A study of 1,388 women with hand arthritis, average age 61, showed that they had higher levels in their colons of the bacteria Bilophila and Desulfovibrio that try to invade their colon cells, as well as a lower level of the genus Roseburia that do not invade colon cells (Arthritis Rheumatol, published online March 24, 2021).
An anti-inflammatory lifestyle has been shown to help grow healthful bacteria in your colon, which can help to treat rheumatoid arthritis (J Rheumatol, 2008;35(8):1477-9). If you have rheumatoid arthritis or any other type of arthritis, anti-inflammatory lifestyle habits should be an important part of your treatment program. For many years, exercise has been recommended as part of the treatment for rheumatoid arthritis, and a recent summary of studies confirms that vigorous exercise is beneficial (Arthritis & Rheumatology, published online April 01, 2019). An anti-inflammatory diet high in plants and low in meat and sugar (Rheum Dis, 2017;76(8):1357-64), and weight control (Arthritis Res Ther, 2015;17:86), also reduce symptoms of rheumatoid arthritis.
Rheumatoid arthritis is a disease in which your own immune system attacks and damages your joints. Nobody knows why some people develop rheumatoid arthritis, while others do not. However, we do know that the joint damage is caused by exactly the same cells and chemicals called cytokines that your body uses to kill germs when they try to invade your body. When your immune system stays active all the time, it is called inflammation (Curr Opin Rheumatol, 2014 Jan;26(1):101-7). Everything that turns on your immune system is called pro-inflammatory and everything that dampens down your immune system is called anti-inflammatory.
Harmful Colon Bacteria May Trigger Rheumatoid Arthritis
You have more than 100 trillion bacteria, of about 1000 different species, living in your colon. Many different studies have shown that what you eat determines which types of bacteria live in your colon and that certain types of bacteria can turn on your immune system to cause inflammation that increases risk for rheumatoid arthritis as well as heart attacks, dementia and certain cancers (J Alzheimers Dis, 2017;58:1-15). Colon bacteria eat the same foods that you do. The healthful bacteria are content to eat what you eat, so they stay in your colon and do not try to cross into your cells and bloodstream, but the harmful bacteria try to find different foods by invading the cells lining your colon. Your immune system tries to defend you by producing huge amounts of white blood cells and chemicals that work to destroy the invading bacteria by punching holes in their outer membranes and trying to kill them. This constant invasion of your colon cells by harmful bacteria can cause your immune system to stay on all the time. Anything that reduces inflammation helps to reduce the pain and destruction of joints in rheumatoid arthritis. That is why almost all rheumatologists treat rheumatoid arthritis with powerful drugs to reduce inflammation, but unfortunately, these drugs can increase risk for infections and certain cancers.
My wife, Diana, was diagnosed with rheumatoid arthritis at age 54 in 1996. She had an extremely high rheumatoid factor, greater than 300 (normal is <15), and other markers of inflammation such abnormal blood tests for c-reactive protein (CRP) or sed rate. We elected not to treat her with conventional immuno-suppression drugs and instead gave her minocycline, an antibiotic. Both of us faithfully followed an anti-inflammatory lifestyle including a vigorous exercise regimen of riding a bicycle more than 100 miles a week and a high-plant diet. Every time I stopped the minocycline her symptoms worsened, and when I restarted the antibiotics, her symptoms improved. Finally after 14 months, when I stopped the antibiotics her symptoms did not come back. Over the years she has had some flare-ups, but today she is 79 years old, rides more than 150 miles on her bike each week and is relatively pain-free, although she does have some of the hand and foot deformities characteristic of rheumatoid arthritis.
Over the years I have written about the patients with rheumatoid arthritis that I helped and the many studies showing that antibiotics might have a role in treatment of the disease. The recent research on inflammation and gut bacteria suggests that my success in treating rheumatoid arthritis patients with antibiotics may have been due to the effects of altering their colon bacteria. My efforts were not done as a controlled experiment, so further research is needed. We do already have extensive data showing that diet and lifestyle changes can be used to reduce inflammation and that the foods that you eat determine which types of bacteria live in your colon.
Studies on Diet to Treat Rheumatoid Arthritis
People who eat a healthful high-plant diet are at reduced risk for developing rheumatoid arthritis (Nutritional Outlook, Mar 20, 2019;22(2)). Previous studies have shown that a vegan diet is associated with reduced symptoms and reduced progression of the disease (Clin Rheumatol, 1994;13(3):475–82; Rheumatology, 2001;40(10):1175–9; J Altern Complement Med, 2002;8(1):71–5). An excellent review of dietary factors that can increase or decrease joint destruction in rheumatoid arthritis can be found in Frontiers of Nutrition (Nov 8, 2017;4:52). Rheumatoid arthritis patients who ate:
• a healthy plant-based diet had reduced markers of inflammation (CRP and sed rate) and reduced progression of disease compared to those with less healthy diets (Nutrients, Oct 18, 2018;10(10):1535)
• more vegetables, greens, beans, whole grains, dairy and seafood, and less refined grains, salt, and empty calories had less severe symptoms than those who ate less healthful diets (Nutrition and Health, 2017; 23(1):17-24)
• more milk, fried foods, butter and solid oils had more severe symptoms (Clin Rheumatol, Oct 2018;37(10):2643-2648)
• a Mediterranean diet, with lots of fiber, had reduced inflammation and pain (Ann Rheum Dis, 2003;62(3):208–14)
Research on Rheumatoid Arthritis, Gut Bacteria and Antibiotics
Analysis of the bacteria in your colon can predict susceptibility to developing rheumatoid arthritis (Genome Medicine, 2016;8(1). Treating arthritis-susceptible mice with the healthful Provatella histicola bacteria decreased frequency and severity of arthritis, and they had fewer inflammatory conditions associated with rheumatoid arthritis (Arthritis Rheumatol, Dec 2016;68(12):2878-2888). Many papers have reported improvement in rheumatoid arthritis symptoms with the prescription of antibiotics (Klin Med, 2010;89(4):45–8; J Rheumatol, 2008;35(8):1500–5; Ann Rheum Dis, 2003;62(9):807–11; Elife, 2013;2:e01202).
Antibiotics do affect the makeup of colon bacteria in humans, but at this time we do not know enough to suggest that patients with rheumatoid arthritis should be treated with antibiotics to change colon bacteria. A more conservative approach would be to encourage a healthful change in colon bacteria using an anti-inflammatory diet and other lifestyle changes (exercise, weight loss if indicated, avoiding smoke and alcohol, and so forth).
My Recommendations
Most types of arthritis are associated with inflammation, an overactive immune system that attacks and damages your joints and other tissues. Symptoms of rheumatoid arthritis can improve with lifestyle changes to increase healthful bacteria and decrease harmful bacteria in your colon. At this time, there is still uncertainty about how effective an anti-inflammatory lifestyle is in treating rheumatoid arthritis, but I recommend that people who suffer from any type of arthritis should include the following lifestyle habits with their other treatments; check with your doctor.
• A diet that is high in vegetables, unground whole grains, beans, fruits, nuts and and other seeds, and low in red meat, processed meats, fried foods, sugared drinks and foods with added sugars
• A regular exercise program (with your doctor’s approval)
• Maintenance of a healthful weight
• Avoidance or restriction of alcohol
• Avoidance of smoking and second-hand smoke
• Avoidance of other toxic substances and pollutants
Checked 6/2/23
