The role of microbiome in the pathogenesis of immune-mediated inflammatory diseases: controversial issues

Abstract

Increasing attention in rheumatology is today paid to the detection of diseases at the earliest possible (preclinical) stages, which can contribute to a more favorable response to therapy. The preclinical period of a systemic autoimmune reaction is assumed to be related to dysregulation of immune interactions with the synanthropic microflora. A sequencing method was used to study deviations in the diversity of the gut microflora in patients with rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. However, a number of unresolved issues remain, since the emphasis has been on the cataloguing of the microorganisms present and on the identification of correlations between microbial species and diseases. The main difference in future microbiome research in patients with immune-mediated inflammatory diseases should be a closer examination of the functions of microbiota components, and not just their description. Long-term studies with the collection of intestinal microbiome samples are required at several time intervals: before disease-modifying antirheumatic drug therapy and during ineffective therapy. Such studies will contribute to the development of new diagnostic and therapeutic interventions. Until they are completed, it is untimely to recommend microbiome analysis as a diagnostic or prognostic tool for the management of rheumatic diseases in clinical practice.