Microbiome and Leaky Gut Syndrome as Extra-articular Factors for Rheumatoid Arthritis

Abstract

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation of the joints and causes damage to cartilage and joints. Not only genetic factors but also environmental factors are involved in the development and progression of this disease. In particular, diet has a significant impact on the development and course of the disease. Therefore, the question of the impact of changes in the intestinal microbiome in patients with RA is relevant and debatable. Scientific evidence in recent decades suggests that dysbacteriosis affects the chronic inflammatory response in RA and can be modified. The next issue in the development and progression of RA is the integrity of the intestinal barrier. According to the latest scientific findings, changes in the intestinal barrier are one of the key factors in the pathogenesis of RA. The study of intestinal barrier damage has found the protein I FABP, which is a promising marker of change in intestinal permeability in patients with RA. Today, a large amount of data has been collected and new approaches to modification of the above aspects of RA pathogenesis are being investigated. In combination with standard therapy, they can potentially reduce the intensity of symptoms and ensure long-term remission. Changes in diet, addition of probiotics, products of bacterial metabolism (for example, butyrate), have a positive effect on disease activity. The addition of larazotide, a drug that affects the integrity of dense joints, can be used in the treatment of patients with RA. This article shows the prospects of modification of the microbiome and intestinal permeability in the treatment of patients with RA. Due to the limited amount of data, this area needs further research.