Therapeutic Potential of Fecal Microbiota Transplantation in Rheumatoid Arthritis: An Integrative Literature Review

Abstract

Rheumatoid arthritis (RA) is a inflammatory chronic autoimmune disease that affects the joints. Recent studies highlight that intestinal dysbiosis plays a significant role in the development and progression of RA by influencing the host’s immune system regulation. This study aims to determine the therapeutic potential of fecal microbiota transplantation (FMT) in RA patients. It is an integrative literature review, conducted using PubMed, Virtual Health Library (VHL) and ScienceDirect, with the descriptors "Fecal Microbiota Transplantation" and "Arthritis Rheumatoid". A total of 80 articles from the past 5 years were identified, and after applying the inclusion and exclusion criteria, 13 were selected for the study. Dysbiosis associated with rheumatoid arthritis typically begins in the preclinical phase of the disease and is characterized by reduced microbial diversity. Examples of microbial populations that may be altered in the disease include an increase in Lactobacillus salivarius and Prevotella copri and a decrease in Haemophilus spp. These changes result in the activation of immunological mechanisms, such as molecular mimicry and damage to intestinal barrier function, leading to systemic inflammation and polyarthritis. In this context, fecal microbiota transplantation (FMT) has recently gained prominence as a procedure to treat the autoimmunity involved in the disease. In murine studies, the inhibition of inflammatory cytokines and the induction of anti-inflammatory cytokines were observed as a result of microbiota transplantation from healthy mice to mice with collagen-induced arthritis. Furthermore, in a case report, the procedure demonstrated improvement in disease activity scores. Nonetheless, clinical studies are still necessary to explore fecal microbiota transplantation as a treatment for rheumatoid arthritis.