Abstract
Rheumatoid arthritis (RA) is an autoimmune disorder in which gut and oral microbiota play a crucial role. Diet is a modifiable factor that can influence both microbiota composition and arthritis outcome; previous studies have suggested associations between dietary habits and RA, with contrasting results. We investigate the protective effect of the Mediterranean diet (MD) on disease activity and the gut microbiota profile in RA patients. Sixty consecutive RA patients were enrolled upon filling a validated 14-item questionnaire for the assessment of adherence to the Mediterranean diet (Prevention with Mediterranean Diet-PREDIMED). Then, 16S analysis was employed to explore the gut microbiota within the two cohorts of patients. Patients with high adherence to MD (20) had a significantly lower C-reactive protein (p < 0.037) and disease activity (p < 0.034) than the 40 patients with low/moderate adherence to MD. An inverse association between MD and disease activity was confirmed by multivariate analysis after adjustments for all the different demographic, clinical and serologic variables. A healthier gut microbiota composition was observed in the high adherence group, with a significant decrease in Lactobacillaceae and an almost complete absence of Prevotella copri with respect to the low/moderate adherence group. In conclusion, our findings support the protective role of MD on disease activity and microbiota composition in RA patients, and suggest the feasibility of shifting the habitual diet to modulate the gut microbiota and promote the benefits associated with MD.
Highlights
Rheumatoid arthritis (RA) is a chronic autoimmune disease of unknown etiology, in which gut and oral microbiota play a crucial role in modulating innate and acquired immune responses, and interfering with the fragile balance between inflammation and tolerance
We have recently demonstrated that RA patients present specific gut microbiota abnormalities, some of which were correlated with disease activity; the treatment with the anti-TNFα biologic agent etanercept was able to partially restore a healthy microbiota composition [9]
We found a protective role of the Mediterranean diet on the disease activity of RA patients supported by a healthy impact on microbiota composition
Summary
Rheumatoid arthritis (RA) is a chronic autoimmune disease of unknown etiology, in which gut and oral microbiota play a crucial role in modulating innate and acquired immune responses, and interfering with the fragile balance between inflammation and tolerance. The impact of diet on the gut microbiota is suggested by the differences in its composition/variety between geographically and life-style distant populations [10]. It is known, that a diet rich in animal proteins, simple sugars, and saturated fats, typical of western countries, is characterized by a reduction in the variety of microbiomes and is associated with the Bacteroides enterotype, whereas Prevotella is the most prevalent in a diet habit rich in fruits and vegetables [11]. We found a protective role of the Mediterranean diet on the disease activity of RA patients supported by a healthy impact on microbiota composition
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