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A new study found that changes in gut microbes can be linked to the onset of rheumatoid arthritis which eventually translates to symptoms that can be diagnosed. The study was conducted by researchers from the University of Leeds, UK and published in the Annals of the Rheumatic Diseases.

The researchers found that people who develop the autoimmune condition have the most number of changes or “instabilities”, in specific strains of gut bacteria (of Prevotellaceae species) that were seen 10 months prior to diagnosis. This also suggests that the gut changes can signal a late stage.

Rheumatoid arthritis (RA) is a chronic autoimmune condition wherein the immune system mistakenly attacks the healthy tissues, of your body, leading to inflammation in the joints. This inflammation eventually leads to pain, swelling and damage to the joints.

However, the researchers say that it was not clear if changes or ‘instabilities’ in gut microbes trigger the development of the disease or follow it. The findings can help identify those most at risk of rheumatoid arthritis and require personalised treatment.

For the study, the researchers tracked 124 people who had a risk of developing rheumatoid arthritis for a period of 15 months; seven of whom were newly diagnosed, 22 were healthy and the remaining were at risk. Stool and blood samples were taken five times during the study period which helped analyse changes in gut microbes.

The researchers found that those at risk had ‘anticyclic citrullinated protein’ or anti-CCP, antibodies which are known to attack healthy cells and to be specific to rheumatoid arthritis and experienced joint pain in the past three months.

The researchers said that of the 124 participants, 30 went on to develop the condition. They also found that the diversity of gut microbes in these 30 had notably reduced, compared to the healthy participants. Specifically, ‘alpha diversity’ which is a common measure of gut health and closely related to disease status, had reduced.

However, alpha diversity was also reduced in those who did not progress to developing rheumatoid arthritis. In these participants, the autoimmune condition was related to anti-CCP antibody levels, those having low levels of the antibodies specific to rheumatoid arthritis had a gut microbe diversity similar to that in the healthy group, the team said.

Risk factors known to contribute to rheumatoid arthritis, such as genetic and blood-related ones, were also linked with a lower diversity of gut bugs.

However, the greatest instability in gut bugs was seen in the participants who developed the chronic condition up to 10 months prior to diagnosis following which the gut profile remained relatively stable.

This suggested that changes to the gut microbes could be a late-stage phenomenon, they said.

The authors wrote, “Individuals at risk of rheumatoid arthritis harbour a distinctive gut microbial composition, including but not limited to an overabundance of Prevotellaceae species. This microbial signature is consistent and correlates with traditional risk factors.”

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