Recent research indicates that changes in the gut microbiome prior to the onset of rheumatoid arthritis could open up opportunities for preventive treatments.
Researchers from Leeds have discovered that levels of certain bacteria linked to inflammation are significantly higher in the gut about ten months before patients show clinical signs of rheumatoid arthritis.
Rheumatoid arthritis, which affects over half a million individuals in the UK, is a long-lasting condition characterized by joint pain, swelling, and stiffness caused by the immune system attacking healthy cells by mistake.
While earlier studies have suggested a connection between rheumatoid arthritis and the gut microbiome—the community of microorganisms residing in our intestines—this latest study published in the Annals of the Rheumatic Diseases highlights a key opportunity for intervention.
Dr. Christopher Rooney, the lead researcher and an NIHR Academic Clinical Lecturer at the University of Leeds and Leeds Teaching Hospitals NHS Trust, stated: “Patients at risk for rheumatoid arthritis often experience early symptoms like fatigue and joint pain and may have a family history of the disease. Lacking a known cure, these individuals frequently feel hopeless, some even delaying necessary testing.”
“These findings could provide a critical chance to take preventive measures against rheumatoid arthritis sooner.”
A Significant Treatment Opportunity
This longitudinal study, funded by Versus Arthritis, involved 19 patients considered at risk for rheumatoid arthritis, with samples collected five times over a 15-month span.
Of these, five patients developed clinical arthritis, revealing that they exhibited gut instability and increased amounts of Prevotella—a type of bacteria associated with rheumatoid arthritis—approximately ten months before symptoms progressed. In contrast, the other 14 patients maintained stable gut bacteria levels and did not see disease progression.
The researchers plan to explore various potential treatments within that ten-month timeframe, including dietary changes such as increasing fiber intake, taking prebiotics or probiotics, and enhancing dental hygiene to prevent harmful bacteria from entering the gut.
While the link between gut inflammation and the development of rheumatoid arthritis remains uncertain, some study participants showed gut changes even before joint changes were noted by a rheumatologist, warranting further investigation into their interrelationship.
While specific bacteria are linked to rheumatoid arthritis, the researchers emphasize that there is no evidence to suggest that this condition is contagious.
Lucy Donaldson, Director of Research and Health Intelligence at Versus Arthritis, commented: “We are encouraged by this study’s findings, which could provide future clinicians with a vital opportunity to delay or potentially prevent the onset of rheumatoid arthritis. This success is a testament to the hard work of UK researchers who are dedicated to personalizing treatments and preventing chronic illnesses that greatly affect individuals’ lives and independence.”
Years of Research Effort
The study was conducted in conjunction with the National Institute for Health Research Leeds Biomedical Research Centre, focusing on themes related to Antimicrobial Resistance, Infections, and Musculoskeletal Diseases.
Collaborators included Leeds Teaching Hospitals NHS Trust, Versus Arthritis, and Leeds Hospitals Charity. Patients from Chapel Allerton Hospital contributed to simplifying the stool sampling process for research participants.
The initial data came from 124 individuals with elevated levels of CCP+, an antibody that attacks healthy blood cells, indicating a risk of rheumatoid arthritis. These samples were compared to those from 22 healthy participants and seven individuals newly diagnosed with rheumatoid arthritis.
Analysis from this larger group demonstrated that the gut microbiome was less diverse among those at risk compared to those in the healthy control group.
The longitudinal study revealed bacterial changes occurring ten months prior to the progression of rheumatoid arthritis in the 19 patients monitored over the 15-month duration.
The research team in Leeds will now analyze previously trialed treatments to guide future testing of interventions during this critical ten-month period.
