Zhan Jiaguo, Fu Yu, Liu Zhanbiao, Zhang Shaozhuo, Wu Chongming
School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Laboratory Animal Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Front Immunol. 2025 Sep 11;16:1637942. doi: 10.3389/fimmu.2025.1637942. eCollection 2025.
Rheumatoid arthritis (RA), a chronic autoimmune disorder marked by systemic inflammation and joint destruction, remains challenging to treat due to the limitations of conventional therapies, including side effects and diminishing efficacy. Emerging research underscores the gut-immune axis-a dynamic interplay between gut microbiota, immune responses, and inflammation-as a pivotal contributor to RA pathogenesis. Traditional Chinese Medicine (TCM), recognized for its established safety and accessibility, has been shown to synergistically alleviate symptoms of RA when used alongside conventional treatments, while significantly reducing drug-related toxicity. Pre-clinical models and clinical trials have demonstrated that TCM formulations, bioactive phytochemicals, and their metabolites can modulate the gut-immune axis by restoring gut microbiota balance and regulating immune-inflammatory pathways. This review summarizes the multi-target effects of TCM, including microbiota modulation and immune system regulation, and proposes a microbiota-centered therapeutic strategy for RA. Although the role of Traditional Chinese Medicine in regulating gut microbiota and immune modulation supports its clinical translatability, rigorous mechanistic studies remain essential to facilitate its integration into mainstream rheumatology treatment strategies. This involves research on its pharmacokinetic-pharmacodynamic characteristics, validation of microbiome-dependent mechanisms, and investigation into mechanisms involving microbial metabolites. By integrating millennia of empirical knowledge with cutting-edge systems biology, TCM presents a microbiota-centered holistic strategy for RA management.
类风湿性关节炎（RA）是一种以全身炎症和关节破坏为特征的慢性自身免疫性疾病，由于传统疗法存在局限性，包括副作用和疗效降低，其治疗仍然具有挑战性。新出现的研究强调肠道-免疫轴——肠道微生物群、免疫反应和炎症之间的动态相互作用——是RA发病机制的关键因素。中药（TCM）以其既定的安全性和可及性而闻名，已被证明与传统治疗方法一起使用时可协同缓解RA症状，同时显著降低药物相关毒性。临床前模型和临床试验表明，中药配方、生物活性植物化学物质及其代谢产物可通过恢复肠道微生物群平衡和调节免疫炎症途径来调节肠道-免疫轴。本综述总结了中药的多靶点作用，包括微生物群调节和免疫系统调节，并提出了以微生物群为中心的RA治疗策略。尽管中药在调节肠道微生物群和免疫调节方面的作用支持其临床可转化性，但严格的机制研究对于促进其纳入主流风湿病治疗策略仍然至关重要。这涉及对其药代动力学-药效学特征的研究、微生物群依赖性机制的验证以及对涉及微生物代谢产物的机制的研究。通过将数千年的经验知识与前沿的系统生物学相结合，中药为RA管理提供了一种以微生物群为中心的整体策略。
