Abstract
BackgroundJuvenile idiopathic arthritis is the most common form of chronic arthritis in children. There is mounting evidence that the microbiota may influence the disease.Main bodyRecent observations in several systemic inflammatory diseases including JIA have indicated that abnormalities in the contents of the microbiota may be factors in disease pathogenesis, while other studies in turn have shown that environmental factors impacting the composition of the microbiota, such as delivery mode and early exposure to antibiotics, affect the risk of chronic inflammatory diseases including JIA. Microbial alterations may predispose to JIA through a variety of mechanisms, including impaired immunologic development, alterations in the balances of pro- versus anti-inflammatory bacteria, and low-grade mucosal inflammation. Additional confirmatory studies of microbiota aberrations and their risk factors are needed, as well as additional mechanistic studies linking these alterations to the disease itself.ConclusionsThe microbiota may influence the risk of JIA and other systemic inflammatory conditions through a variety of mechanisms. Additional research is required to improve our understanding of the links between the microbiota and arthritis, and the treatment implications thereof.
Highlights
Juvenile idiopathic arthritis is the most common form of chronic arthritis in children
The microbiota may influence the risk of juvenile idiopathic arthritis (JIA) and other systemic inflammatory conditions through a variety of mechanisms
Children with multiple categories of JIA have an altered intestinal microbiota, with the characteristics of microbiota sharing some features linked with other autoimmune diseases such as type 1 diabetes [5, 6] and inflammatory bowel disease (IBD) [9]
Summary
Children with multiple categories of JIA have an altered intestinal microbiota, with the characteristics of microbiota sharing some features linked with other autoimmune diseases such as type 1 diabetes [5, 6] and IBD [9]. The immunologic responses to the microbiota are altered in at least ERA and RF+ JIA, and aberrant intestinal immunity appears to be present in multiple JIA categories. Several of the identified risk factors of JIA, including antibiotic use, C-section delivery, and possibly infant feeding practice, may all exert their role via alterations in the intestinal microbiota, potentially at a critical window of mucosal immunologic development. Abbreviations ERA, enthesitis-related arthritis; IBD, inflammatory bowel disease; JIA, juvenile idiopathic arthritis; RA, rheumatoid arthritis; RF, rheumatoid factor; SCFAs, short-chain fatty acids
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