Microbiota and Arthritis: Correlations or Cause?

Alberto Bravo-Blas; Hannah Wessel; Simon Milling


Curr Opin Rheumatol. 2016;28(2):161-167. 

In This Article

Abstract and Introduction


Purpose of review The microorganisms that colonise our bodies, the commensal 'microbiota', respond to changes in our behaviour and environment, and can also profoundly affect our health. We can now investigate these organisms with unprecedented depth and precision, revealing that they may contribute to the pathogenesis of diseases including arthritis. Here we discuss the changes occurring in the microbiota in people with arthritis, and how manipulation of the microbiota may provide an additional pathway for therapy.

Recent findings We highlight two important aspects of the recent literature. First we describe changes in the microbiota identified in people with arthritis; these correlations give insights into the microbial changes that may contribute to symptoms of arthritis. We then discuss attempts to ameliorate arthritis by manipulating the microbiota. This is a rapidly developing area of research. There are tantalising hints that interventions targeting the microbiota may become therapeutically viable for some types of inflammatory arthritis.

Summary Our commensal microbial communities respond to changes in our health, and are altered in people with arthritis. Understanding the complex relationships between the microbiota and the body may enable us to deliberately manipulate these organisms and provide additional therapeutic options for people with arthritis.


Advances in technologies for sequencing genetic material, and in using available computing power to decipher the vast quantities of data generated, have enabled us to characterise the microbial communities with which we have coevolved, our microbiota. There are many times more microorganisms living in and on us than we possess human cells. It is perhaps not surprising then that interactions between mammals and their commensal microorganisms play critical functions in maintaining health and in the development of disease.[1] Many common diseases are triggered by factors from the environment and could therefore be influenced by the microbiota. Helicobacter pylori infection provides a well understood example wherein a single organism predisposes to gastric cancer.[2] Other inflammatory diseases, Crohn's disease for instance, appear not to be caused by a single microorganism. Instead, changes in microbial communities are observed in the intestines of patients with Crohn's and it is this 'dysbiosis' that may contribute to the disease.[3,4] Owing to the fact that the microbiota has profound effects on the immune system, investigators have sought to identify changes in our microbial communities that may occur in people with arthritis. We describe the results from these studies, which have begun to identify potential mechanisms triggering and sustaining inflammation. We also describe trials designed to manipulate the microbiota and alleviate arthritis, and look towards the future for this potentially exciting approach. The key points of the review are illustrated in Fig. 1.

Figure 1.

Mechanisms triggering and sustaining inflammation in people with arthritis and potential treatment by altering microbiota.