Hao Yudi
Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Mod Rheumatol. 2025 Aug 29. doi: 10.1093/mr/roaf081.
Rheumatoid Arthritis (RA) is a progressive autoimmune disorder with substantial global health and economic impacts. Despite advancements in conventional therapies, biologics, and targeted drugs, challenges such as adverse effects, cost, and interindividual heterogeneity underscore the need for safer, precision-based treatments. Notably, emerging evidence highlights the pivotal role of the gut microbiota-immune axis in RA pathogenesis. Affected individuals typically exhibit gut dysbiosis, marked by increased pro-inflammatory taxa and reduced anti-inflammatory species, which disrupts immune homeostasis through Th17/Treg imbalance, molecular mimicry, and compromised gut barrier integrity. These processes drive systemic inflammation, exacerbating both articular destruction and extra-articular manifestations. Probiotics demonstrate therapeutic potential by modulating this axis via microbiota restoration, barrier reinforcement, and immune regulation. Strain-specific effects have been documented in both preclinical and clinical studies, although efficacy varies depending on host genetics, baseline microbiota composition, and intervention protocols-a variability underscoring the need for personalized probiotic selection. This review consolidates current knowledge on gut microbiota-immune crosstalk in RA and explores probiotics as precision therapeutics. Integrating multi-omics (metagenomics, metabolomics) with targeted probiotic strategies could enable the development of personalized interventions. While translational obstacles persist, including mechanistic complexity and limited clinical validation, the gut microbiota-immune axis offers a novel paradigm for RA management. Future priorities include large-scale trials, biomarker discovery, and combinatorial approaches to advancing microbiome-guided precision medicine in autoimmune diseases.
类风湿关节炎（RA）是一种进行性自身免疫性疾病，对全球健康和经济产生重大影响。尽管传统疗法、生物制剂和靶向药物取得了进展，但诸如不良反应、成本和个体间异质性等挑战凸显了对更安全、基于精准医学的治疗方法的需求。值得注意的是，新出现的证据强调了肠道微生物群-免疫轴在类风湿关节炎发病机制中的关键作用。受影响的个体通常表现出肠道生态失调，其特征是促炎菌增加和抗炎菌减少，这通过Th17/Treg失衡、分子模拟和肠道屏障完整性受损破坏免疫稳态。这些过程引发全身炎症，加剧关节破坏和关节外表现。益生菌通过恢复微生物群、加强屏障和调节免疫来调节这一轴，从而显示出治疗潜力。临床前和临床研究均记录了菌株特异性效应，尽管疗效因宿主遗传学、基线微生物群组成和干预方案而异——这种变异性突出了个性化益生菌选择的必要性。本综述整合了目前关于类风湿关节炎中肠道微生物群-免疫相互作用的知识，并探讨了益生菌作为精准治疗方法的可能性。将多组学（宏基因组学、代谢组学）与靶向益生菌策略相结合，可能有助于开发个性化干预措施。尽管存在诸如机制复杂性和临床验证有限等转化障碍，但肠道微生物群-免疫轴为类风湿关节炎的管理提供了一种新的范例。未来的重点包括大规模试验、生物标志物发现以及推进自身免疫性疾病中微生物群引导的精准医学的联合方法。
