The Connection Between Ankylosing Spondylitis and Intestinal Microorganisms
Ankylosing Spondylitis (AS), a rare type of inflammatory arthritis, primarily affects the spine, lower back, and sacroiliac joints. Researchers are exploring new treatment options, with a growing focus on the gut microbiome.
The human body contains more bacterial cells than human cells, and certain bacteria in the intestines may pass into the bloodstream and trigger an immune response that could play a role in AS. Dr. Joseph Martinez, a board-certified rheumatologist, believes the link between the gut and AS may lie within the microbiome.
Current research strongly supports a connection between AS and gut microbiome dysbiosis, showing that alterations in gut bacteria contribute to AS onset and progression by influencing immune responses and systemic inflammation.
Some evidence suggests that Lactobacillus, a type of "friendly" bacteria that live in the gut, may help treat various diseases, including AS. In mouse models, giving Lactobacillus kept rats with the HLA-B27 marker—a gene associated with a 100-fold increased risk of developing AS—in remission, while antibiotics decreased the arthritis in the rats.
Key findings and implications include:
- Gut Microbiome Dysbiosis and AS Pathogenesis: Studies demonstrate that imbalanced gut microbiota can promote systemic inflammation and modulate immune pathways implicated in AS progression. For example, certain bacterial metabolic activities and inflammatory mediators are altered in individuals with AS, indicating a gut-joint axis link.
- Therapeutic Effects of Specific Probiotics: Research in mouse models has shown that administration of Limosilactobacillus reuteri can prevent the progression of AS by restoring gut microbiota and metabolic homeostasis. This probiotic also modulates key inflammatory pathways (e.g., AhR/NLRP3) and improves intestinal barrier integrity, reducing disease severity.
- Potential Biomarkers from Gut Microbial Metabolites: Investigations into fecal bacterial siderophores (molecules that bind iron) have identified them as possible biomarkers for AS disease activity, supporting the role of gut-derived factors in systemic inflammation and joint disease.
- Broader Immunomodulatory Role of the Gut Microbiome: While much focus is on rheumatoid arthritis, immunomodulation via gut microbiota is a growing therapeutic approach for autoimmune diseases including AS. Interventions that restore microbial balance—such as probiotics, prebiotics, or metabolites—show promise to enhance treatment efficacy and slow disease progression.
- Precision Medicine and Metabolite Profiling: Beyond probiotics, profiling gut metabolite outputs offers a potential avenue for personalized therapies in inflammatory diseases. Correcting metabolic dysbiosis may become a treatment strategy, tailoring interventions to individual microbiome states.
Overall, the research suggests that modulating the gut microbiome—especially with probiotics like Limosilactobacillus reuteri—could become an adjunct or novel treatment approach for AS, aimed at reducing inflammation, preserving intestinal barrier function, and restoring microbial balance. Such gut-targeted therapies might complement existing immunosuppressive or biologic drugs, offering a new direction particularly for patients with refractory disease or those looking for adjunctive, less immunosuppressive options.
However, these findings are largely preclinical or early clinical, emphasizing the need for larger, controlled human trials to establish effective, standardized gut microbiome-based treatments in AS. The gut-joint axis remains a promising, evolving area in AS research with potential to impact future patient care significantly.
Additionally, 6-14% of people with AS also have inflammatory bowel diseases (IBDs), while 2-3% of people with IBD also have AS. Treatment options for AS include medication, exercise, and physical therapy with a focus on maintaining proper posture. Medications for AS include NSAIDs, tumor necrosis factor inhibitors, and interleukin 17 inhibitors, each with potential side effects and some that can negatively affect gut health.
The potential benefits of supplements and diet in ankylosing spondylitis are unclear; more studies are needed on this matter. Taking Lactobacillus can also help relieve symptoms of IBD, which many people with AS have. However, the gut microbiome may interact with the HLA-B27 gene in the development of AS, and just having the HLA-B27 gene does not guarantee a person will develop AS.
Rifaximin, a medication, has shown promising effects on AS progression in animal models, but further studies are needed to determine its benefits in humans. Scientists have treated various diseases in mice, including colitis, by feeding them specific bacteria or products from these bacteria.
In conclusion, the link between the gut and AS is a promising area of research, with potential to revolutionise the treatment of this debilitating condition. The use of probiotics and other gut-targeted therapies could provide a less immunosuppressive, adjunctive treatment option for patients with AS. However, more research is needed to confirm these findings and establish effective, standardized treatments for AS based on gut microbiome modulation.
- The gut microbiome, teeming with millions of bacterial cells, plays a significant role in Ankylosing Spondylitis (AS), a chronic disease that primarily affects the axial skeleton.
- Research indicates that imbalances in the gut microbiome, often referred to as dysbiosis, might contribute to the development and progression of AS by triggering systemic inflammation.
- The science behind AS and the gut microbiome highlights the role of specific bacteria, such as Lactobacillus, in potentially alleviating symptoms and influencing treatment outcomes.
- In the realm of health and wellness, maintaining a balanced gut microbiota, through diet, supplements, or probiotics, could be a tremendous boost for individuals suffering from AS or related medical conditions like inflammatory bowel syndrome (IBS).
- Beyond AS, the gut microbiome has emerged as a key player in numerous chronic diseases, underscoring the importance of mental health, fitness, and exercise in maintaining overall health and skin care.
- The findings suggest that the microbiome's immunomodulatory effects could be harnessed for precision medicine, with personalized therapies tailored to individual microbiome states.
- Nutrition plays a crucial role in fostering a healthy gut microbiome, offering potential avenues for managing gut microbiome-associated disorders like AS and food-related benefits for those affected.
- As the research progresses, the medical community may discover additional links between the gut microbiome, immune system, and chronic diseases like AS, paving the way for novel and adjunctive treatment options without extensive immunosuppression.
- The exploration of the gut-joint axis and the potential of gut-targeted therapies represents a significant stride in the quest to alleviate the suffering of patients with AS and other inflammatory joint diseases, ultimately improving their quality of life.
