Rodriguez Valeria Rios, Essex Morgan, Poddubnyy Denis
Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Division of Rheumatology, University of Toronto and University Health Network, Toronto, Ontario, Canada.
Curr Opin Rheumatol. 2025 May 1;37(3):199-206. doi: 10.1097/BOR.0000000000001079. Epub 2025 Feb 19.
This review provides an updated overview of the gut microbiota's involvement in spondyloarthritis (SpA) from a clinical perspective. It explores mechanisms by which the gut microbiota may influence SpA pathogenesis and considers the therapeutic implications of targeting the microbiome in SpA treatment.
The pathogenesis of SpA is multifactorial, involving genetic predisposition, external factors and dysregulation of the immune system. Recent studies have identified alterations in the gut microbiome of patients with SpA, including changes in microbial diversity and specific taxa linked to disease activity. HLA-B27 status seems to influence gut microbiota composition, potentially impacting disease progression. In HLA-B27 transgenic rats, the association between gut microbiota and SpA development has been confirmed, supporting findings from human studies. A compromised gut barrier, influenced by proteins like zonulin, may allow microbial antigens to translocate, triggering immune responses associated with SpA.
These findings highlight the potential for microbiota-modulating therapies, such as probiotics, prebiotics, diet and exercise, in managing SpA. However, methodological variability in human studies exposes the need for more rigorous research to better understand these associations. This may offer the opportunity to refine treatment strategies, offering a personalized approach to managing the disease.
本综述从临床角度对肠道微生物群在脊柱关节炎（SpA）中的作用提供最新概述。探讨肠道微生物群可能影响SpA发病机制的途径，并考虑针对微生物群在SpA治疗中的治疗意义。
SpA的发病机制是多因素的，涉及遗传易感性、外部因素和免疫系统失调。最近的研究已经确定了SpA患者肠道微生物群的改变，包括微生物多样性的变化以及与疾病活动相关的特定分类群的变化。HLA-B27状态似乎会影响肠道微生物群组成，可能影响疾病进展。在HLA-B27转基因大鼠中，肠道微生物群与SpA发展之间的关联已得到证实，支持了人体研究的结果。受如闭合蛋白等蛋白质影响的肠道屏障受损，可能会使微生物抗原发生易位，引发与SpA相关的免疫反应。
这些发现凸显了微生物群调节疗法（如益生菌、益生元、饮食和运动）在管理SpA方面的潜力。然而，人体研究中的方法学差异表明，需要进行更严格的研究，以更好地理解这些关联。这可能提供改进治疗策略的机会，为管理该疾病提供个性化方法。
