognized the enormous contribution of Dr. Brown and his research in the field of rheumatology. The impact of that work could effect millions. Dr. Franco thought it was only right that that vital work continue. It was then that he decided to put Dr. Brown's theory into practice.
Starting in 1988, Dr. Franco enrolled approximately 150 patients with rheumatoid arthritis on the antibiotic treatment. He began by prescribing low dose tetracycline. Later he added other antibiotics, including doxicycline, erythromycin and minocycline.
With this treatment, he noticed that most patients would initially worsen, due to the development of the Herxheimer's Reaction. However, this would pass after a few weeks or months and thereafter improvement would ensue. Progress was usually slow, except with patients who had rheumatoid arthritis for a short period of time and an even faster recovery in younger individuals.
After seven years of using this treatment modality, the overall results were very encouraging. In order to confirm this, Dr. Franco reviewed, retrospectively, the cases of 255 patients with R. A. who had been treated over a period of between six months and seven years. The data confirmed that patients with R. A. improved on various antibiotics.