Open access
Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement No data are available. Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise. Open access This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/ licenses/by/4.0/.
13 Zaiss MM, Joyce Wu H-J, Mauro D, et al . The gut-joint axis in rheumatoid arthritis. Nat Rev Rheumatol 2021;17:224–37. 14 Salem F, Kindt N, Marchesi JR, et al . Gut microbiome in chronic rheumatic and inflammatory bowel diseases: Similarities and differences. United European Gastroenterol J 2019;7:1008–32. 15 Zhou H, Balint D, Shi Q, et al . Lupus and inflammatory bowel disease share a common set of microbiome features distinct from other autoimmune disorders. Ann Rheum Dis 2025;84:93–105. 16 Xiang S, Qu Y, Qian S, et al . Association between systemic lupus erythematosus and disruption of gut microbiota: a meta-analysis. Lupus Sci Med 2022;9:e000599. 17 Zegarra-Ruiz DF, El Beidaq A, Iñiguez AJ, et al . A Diet-Sensitive Commensal Lactobacillus Strain Mediates TLR7-Dependent Systemic Autoimmunity. Cell Host Microbe 2019;25:113–27. 18 Manfredo Vieira S, Hiltensperger M, Kumar V, et al . Translocation of a gut pathobiont drives autoimmunity in mice and humans. Science 2018;359:1156–61. 19 Gronke K, Nguyen M, Fuhrmann H, et al . Translocating gut pathobiont Enterococcus gallinarum induces T H 17 and IgG3 anti- RNA-directed autoimmunity in mouse and human. Sci Transl Med 2025;17:eadj6294. 20 Greiling TM, Dehner C, Chen X, et al . Commensal orthologs of the human autoantigen Ro60 as triggers of autoimmunity in lupus. Sci Transl Med 2018;10:eaan2306. 21 Breban M, Tap J, Leboime A, et al . Faecal microbiota study reveals specific dysbiosis in spondyloarthritis. Ann Rheum Dis 2017;76:1614–22. 22 Berland M, Meslier V, Berreira Ibraim S, et al . Both Disease Activity and HLA–B27 Status Are Associated With Gut Microbiome Dysbiosis in Spondyloarthritis Patients. Arthritis & Rheumatology 2023;75:41–52. 23 Scher JU, Sczesnak A, Longman RS, et al . Expansion of intestinal Prevotella copri correlates with enhanced susceptibility to arthritis. Elife 2013;2:e01202. 24 Konig MF, Abusleme L, Reinholdt J, et al . Aggregatibacter actinomycetemcomitans-induced hypercitrullination links periodontal infection to autoimmunity in rheumatoid arthritis. Sci Transl Med 2016;8:369ra176. 25 Brewer RC, Lanz TV, Hale CR, et al . Oral mucosal breaks trigger anti-citrullinated bacterial and human protein antibody responses in rheumatoid arthritis. Sci Transl Med 2023;15:eabq8476. 26 Chriswell ME, Lefferts AR, Clay MR, et al . Clonal IgA and IgG autoantibodies from individuals at risk for rheumatoid arthritis identify an arthritogenic strain of Subdoligranulum . Sci Transl Med 2022;14:eabn5166. 27 Hou K, Wu Z-X, Chen X-Y, et al . Microbiota in health and diseases. Sig Transduct Target Ther 2022;7:135. 28 Gulliver EL, Young RB, Chonwerawong M, et al . Review article: the future of microbiome‐based therapeutics. Aliment Pharmacol Ther 2022;56:192–208. 29 Sorbara MT, Pamer EG. Microbiome-based therapeutics. Nat Rev Microbiol 2022;20:365–80. 30 Uchiyama K, Naito Y, Takagi T. Intestinal microbiome as a novel therapeutic target for local and systemic inflammation. Pharmacology & Therapeutics 2019;199:164–72. 31 Van de Wiele T, Van Praet JT, Marzorati M, et al . How the microbiota shapes rheumatic diseases. Nat Rev Rheumatol 2016;12:398–411. 32 Dore MP, Bibbò S, Fresi G, et al . Side Effects Associated with Probiotic Use in Adult Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2019;11:2913. 33 Imdad A, Pandit NG, Zaman M, et al . Fecal transplantation for treatment of inflammatory bowel disease. Cochrane Database Syst Rev 2023;4:CD012774. 34 Kragsnaes MS, Kjeldsen J, Horn HC, et al . Efficacy and safety of faecal microbiota transplantation in patients with psoriatic arthritis: protocol for a 6-month, double-blind, randomised, placebo- controlled trial. BMJ Open 2018;8:e019231. 35 Mandrioli J, Amedei A, Cammarota G, et al . FETR-ALS Study Protocol: A Randomized Clinical Trial of Fecal Microbiota Transplantation in Amyotrophic Lateral Sclerosis. Front Neurol 2019;10:1021. 36 Woodhouse CA, Patel VC, Goldenberg S, et al . PROFIT, a PROspective, randomised placebo controlled feasibility trial of Faecal mIcrobiota Transplantation in cirrhosis: study protocol for a single-blinded trial. BMJ Open 2019;9:e023518. 37 Mohammed AT, Khattab M, Ahmed AM, et al . The therapeutic effect of probiotics on rheumatoid arthritis: a systematic review and meta-analysis of randomized control trials. Clin Rheumatol 2017;36:2697–707.
ORCID iDs Maja Skov Kragsnaes https://orcid.org/0000-0001-9641-9065 Benoit Thomas P Gilbert https://orcid.org/0000-0001-6037-6470 Bjørk Khaliqi Sofíudóttir https://orcid.org/0000-0002-5918-3206 Benjamin H Mullish https://orcid.org/0000-0001-6300-3100 Simone Li https://orcid.org/0000-0002-0073-3656 Philip Rask Lage-Hansen https://orcid.org/0000-0002-1449-254X Georg Schett https://orcid.org/0000-0001-8740-9615 Dennis McGonagle https://orcid.org/0000-0001-7715-8226 Dirk Elewaut https://orcid.org/0000-0002-7468-974X Axel Finckh https://orcid.org/0000-0002-1210-4347 Torkell Ellingsen https://orcid.org/0000-0003-0426-4962 Robin Christensen https://orcid.org/0000-0002-6600-0631
REFERENCES 1 Sarzi-Puttini P, Ceribelli A, Marotto D, et al . Systemic rheumatic diseases: From biological agents to small molecules. Autoimmun Rev 2019;18:583–92. 2 Wang S, Ning W, Tang H, et al . Efficacy and safety study of targeted small-molecule drugs in the treatment of systemic lupus erythematosus. Arthritis Res Ther 2024;26:98. 3 Buch MH, Eyre S, McGonagle D. Persistent inflammatory and non- inflammatory mechanisms in refractory rheumatoid arthritis. Nat Rev Rheumatol 2021;17:17–33. 4 Poddubnyy D, Navarro-Compán V, Torgutalp M, et al . The Assessment of SpondyloArthritis International Society (ASAS) Consensus-Based Expert Definition of Difficult-to-Manage, including Treatment-Refractory, Axial Spondyloarthritis. Ann Rheum Dis 2025;84:538–46. 5 Scher JU, Nayak R, Clemente JC. Microbiome research in autoimmune and immune-mediated inflammatory diseases: lessons, advances and unmet needs. Ann Rheum Dis 2025;84:9–13. 6 Wang Y, Wei J, Zhang W, et al . Gut dysbiosis in rheumatic diseases: A systematic review and meta-analysis of 92 observational studies. EBioMedicine 2022;80:104055. 7 Rooney CM, Jeffery IB, Mankia K, et al . Dynamics of the gut microbiome in individuals at risk of rheumatoid arthritis: a cross- sectional and longitudinal observational study. Ann Rheum Dis 2024. 8 Liu W, Li C, Xie W, et al . The signature of the gut microbiota associated with psoriatic arthritis revealed by metagenomics. Ther Adv Musculoskelet Dis 2024;16. 9 Joubert M, André M, Barnich N, et al . Microbiome and Behçet’s disease: a systematic review. Clin Exp Rheumatol 2023;41:2093–104. 10 Thompson KN, Bonham KS, Ilott NE, et al . Alterations in the gut microbiome implicate key taxa and metabolic pathways across inflammatory arthritis phenotypes. Sci Transl Med 2023;15:eabn4722. 11 Ruff WE, Greiling TM, Kriegel MA. Host-microbiota interactions in immune-mediated diseases. Nat Rev Microbiol 2020;18:521–38. 12 Mauro D, Thomas R, Guggino G, et al . Ankylosing spondylitis: an autoimmune or autoinflammatory disease? Nat Rev Rheumatol 2021;17:387–404.
10
Kragsnaes MS, et al . BMJ Open 2025; 15 :e101593. doi:10.1136/bmjopen-2025-101593
Powered by FlippingBook