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Rheumatoid arthritis is a condition that can cause pain, swelling and stiffness in joints. It is what is known as an auto-immune condition. A new study has revealed that damage to the lining of the gut plays a key role in diagnosing the disease.
The study has shown that damage to the gut causes it to leak and allows bacteria to cross the lining of the gut into the body.
This intensifies inflammation in the stomach and causes increasing pain to the joints. University College London (UCL) researchers discovered that restoration of the gut-barrier could offer a new therapeutic approach to reducing the severity of RA symptoms.
Despite the understanding of some of the genetic and environmental factors that might be involved in the development of RA, scientists still did not completely understand what initiates disease and how it accelerates, until now.
Researchers of the study suggest that the discovery of the growth of bacteria in the gut will play a vital part in initiating the disease.
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Researchers of the pre-clinical study, which used mouse models and patient samples, identified existing stomach-repairing drugs used for the digestive disorders, coeliac disease and Crohn’s disease that could be used to treat RA.
Laboratory tests on human tissue and mice samples found a drug currently in clinical trials for Coeliac disease – known as AT1001 – was effective at repairing the gut lining and relieving symptoms.
As well as this, vercirnon – a treatment already being used on the NHS to treat Crohn’s – is another potential candidate.
The researchers are now working towards a clinical trial involving one or more of these drugs in humans for RA, which affects around 400,000 people in the UK – a third of whom gain very little benefit from current treatments.
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Professor Claudia Mauri of UCL and the co-lead author of the study said: “We wanted to know what was happening in the gut and whether changes to the intestinal lining – which usually acts as a barrier to protect the body from bacteria – are a feature of the disease and contribute to its development.”
If the second clinical trial is deemed a success, an existing drug will be found to be effective and become available for RA patients on the NHS within three to four years, Professor Mauri said.
She also stressed that if there were limitations to the next study, these drugs may take longer to be available for patients, but “our findings suggest that the intestinal lining is a therapeutic target. Importantly, we found that using existing drugs that restore the gut-barrier integrity i.e., prevent the gut from becoming leaky or inhibit inflammatory cells from moving to and from to the gut, could reduce the severity of arthritis in pre-clinical models”.
According to Professor Mauri, current treatments for RA do not seem to correct the problems in the gut and so may leave the patient susceptible to reactivation of disease from the continuing inflammation in that area.
Experts not involved in the study said the findings significantly increase our understanding of disease that could lead to the increase in efficacy of new treatments.
“This is an exciting study [that] may help to identify new ways to treat arthritis in some patients,” said Professor Simon Milling, of the University of Glasgow.
The RA research is published in the Medicine Journal; funded by the Versus Arthritis charity.
Dr Neha Issar-Brown, Director of Research at Versus Arthritis said: “The findings are exciting on many fronts. Not only do they demonstrate a link between damage to the gut lining, its microbiome and rheumatoid arthritis, but they also show how it might be triggering the immune system and contributing to inflammation and the onset of RA.”
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