The gut microbiome can predict treatment response in rheumatoid arthritis

Professor Frances Williams’ chronic pain research group within TwinsUK at King’s College London has recently published an important article which helps understand the complex and varied response to treatment in rheumatoid arthritis.

Rheumatoid arthritis is an autoimmune disorder affecting many bodily systems, it is often characterised by painful swelling of the joints in the hands called flares, which creates irreversible damage. When an individual is diagnosed with rheumatoid arthritis, it is important to quickly work out the most suitable medication for them to halt or subdue flares. Disease Modifying Anti Rheumatic Drugs (DMARDs) are usually prescribed when a patient is diagnosed with rheumatoid arthritis. For about a third of patients these medications work well, however for others, they do not, and some people experience very unpleasant side-effects. Knowing who will respond well to DMARD therapy such as a drug called methotrexate before medication regimes begin will save a lot of pain and joint damage for those with rheumatoid arthritis.

This large project, funded by Versus Arthritis, recruited newly-diagnosed rheumatoid arthritis patients from 12 NHS rheumatology outpatient clinics throughout London and Southeast England. 160 patients agreed to take part before they started DMARD treatment. Participants completed health questionnaires and gave samples of stool to assess their gut microbiome. Then they started methotrexate treatment and were followed up three and six months later.

The aim of the research was to see if the gut microbiome could be used to predict who would respond well to DMARD treatment and who would require alternative medication to manage their rheumatoid arthritis.

Lead co-author Max Freidin said:

“We currently have no tools to help us know who will do well on DMARD medication. It is difficult to establish the correct treatment without a trial-and-error approach, which sometimes takes many months, during which time significant joint damage can occur.”

The participants’ gut microbiome data predicted treatment who would respond well to methotrexate and who wouldn’t. The work sheds light on how methotrexate treats the disease – with decreased prevotella bugs seen early on in the stool in those who responded well to methotrexate. This suggests the early stool testing could lead to more rapid drug switching and improve outcomes.

Such steps forward are only made possible with the generous support of charities such as Versus Arthritis, along with the time and efforts of the clinicians, research nurses and of course rheumatoid arthritis patients attending rheumatology out-patient clinics.