Abstract
Objectives: To characterize the gut microbiota profile in rheumatoid arthritis (RA) patients and investigate its association with certain characteristics of RA. Patients and methods: A nested case–control cohort of 40 patients with RA and 40 sex-age matched controls was studied. Subjects with diabetes, with any other inflammatory disease, practicing extreme diets, taking antibiotics, probiotics or under any new treatment for at least three months prior to sampling were excluded. The microbiota composition was determined by 16S rRNA pyrosequencing and bioinformatics analysis by Quantitative Insights Into Microbial Ecology (QIIME). Other variables included clinical-laboratory variables and average Disease Activity Score 28 points during the follow-up period. Multiple linear regression models were constructed to investigate the possible risk factors for the microbiota. Results: β-diversity data showed that patients tend to differ from healthy subjects according to their microbiota (p = 0.07). The analysis showed an increase in Collinsella aerofaciens, Sedimentibacter and Enterococcus genera in patients compared to controls, as well as a decrease in Dorea formicigenerans. Likewise, an increase in the activity of arginine deiminase was observed, which was found in approximately 90% of the RA genes of the genus Collinsela. The sequence number of Collinsella aerofaciens was independently associated with age (B (95%CI), −0.347 (−21.6, −2.1)), high ACPA (0.323 (27.4–390.0)) and smoking (0.300 (8.8–256.4)) in RA patients. In addition, we observed decreases in Sarcina, 02d06 and Porphyromonas bacterial lineages. Conclusion: Patients with RA present dysbiosis, resulting from an abundance of certain bacterial lineages and a decrease in others. These alterations could influence the maintenance of autoimmunity to this disease.
Highlights
Rheumatoid arthritis (RA) is a systemic autoimmune disorder that causes joint swelling, deformity, and dysfunction
Most patients had positive RF and ACPA titers and low disease activity, and all patients were under treatment with disease-modifying anti-rheumatic drugs (DMARDs), mainly methotrexate followed by biologic therapy
Most studies of dysbiosis in RA report lower microbial diversity characterized by the expansion of some microbial lineages, along with the contraction of others [14,28,29]
Summary
Rheumatoid arthritis (RA) is a systemic autoimmune disorder that causes joint swelling, deformity, and dysfunction. Data from recent studies suggest that RA begins to develop after exposure of the mucous membranes to environmental factors [3]. Dysbiosis may cause a local imbalance between tolerance and immunity, which may spread to other distant tissues. This imbalance may occur through mechanisms such as: ATP-stimulated Th17 cells activated by commensal bacteria [16], molecular mimicry [14,17], citrullination of proteins [18], or translocations of bacteria from the mucous membrane to joints [19]. Citrullination of bacterial and human proteins can expose hidden epitopes, leading to loss of tolerance and to the production of ACPA [20]
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