Changes in the gut microbiome before rheumatoid arthritis develops could provide a window of opportunity for preventive treatments, new research suggests.
Bacteria associated with inflammation are found in the gut in greater numbers about ten months before patients develop clinical rheumatoid arthritis, according to a longitudinal study by Leeds researchers.
Rheumatoid arthritis, which affects more than half a million people in the UK, is a chronic disease that causes swelling, pain and stiffness in the joints because the immune system mistakenly attacks healthy cells in the body.
Previous research has linked rheumatoid arthritis to the gut microbiome, which is the ecosystem of microbes in the intestines. But this new study, published today in the Annals of rheumatic diseasesreveals a possible point of intervention.
Lead researcher Dr Christopher Rooney, NIHR Academic Clinical Professor at the University of Leeds and Leeds Teaching Hospitals NHS Trust, said: “Patients at risk of rheumatoid arthritis are already experiencing symptoms such as fatigue and joint pain. , and they may know someone in their family who has developed the disease. As there is no known cure, at-risk patients often feel a sense of hopelessness or even avoid getting tested.
“This new research could give us a great opportunity to act sooner to prevent rheumatoid arthritis.”
Great treatment opportunity.
Funded by Versus Arthritis, the longitudinal study was conducted on 19 patients at risk for rheumatoid arthritis, and samples were taken five times over a 15-month period.
Five of these patients progressed to clinical arthritis and investigation showed that they had intestinal instability with increased amounts of bacteria, including Prevotella, which is associated with rheumatoid arthritis, approximately ten months before progression. The remaining 14, whose disease did not progress, had largely stable numbers of bacteria in their intestines.
Possible treatments that researchers want to test within ten months include dietary changes, such as eating more fiber, taking prebiotics or probiotics, and improving dental hygiene to keep harmful periodontal disease bacteria away from the gut.
The exact relationship between intestinal inflammation and the development of rheumatoid arthritis is still unclear. In a small number of patients in the study, intestinal changes occurred before a rheumatologist observed joint changes, but more research is needed to determine whether these influence each other.
Although bacteria are associated with rheumatoid arthritis, researchers want to be clear that there is no evidence that it is contagious.
Lucy Donaldson, director of health research and intelligence at Versus Arthritis, said: “At Versus Arthritis, we welcome the findings of this study which could provide doctors of the future with a crucial window of opportunity to delay, or even prevent, the emergence of rheumatoid arthritis. This success is testament to the dedication of UK researchers who are working to personalize treatment and prevent chronic diseases that have significant impacts on a person’s ability to work, raise families and live well. independent”.
Years in the making
The research was carried out in collaboration with the Leeds Biomedical Research Center of the National Institute for Health Research, under the research themes of Antimicrobial Resistance and Infection and Musculoskeletal Diseases.
Leeds Teaching Hospitals NHS Trust, Versus Arthritis and Leeds Hospitals Charity were also partners in the project. Patients at Chapel Allerton Hospital helped design the research to make stool sampling easier for participants.
The study initially took data from 124 people who had high levels of CCP+, an antibody that attacks healthy cells in the blood, indicating risk of developing rheumatoid arthritis. The researchers compared their samples to 22 healthy individuals and seven people who had a new diagnosis of rheumatoid arthritis.
Findings from this larger group showed that the gut microbiome was less diverse in the at-risk group, compared to the healthy control group.
The longitudinal study, which sampled 19 patients over 15 months, revealed changes in bacteria ten months before progression to rheumatoid arthritis.
The Leeds research team will now carry out an analysis of the treatments that have already been tested, to inform future testing of the treatments at this potential ten month intervention point.