Microbiota and immune dynamics in rheumatoid arthritis: Mechanisms and therapeutic potential

Jiayang Jin; Xuanlin Cai; Peishi Rao; Jun Xu; Jing Li

doi:10.1016/j.berh.2025.102035

Microbiota and immune dynamics in rheumatoid arthritis: Mechanisms and therapeutic potential

Best Pract Res Clin Rheumatol. 2025 Jan 25:102035. doi: 10.1016/j.berh.2025.102035. Online ahead of print.

Authors

Jiayang Jin¹, Xuanlin Cai¹, Peishi Rao¹, Jun Xu², Jing Li³

Affiliations

¹ Department of Rheumatology and Immunology, Peking University People's Hospital, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China; Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China.
² Department of Gastroenterology, Peking University People's Hospital, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China; Clinical Center of Immune-Mediated Digestive Diseases, Peking University People's Hospital, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China.
³ Department of Rheumatology and Immunology, Peking University People's Hospital, No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China; Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), No. 11, Xizhimen South Street, Xicheng District, Beijing, 100044, China; Division of Rheumatology, Department of Medicine, University of Colorado, No. 11, Xizhimen South Street, Xicheng District, Aurora, CO, 80045, USA. Electronic address: muzijing1026@gmail.com.

PMID: 39863438
DOI: 10.1016/j.berh.2025.102035

Abstract

Rheumatoid arthritis (RA) is a complex autoimmune disease with growing evidence implicating the microbiota as a critical contributor to its pathogenesis. This review explores the multifaceted roles of microbial dysbiosis in RA, emphasizing its impact on immune cell modulation, autoantibody production, gut barrier integrity, and joint inflammation. Animal models reveal how genetic predisposition and environmental factors interact with specific microbial taxa to influence disease susceptibility. Dysbiosis-driven metabolic disruptions, including alterations in short-chain fatty acids and bile acids, further exacerbate immune dysregulation and systemic inflammation. Emerging therapeutic strategies-probiotics, microbial metabolites, fecal microbiota transplantation, and antibiotics-offer innovative avenues for restoring microbial balance and mitigating disease progression. By integrating microbiota-targeted approaches with existing treatments, this review highlights the potential to revolutionize RA management through precision medicine and underscores the need for further research to harness the microbiota's therapeutic potential.

Keywords: Immune modulation; Microbial metabolites; Microbiota dysbiosis; Rheumatoid arthritis pathogenesis; Therapeutic strategies.

Publication types

Review