Meléndez-Oliva Erika, Martínez-Pozas Oliver, Sinatti Pierluigi, Martín Carreras-Presas Carmen, Cuenca-Zaldívar Juan Nicolás, Turroni Silvia, Sánchez Romero Eleuterio A
Grupo de Investigación en Dietética Aplicada, Nutrición y Composición Corporal (DANuC), Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 Alicante, Spain.
Grupo de Investigación en Calidad de Vida y Salud, Departamento de Ciencias de la Salud, Universidad Europea de Valencia, 03016 Alicante, Spain.
Nutrients. 2025 Jan 12;17(2):264. doi: 10.3390/nu17020264.
Osteoarthritis (OA) is the most prevalent form of arthritis and affects over 528 million people worldwide. Degenerative joint disease involves cartilage degradation, subchondral bone remodeling, and synovial inflammation, leading to chronic pain, stiffness, and impaired joint function. Initially regarded as a "wear and tear" condition associated with aging and mechanical stress, OA is now recognized as a multifaceted disease influenced by systemic factors such as metabolic syndrome, obesity, and chronic low-grade inflammation. Recent studies have focused on the gut-joint axis to investigate how the gut microbiome modulates inflammation and pain in OA.
A systematic review was conducted following the PRISMA guidelines and was registered with PROSPERO (CRD42024556265). This review included studies involving adults with symptomatic OA and analyzed the relationship between the gut microbiome and OA-related pain. Randomized and non-randomized clinical trials, case reports, editorials, and pilot studies were excluded. Searches were performed in PubMed, Cochrane Library, and Web of Science without publication date restrictions, and filtered for "observational studies". The study selection and data extraction were performed by two independent researchers, and the risk of bias was assessed using appropriate tools.
Five observational studies were included in the systematic review, and three were included in the meta-analysis. Two studies reported an association between different tryptophan metabolites and pain levels in patients with OA. Two other studies demonstrated a correlation between lipopolysaccharide levels and pain in OA. A fifth study confirmed the relationship between relative abundance of spp. and knee pain. These results were not supported by a meta-analysis, which found no significant association between the presence of pain in OA and the presence of bacilli of the genus or plasma markers of the tryptophan pathway.
Current evidence indicates a potential link between gut microbiome dysbiosis and OA-related pain. However, methodological limitations preclude definitive conclusions. Further research using advanced techniques and larger cohorts is needed to validate and extend these findings and elucidate the underlying mechanisms. Targeted manipulation of the gut microbiome may be a valuable strategy for pain management in OA patients.
骨关节炎（OA）是最常见的关节炎形式，全球有超过5.28亿人受其影响。退行性关节病涉及软骨降解、软骨下骨重塑和滑膜炎症，导致慢性疼痛、僵硬和关节功能受损。OA最初被认为是一种与衰老和机械应力相关的“磨损”病症，现在被认为是一种受代谢综合征、肥胖和慢性低度炎症等全身因素影响的多方面疾病。最近的研究集中在肠道-关节轴上，以研究肠道微生物群如何调节OA中的炎症和疼痛。
按照PRISMA指南进行了系统评价，并在PROSPERO（CRD42024556265）上进行了注册。该评价纳入了涉及有症状OA成人的研究，并分析了肠道微生物群与OA相关疼痛之间的关系。排除了随机和非随机临床试验、病例报告、社论和试点研究。在PubMed、Cochrane图书馆和Web of Science中进行检索，无出版日期限制，并筛选“观察性研究”。研究选择和数据提取由两名独立研究人员进行，使用适当工具评估偏倚风险。
系统评价纳入了五项观察性研究，荟萃分析纳入了三项。两项研究报告了OA患者不同色氨酸代谢物与疼痛水平之间的关联。另外两项研究表明脂多糖水平与OA疼痛之间存在相关性。第五项研究证实了spp.的相对丰度与膝关节疼痛之间的关系。荟萃分析不支持这些结果，该分析发现OA中疼痛的存在与属杆菌的存在或色氨酸途径的血浆标志物之间无显著关联。
目前的证据表明肠道微生物群失调与OA相关疼痛之间存在潜在联系。然而，方法学上的局限性排除了得出明确结论的可能性。需要使用先进技术和更大样本量的队列进行进一步研究，以验证和扩展这些发现并阐明潜在机制。针对性地操纵肠道微生物群可能是OA患者疼痛管理的一种有价值的策略。
