Rheumatoid arthritis and the microbiome

Several readers asked me to summarize Rheumatoid arthritis and the microbiome like I did for multiple sclerosis. The readers often cited high rates of RA in immediate family, and the risk was known since at least 1993. A followup post on mitigation is here.

“A high frequency of small intestinal bacterial overgrowth was found in patients with RA; it was associated with a high disease activity and observed in patients with hypochlorhydria or achlorhydria and in those with normal acid secretion.” [1993]

The pattern for autoimmune seem to be an interaction between DNA/SNPS/Genes and the microbiome. How the two come together determines if onset occurs, severity etc. 

DNA is not an easy to change. Microbiome is. Many successful treatments for rheumatoid arthritis have involved antibiotics before the microbiome dimension was discovered.

  • “In this article, we discussed the role of gut microbiota in the pathogenesis of rheumatic diseases based on a large number of experimental and clinical materials, thereby providing a new insight for microbiota-targeted therapies to prevent or cure rheumatic diseases.” ]2017]
  • “Altered microbiota, well described in patients affected by RA, seems associated with perturbation of certain metabolic pathways and the therapies addressed to correct gut microbiome dysbiosis could help in the maintenance of immune homeostasis of the host.” [2017]
  • From [20172017]


Rheumatoid arthritis and the Microbiome 

  • “the genus Pseudonocardia and various related OTUs were the only taxa overrepresented in RA  bronchoalveolar lavage fluid and correlated with higher disease activity and erosions.”[2016]
  • The aggravation of arthritis by periodontitis is dependent of IL-17 receptor A activation[2017].
    • “The effects of P. gingivalis-induced periodontitis on arthritis … lead to increased neutrophil infiltration into the joints.”
  • The oral and gut microbiomes are perturbed in rheumatoid arthritis and partly normalized after treatment[2015].
    • “The redox environment, transport and metabolism of iron, sulfur, zinc and arginine were altered in the microbiota of individuals with RA.”
  • Alteration of Fecal Microbiota Profiles in Juvenile Idiopathic Arthritis. Associations with HLA-B27 Allele and Disease Status[2016].
    • HS: Healthy Subjects
    • fmicb-07-01703-g001
    • “abundant taxa identified JIA patients for the HLA-B27 allele, including Bilophila, Clostridium cluster XIVb, Oscillibacter, and Parvimonas. “
    • “reduction in Clostridiaceae and Peptostreptococcaceae in JIA-ERA, and increase in Veillonellaceae in JIA-nERA, “
  • “A growing number of microbiota constituents such as Prevotella copri, Porphyromonas gingivalis, and Collinsella have been correlated or causally related to rheumatic disease. [2016]
  • “Mice susceptible to collagen-induced arthritis (CIA) showed enriched operational taxonomic units (OTUs) affiliated with the genus Lactobacillus as the dominant genus prior to arthritis onset. With disease development, the abundance of OTUs affiliated with the families Bacteroidaceae, Lachnospiraceae” [2016]
  • An expansion of rare lineage intestinal microbes characterizes rheumatoid arthritis [2016].
    • “A taxon-level analysis suggested an expansion of rare taxa, Actinobacteria, with a decrease in abundant taxa in patients with RA compared with controls. Prediction models based on the random forests algorithm suggested that three genera, Collinsella, Eggerthella, and Faecalibacterium, segregated with RA. The abundance of Collinsella correlated strongly with high levels of alpha-aminoadipic acid and asparagine as well as production of the proinflammatory cytokine IL-17A. A role for Collinsella in altering gut permeability and disease severity was confirmed in experimental arthritis.”
  • “reducing the concentration of Bacteroides spp., Bifidobacterium spp., Lactobacillus spp. populations, typical strain E. coli. But over growth of populations Klebsiella spp., Proteus spp., Staphylococcus spp., atypical forms of E. coli, Candida spp. ” [2014]


Treatment Options

Bottom Line

The first item is a refrain from older posts —   start by getting your mouth in shape!

  • “The association between rheumatoid arthritis (RA) and periodontitis is well established.” [2016]

During the survey found several probiotics having symptom relief of RA, the ones that are easy to obtain are:

  • Lactobacillus  casei
  • Lactobacillus plantarum
  • Bacillus  coagulans

In my next post, I will do the same type of theoretical analysis that I did for multiple sclerosis.

The gem of knowledge that I found interesting was “Gastrointestinal and urogenital infections, but not respiratory infections, are associated with a significantly lowered risk of RA. “. A hundred years ago, this information could have lead to the intentional causing of a gastrointestinal infection to treat RA — similar to the willful infection of Cowpox to prevent Smallpox [History]. I would not be surprise to read of people recovering from CFS after a bout of stomach flu (viral gastroenteritis) — it’s theoretically possible.

As always, this is intended as an educational post and not intended to treat any condition. Always consult with a knowledgeable medical profession before modifying supplements, diet, etc.