Treatment for Rheumatoid Arthritis Associated With Alterations in the Gastrointestinal Microbiota
(2024) In ACR Open Rheumatology- Abstract
Objective: Emerging research suggests that rheumatoid arthritis (RA) is associated with intestinal dysbiosis. This prospective pilot study evaluates changes in intestinal microbial composition in patients with RA initiating treatment with either methotrexate (MTX) or a tumor necrosis factor inhibitor (TNFi). Methods: Consecutive patients, fulfilling the 2010 American College of Rheumatology/EULAR classification criteria for RA, who started treatment with either MTX or TNFi delivered a stool sample upon initiation of immunosuppression and 3 months later. A 16S ribosomal RNA gene-based validated microbiota test (GA-map Dysbiosis Index Score [DIS], Genetic Analysis, Oslo, Norway) was used to evaluate for the presence and degree of... (More)
Objective: Emerging research suggests that rheumatoid arthritis (RA) is associated with intestinal dysbiosis. This prospective pilot study evaluates changes in intestinal microbial composition in patients with RA initiating treatment with either methotrexate (MTX) or a tumor necrosis factor inhibitor (TNFi). Methods: Consecutive patients, fulfilling the 2010 American College of Rheumatology/EULAR classification criteria for RA, who started treatment with either MTX or TNFi delivered a stool sample upon initiation of immunosuppression and 3 months later. A 16S ribosomal RNA gene-based validated microbiota test (GA-map Dysbiosis Index Score [DIS], Genetic Analysis, Oslo, Norway) was used to evaluate for the presence and degree of dysbiosis. Fecal levels of Prevotella copri (P. copri) were analyzed by custom-made quantitative polymerase chain reaction. Changes in microbial composition were analyzed in relation to changes in disease activity, as measured by the disease activity score based on 28-joint counts, using C-reactive protein. Results: At baseline, dysbiosis was present in 33 of 50 (66%) participants and more common in participants with more than 2 years of disease duration (P = 0.019). At the 3-month follow-up, 27 of 50 (54%) were good treatment responders and the DIS had improved in 14 of 50 (28%). Participants initiating TNFi more often exhibited improvement in the DIS compared with those initiating MTX (P = 0.031). P. copri was identified in 32 of 50 (64%) at baseline. An improvement in disease activity score based on 28-joint counts, using C-reactive protein was associated with a simultaneous decrease in P. copri abundance (rs = 0.30, P = 0.036). Conclusion: This study affirms that dysbiosis is a feature of RA. Although patients were not randomized to MTX or TNFi, the findings suggest that specific therapies may differentially modulate the gastrointestinal microbiota in RA. The association between P. copri and treatment response requires further study.
(Less)
- author
- Andréasson, Kristofer LU ; Olofsson, Tor LU ; Lagishetty, Venu ; Alrawi, Zaid ; Klaassens, Eline ; Holster, Savanne ; Hesselstrand, Roger LU ; Jacobs, Jonathan P. ; Wallman, Johan K. LU and Volkmann, Elizabeth R.
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- in press
- subject
- in
- ACR Open Rheumatology
- publisher
- Wiley
- external identifiers
-
- pmid:38653503
- scopus:85191191376
- ISSN
- 2578-5745
- DOI
- 10.1002/acr2.11673
- language
- English
- LU publication?
- yes
- id
- 4cd7c089-38be-40f0-ad4d-f497282dda32
- date added to LUP
- 2024-05-06 15:29:45
- date last changed
- 2024-05-07 03:00:32
@article{4cd7c089-38be-40f0-ad4d-f497282dda32,
abstract = {{<p>Objective: Emerging research suggests that rheumatoid arthritis (RA) is associated with intestinal dysbiosis. This prospective pilot study evaluates changes in intestinal microbial composition in patients with RA initiating treatment with either methotrexate (MTX) or a tumor necrosis factor inhibitor (TNFi). Methods: Consecutive patients, fulfilling the 2010 American College of Rheumatology/EULAR classification criteria for RA, who started treatment with either MTX or TNFi delivered a stool sample upon initiation of immunosuppression and 3 months later. A 16S ribosomal RNA gene-based validated microbiota test (GA-map Dysbiosis Index Score [DIS], Genetic Analysis, Oslo, Norway) was used to evaluate for the presence and degree of dysbiosis. Fecal levels of Prevotella copri (P. copri) were analyzed by custom-made quantitative polymerase chain reaction. Changes in microbial composition were analyzed in relation to changes in disease activity, as measured by the disease activity score based on 28-joint counts, using C-reactive protein. Results: At baseline, dysbiosis was present in 33 of 50 (66%) participants and more common in participants with more than 2 years of disease duration (P = 0.019). At the 3-month follow-up, 27 of 50 (54%) were good treatment responders and the DIS had improved in 14 of 50 (28%). Participants initiating TNFi more often exhibited improvement in the DIS compared with those initiating MTX (P = 0.031). P. copri was identified in 32 of 50 (64%) at baseline. An improvement in disease activity score based on 28-joint counts, using C-reactive protein was associated with a simultaneous decrease in P. copri abundance (r<sub>s</sub> = 0.30, P = 0.036). Conclusion: This study affirms that dysbiosis is a feature of RA. Although patients were not randomized to MTX or TNFi, the findings suggest that specific therapies may differentially modulate the gastrointestinal microbiota in RA. The association between P. copri and treatment response requires further study.</p>}},
author = {{Andréasson, Kristofer and Olofsson, Tor and Lagishetty, Venu and Alrawi, Zaid and Klaassens, Eline and Holster, Savanne and Hesselstrand, Roger and Jacobs, Jonathan P. and Wallman, Johan K. and Volkmann, Elizabeth R.}},
issn = {{2578-5745}},
language = {{eng}},
publisher = {{Wiley}},
series = {{ACR Open Rheumatology}},
title = {{Treatment for Rheumatoid Arthritis Associated With Alterations in the Gastrointestinal Microbiota}},
url = {{http://dx.doi.org/10.1002/acr2.11673}},
doi = {{10.1002/acr2.11673}},
year = {{2024}},
}