Modifying Gut Microbiota May Enhance DMARD Efficacy in RA

If your gut is telling you that your disease-modifying antirheumatic drugs aren't working as well as they should, listen to it.That's the advice of Rebecca B. Blank, MD, PhD, a rheumatologist at NYU Langone Health in New York City, who studies methods for modulating the gut microbiome to enhance DMARD efficacy for patients with rheumatoid arthritis .

"And so indeed, we were able to find a human gut microbial signature that predicted methotrexate responsiveness in these baseline microbiome samples," Blank said. Their work was further supported by colleagues at the University of California San Francisco, who found evidence in mouse models to suggest that microbial metabolism plays a role in methotrexate levels in plasma."Our next question was: Can we modulate the gut microbiome to improve methotrexate efficacy?" Blank said.

One such short-chain fatty acid, butyrate, is produced through microbial fermentation of dietary fiber in the colon; it is available in various foods and in supplement form. In preliminary analyses, they found that at baseline, fecal butyrate was significantly elevated in methotrexate responders compared with in nonresponders. In addition, in the new-onset RA cohort, they saw that the 4-month responsiveness rate was 52.6% for those treated with methotrexate compared with 64.7% for those treated with methotrexate plus butyrate.

RA - Rheumatoid Arthritis Rheumatoid Arthritis (RA) Arthritis Joint Inflammation Microbiome Microbiota Disease-Modifying Antirheumatic Drugs Dmards DMARD Fatty Acids Bacteria Bacterial Infection Metabolism Metabolic New York California Dietary Fiber Dietary Supplements Food Supplements Diversity Hospitals Lung Maryland Plasma Probiotics Surgery

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