Does gut health affect rheumatoid arthritis?
According to some studies, an imbalance of the intestinal microbiota could be linked to the development of certain diseases, including rheumatoid arthritis.
As a whole, the exact origin of rheumatoid arthritis is still unknown. But now, a new component has caught researchers’ eye: the intestinal microbiota. It has been discovered that sufferers have a decrease in microbial diversity and firmicutes, and then an increase in Bacteroides.
This article will explain the potential link between our gut microbiota and rheumatoid arthritis, so read on to learn more.
Table of Contents
- 1 Does gut health affect rheumatoid arthritis? Introduction
- 2 An inflammatory rheumatic disease
- 3 The link between gut health and rheumatoid arthritis
- 4 Gut microbiota interventions and rheumatoid arthritis
- 5 Does gut health affect rheumatoid arthritis? Conclusion
Does gut health affect rheumatoid arthritis? Introduction
Rheumatoid arthritis is an inflammatory disease often associated with general manifestations caused by an immune disorder.
This inflammatory disease affects and destroys the joints. In fact, rheumatoid arthritis causes joint pain, swelling and inflammation.
It is also a multifactorial disease fed by environmental, hormonal, immunological and genetic factors.
An inflammatory rheumatic disease
Rheumatoid arthritis is an autoimmune disease caused by abnormal antibodies directed against the synovial membrane.
The latter is a thin membrane that lines all the surfaces of our joints to allow them to slide against each other.
This disease is two to three times more frequent in women than in men, with a peak in frequency around the age of 45.
Some environmental factors such as genetic predisposition may play a role in the risk of developing this disease. However, this risk would be about 15% of cases.
Some people with rheumatoid arthritis have also reported that a viral or bacterial infection triggered the disease.
If innate immunity is also disrupted, the immunological disorder that causes rheumatoid arthritis is characterized by the activation of T-helper lymphocytes.
These lymphocytes are located in the intestinal wall in the presence of microbiota bacteria. These are at the origin of a general immunological stimulation and the secretion of cytokines responsible for an inflammatory reaction.
Source: Taneja, T follicular helper cells and the gut microbiome in arthritis, Nature Reviews Rheumatology, 2017
Rheumatoid factor is one of the autoantibodies (i.e., antibodies to the body’s components) often found in patients with rheumatoid arthritis.
It is directed against normal antibodies in the body, reflecting the disordered activity of immunity.
This disease is also often related to other autoimmune manifestations, underlining the generalized character of the immunological disorder.
Having this disease will also increase the risk of cardiovascular disease, myocardial infarction and stroke.
Here is a list of the first signs that can evoke the disease:
- Suppose a person is awakened at the night’s end by joint pain and feels numbness and stiffness in those joints for about 35 minutes in the morning. In that case, the person may be able to walk around the room and feel the pain.
- The joints are swollen and red, with an unpleasant heat sensation, and it first affects the hands and wrists, the feet, and sometimes the knees, shoulders or elbows.
- Joint damage and destruction often occur symmetrically on both sides of the body.
The link between gut health and rheumatoid arthritis
Scientific research has shown that taking antibiotics increases the risk of developing this disease by 60%.
Indeed, as we know, broad-spectrum antibiotics permanently disrupt the composition of the diverse microbiota in our body.
This research indirectly suggests that antibiotic-induced dysbiosis, which may induce bacterial translocation, could consequently promote the immune disorders allowing the development of rheumatoid arthritis.
Source: Sultan, et al., Antibiotic use and the risk of rheumatoid arthritis: a population-based case-control study, BMC Medicine, 2019
Gut dysbiosis is common in patients with rheumatoid arthritis
In other research, gut dysbiosis in patients suffering from rheumatoid arthritis is mainly marked by a decrease in microbial diversity and firmicutes, with an increase in Bacteroides.
These abnormalities are present at the initial stages of the disease.
An increase in endotoxin-producing bacteria in patients with more advanced rheumatoid arthritis increases these abnormalities.
Source: Abdollahi-Roodsaz, et al., The metabolic role of the gut microbiota in health and rheumatic disease: mechanisms and interventions. Nature Reviews Rheumatology, 2016
A dysbiosis of the oral microbiota also seems to be involved
Gum lesions have been reported in a large majority (about 80%) of people with positive rheumatoid arthritis blood markers, without even reporting the disease.
Recently, correlations have been demonstrated between losses in gut and oral microbiota diversity in people with rheumatoid arthritis.
The presence of antibodies in patients’ blood directed against the bacteria involved in the gum infection shows an immune stimulation by these bacteria that is likely to have favored the emergence of rheumatoid arthritis in people who are already prone to it.
Source: Chen, et al., Variations in oral microbiome profiles in rheumatoid arthritis and osteoarthritis with potential biomarkers for arthritis screening. Scientific Reports, 2018
Gut microbiota interventions and rheumatoid arthritis
The correction of intestinal dysbiosis has led to various treatment trials for rheumatoid arthritis.
A study conducted to test the effectiveness of probiotics in rheumatoid arthritis on many patients was disappointing.
Indeed, even if probiotics decreased the blood concentration of interleukin-6 (an inflammatory cytokine), they did not significantly affect the general state of the patients or the activity of the disease.
More studies are needed to determine the impact of prebiotics and probiotics, whether alone or in combination with nutritional measures on the symptoms and progression of rheumatoid arthritis.
These studies should include more patients, take into account the stage of the disease, the nature of the symptoms, and the presence of oral involvement.
Source: Mohammed, et al., The therapeutic effect of probiotics on rheumatoid arthritis: a systematic review and meta-analysis of randomized control trials, Clinical Rheumatology, 2017
Diet and rheumatoid arthritis
Research on women who eat a healthy diet high in fiber and low in saturated fat has shown a 30% reduced risk of developing rheumatoid arthritis by age 55.
On the other hand, a high salt consumption, whose inflammatory effects are known, increases the frequency of rheumatoid arthritis by 50%.
Source: Salgado, et al., High Sodium Intake Is Associated With Self-Reported Rheumatoid Arthritis, Medicine, 2015
A dietary fiber intake was tested in a study in 35 patients with rheumatoid arthritis.
Soluble and insoluble fibers, with added prebiotics that promote the growth of short-chain fatty acid-producing bacteria, were manufactured in the form of tablets and added to the patients’ diet.
After taking these pills daily for a whole month, amounting to about one ounce, the researchers noted an improvement in the general condition of the patients and at the biological level, a decrease in markers of bone damage, and an increase in the number of regulatory T cells.
Source: Häger, et al., The Role of Dietary Fiber in Rheumatoid Arthritis Patients: A Feasibility Study, Nutrients, 2019
Essential fatty acids of the omega-3 type
Omega-3 essential fatty acids contain anti-inflammatory properties. Numerous studies have confirmed that an adequate intake of omega-3 is beneficial to patients with rheumatoid arthritis.
In fact, the progression of the disease was slower and the general state of health better in people who followed the nutritional recommendations for seafood intake, as opposed to people who consumed little fish and seafood.
Other research has also been done to test the effectiveness of omega-3 intake in improving rheumatoid arthritis.
From these studies, it emerged that a significant supplementation of omega-3 (0.10 oz per day) in people with rheumatoid arthritis:
- Reduces inflammation and joint symptoms
- Improves general condition and physical abilities
- Reduces the use of analgesic treatments
- And all this without gaining weight.
Source: Navarini, et al., Polyunsaturated fatty acids: any role in rheumatoid arthritis? Lipids in Health and Disease, 2017
A diet enriched with fish oil would also increase remission rates of the disease and decrease resistance to combined drug treatments.
In addition, it is possible that an “anti-inflammatory” diet, low in animal proteins, could enhance the effectiveness of omega-3 in people with this disease.
Source: Proudman, et al., Fish oil in recent onset rheumatoid arthritis: a randomised, double-blind controlled trial within algorithm-based drug use, Annals of the Rheumatic Diseases, 2015
The Mediterranean diet
Studies have suggested that the adoption of a Mediterranean diet for several months (ranging from two to six months) would allow:
- an improvement in the general condition of the patients,
- an increase in their physical activity capacities,
- a decrease in the symptoms of the disease, and
- a reduction in the inflammation markers in the blood.
The Mediterranean diet can be defined as a diet centered on fresh, seasonal products that exclude all industrial products. It is a diet rich in good fats through olive oil.
We find fruits, vegetables, legumes, and grains as the major players in the Mediterranean diet. Indeed, there is little animal protein, and fish and eggs are preferred to meat.
- Sköldstam, et al., An experimental study of a Mediterranean diet intervention for patients with rheumatoid arthritis, Annals of the Rheumatic Diseases, 2003
- McKellar, et al., A pilot study of a Mediterranean-type diet intervention in female patients with rheumatoid arthritis living in areas of social deprivation in Glasgow, Annals of the Rheumatic Diseases, 2007
Presently there have been no actual studies on the effectiveness of fecal transplantation in the treatment of rheumatoid arthritis.
Does gut health affect rheumatoid arthritis? Conclusion
Therefore, numerous studies argue for the role of intestinal and oral dysbiosis in the risk of rheumatoid arthritis and its aggravation.
There are no effective treatments other than fiber and omega-3 supplements, which help reduce the risk of developing rheumatoid arthritis and the progression of this disabling autoimmune disease.
People at risk or with rheumatoid arthritis are advised to follow a Mediterranean-style diet.
A complimentary intake of fish oil can also be added. Still, it is essential to discuss this with a doctor competent in nutrition.
Rheumatoid arthritis is a very disabling disease that causes joint pain and swelling.
In addition, our gut microbiota is thought to play a role in the severity of disease symptoms, so it is essential to always have a balanced gut flora.