Impaired Microbiota May Lead to Spondyloarthritis

A comprehensive review of published studies on gut microbiota, immunity and arthritis suggests that having a microbial imbalance may precede the development of spondyloarthritides and osteoarthritis.

The review, which was published in Seminars in Arthritis and Rheumatism, suggests a close connection between an impaired microbiota, the immune system and inflammatory arthritis.

"In this review, we presented data supporting the idea that dysbiosis via a close, dynamic and tightly regulated cross talk with gut-associated lymphoid tissue, governs the development of inflammatory arthropathies, such as rheumatoid arthritis, spondyloarthritis and osteoarthritis. It became clear that unfavorable dysbiosis-mediated immune alterations precede the development of these disorders suggesting causal relationships in this link," wrote authors Alexander Kalinkovich of the Weizmann Institute of Science in Israel, and Gregory Livshits of Tel Aviv University.

The human microbiota is incredibly vast and varied. Consider this: The bacteria of the gastrointestinal tract consists of approximately 150 times more genes than the entire human genome. While its primary function is in controlling digestion, it plays a number of other roles, such as protecting the body from pathogens and, according to one study conducted in animal models, regulating immunity. Gut-associated lymphoid tissue in the intestines make up approximately 70 percent of the entire immune system.

Observational studies have demonstrated an association between a microbial imbalance and conditions such as autoimmune disorders, cardiovascular, metabolic diseases, cancer, brain-related conditions, osteoarthritis, and inflammatory joint conditions, such as rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis.

Drs. Kalinkovich and Livshits identified bacterial species that aided in proinflammation and in the development of inflammatory arthropathies. These included Prevotella, Citrobacter rodentium, Collinsella aerofaciens, and Segmented filamentous bacteria. These species worked differently. Some adopted mimicry, others modified self-antigens, enhanced mechanisms for cell apoptosis, others destroyed tight junction proteins and others impaired the intestinal mucosal barrier hindering the intestines ability to absorb nutrients.

The consumption of probiotics can help build a healthy gut microbiota, but there haven’t been large randomized controlled trials showing significant findings. However, studies in animal models have found that live Lactobacillus casei does have an “anti-arthritic” effect. However, the authors cited a meta-analysis of probiotic use among rheumatoid arthritis patients. The rheumatoid arthritis trials were small, vastly different and short-term with no consistent outcomes.

In terms of prebiotics, which work by stimulating beneficial bacteria and reduce the growth of unfavorable bacteria, small studies have shown they can enhance anti-inflammatory short chain fatty acid activity, reduce oxidative stress and enhance IL-10, IL-18 and IL-1Ra production by dendritic cells. The prebiotics oligofructoseinulin and oligosaccharides have benefitted patients with type 1 diabetes and inflammatory bowel disease by decreasing inflammation.

REFERENCE

Alexander Kalinkovich, Gregory Livshits. "A Cross Talk Between Dysbiosis and Gut-Associated Immune System Governs the Development of Inflammatory Arthropathies," Seminars in Arthritis and Rheumatism. Decembe 2019. DOI: 10.1016/j.semarthrit.2019.05.007