Colon Bacteria and Arthritis

Several recent research papers show that inflammatory types of arthritis such as rheumatoid arthritis, psoriatic arthritis and reactive arthritis may be caused by harmful bacteria in your colon. Your colon is full of more than 100 trillion bacteria. Some are good and some are bad. The good bacteria are happy with what you eat and do not try to enter your colon cells, while the harmful colon bacteria are not happy with what you eat, so they try to enter the cells lining your colon. Your immune system responds by sending out large numbers of cells (lymphocytes), chemicals (cytokines) and antibodies to attack and kill the invading colon bacteria. This is called inflammation. If the harmful colon bacteria continue to penetrate your colon cells, your immune system stays active all the time and uses the same cells and chemicals to attack your body. Doctors call this activity “auto-immune diseases,” which can affect your joints (rheumatoid arthritis), intestines (inflammatory bowel disease), lungs (rheumatoid lung disease) and just about every other tissue in your body.
• Newly discovered species of gut bacteria may cause some cases of rheumatoid arthritis (Science Translational Medicine, Jan 5, 2023).
• People who are susceptible to rheumatoid arthritis have a bacterial colon composition that may cause their immune system to mount an attack on these bacteria, triggering arthritis (Arthritis Rheumatol, May 23, 2023).
• Similar changes in colon bacteria occur in people who have rheumatoid arthritis (Science Translational Medicine, Jul 26, 2023;15(706)).
• Probiotics may help to treat and reduce harmful colon bacteria and intestinal permeability as a cause of rheumatoid arthritis (Am Nutr Assoc, 2023 Jun 9:1-18).

Rheumatoid Arthritis and Colon Bacteria
Analysis of the bacteria in your colon can predict susceptibility to developing rheumatoid arthritis (Genome Medicine, 2016;8(1)). Treating arthritis-susceptible mice with the healthful Provatella histicola bacteria decreased frequency and severity of arthritis, and they had fewer inflammatory conditions associated with rheumatoid arthritis (Arthritis Rheumatol, Dec 2016;68(12):2878-2888). Many papers have reported improvement in rheumatoid arthritis symptoms with the prescription of antibiotics (Klin Med, 2010;89(4):45-8; J Rheumatol, 2008;35(8):1500-5; Ann Rheum Dis, 2003;62(9):807-11; Elife, 2013;2:e01202).

Antibiotics do affect the makeup of colon bacteria in humans, but at this time we do not know enough to suggest that patients with rheumatoid arthritis should be treated with antibiotics to change colon bacteria. A more conservative approach would be to encourage a healthful change in colon bacteria using an anti-inflammatory diet and other lifestyle changes (diet, exercise, weight loss if indicated, avoiding smoke and alcohol, and so forth).

My Recommendations
Symptoms of rheumatoid arthritis can improve with lifestyle changes to increase healthful bacteria and decrease harmful bacteria in your colon. At this time, there is still uncertainty about how effective an anti-inflammatory lifestyle is in treating rheumatoid arthritis, but I recommend that people who suffer from any type of arthritis should include the following lifestyle habits with your other treatments (check with your doctor):
• A diet that is high in vegetables, unground whole grains, beans, fruits, nuts and other seeds, and low in red meat, processed meats, fried foods, sugared drinks and foods with added sugars
• A regular exercise program (with your doctor’s approval)
• Maintenance of a healthful weight
• Avoidance or restriction of alcohol
• Avoidance of smoking and second-hand smoke
• Avoidance of other toxic substances and pollutants

I have written a longer version of this article, with many more journal references. Here is the link to the long article: Arthritis and Colon Bacteria (Long)