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Microbiome and mucosal inflammation as extra-articular triggers for rheumatoid arthritis and autoimmunity

Brusca, Samuel B.a; Abramson, Steven B.b; Scher, Jose U.b

Current Opinion in Rheumatology: January 2014 - Volume 26 - Issue 1 - p 101–107
doi: 10.1097/BOR.0000000000000008

Purpose of review Despite the progress toward understanding the molecular pathogenesis of rheumatoid arthritis (RA), its cause remains elusive. Genes are important but rather insufficient to explain the majority of RA cases. This review describes the novel data supporting the microbiome and its interactions with the human host as potential en(‘in’)vironmental factors in RA pathogenesis.

Recent findings Animal models of inflammatory arthritis have shown that the presence of bacteria in mucosal surfaces is sufficient to alter local and systemic host immune responses and elicit joint inflammation. Human RA studies have focused on three mucosal sites: the gut, the gingiva, and the respiratory tree. The oral microbiome, and specifically Porphyromonas gingivalis, has long been implicated. Novel sequencing technologies have allowed investigations into the role of the gut microbiome in the development of autoimmune arthritis. Most recently, the pulmonary parenchyma has also been described as yet another possible mucosal site of initiation of autoimmunity in RA.

Summary Emerging data implicate the microbiome in RA pathogenesis. Mucosal sites exposed to a high load of bacterial antigens – such as the periodontium, lung, and gut – may represent the initial site of autoimmune generation. If validated, these findings could lead to the discovery of potential biomarkers and therapeutic approaches in the preclinical and clinical phases of RA.

aNew York University School of Medicine

bDivision of Rheumatology, Department of Medicine, New York University School of Medicine, New York, New York, USA

Correspondence to Dr Jose U. Scher, MD, Division of Rheumatology, Department of Medicine, New York University School of Medicine, Microbiome Center for Rheumatology and Autoimmunity (MiCRA), 301 East 17th Street, Room 1611, New York, NY 10003, USA. Tel: +1 212 5986153; e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.