The close bidirectional relation between the microbiome and the immune system is well-supported, and the role of gut dysbiosis has been implied in many systemic autoimmune diseases. This review aims at critically summarising and appraising six murine studies and sixteen clinical studies. The findings of the literature review suggest that gut dysbiosis precedes arthritis and that local intestinal inflammation leads to systemic inflammation in genetically predisposed individuals. However, the exact mechanism by which microorganisms provoke immune responses at distal sites remains to be elucidated. Even though a characteristic RA-microbiome was not identified, there were some common findings among studies: overabundance of Prevotella copri in early RA patients, and proliferation of the genus Collinsela and some Lactobacillus species. Three mechanisms by which microbiota may contribute to RA pathogenesis were proposed: inflammatory responses (Prevotella copri and Lactobacillus), molecular mimicry (Prevotella copri) and loss of intestinal barrier integrity (Collinsella). Larger longitudinal studies are required in order to shed light on the mechanisms involved and unravel microbiome’s therapeutic potential, while clinical trials are needed to evaluate the safety and efficacy of the implied therapeutic interventions. Lay Summary What does this mean for patients? The human body harbors a huge and diverse population of small organisms collectively called the microbiome mainly residing in the gut. The microbiome differs among individuals, but also within the same individual over time, because of various reasons including diet and the use of antibiotics. The small organisms living in our bodies are essential for our health as they play an important role for digestion and protection. Studies in mice and humans have shown that the microbiome and the immune system, the body’s protective system, influence and determine each other. It is therefore not surprising that it has been hypothesized that disruptions in the microbiome may be linked to diseases of the immune system. Recent technological advancements are specifically establishing the role of the microbiome in rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease, where the immune system attacks the healthy cells affecting the whole body but mainly characterized by joint pain and inflammation. Even though alterations in the microbiome is well-reported in rheumatoid arthritis patients, it remains unclear which organisms (present or absent), and how, contribute to the development of rheumatoid arthritis. This review looks at both mice and human studies aiming to reveal the role of the microbiome in the development of rheumatoid arthritis. It is concluded that studies in mice show that changes in the microbiome activate immune cells locally which then enter the body circulation and migrate to joints causing distraction. While the results of the human studies are extensive, complex and not consistent. However, all studies demonstrate alterations in the microbiome of Rheumatoid arthritis patients implying that the microbiome plays a central role in Rheumatoid Arthritis. These are important findings because they imply the therapeutic value of minimally invasive treatments such as diet and supplementation.
This review investigates the burden, prevalence, and associated factors of chronic musculoskeletal pain in immigrants in Europe during the last decade with a focus on immigrants from North Africa and the Middle East. The intentions of the review are to inform healthcare policymakers, to identify gaps in the literature, and aid the planning of future research. Eleven observational studies were identified using online databases. Data suggest that chronic pain is more prevalent, more widespread, and more severe in immigrants, and that chronic pain deteriorates with length of stay in the destination country. Immigrant women were identified as a particularly vulnerable group for developing chronic pain and comorbid mental health disorders. Older age, lower education, financial hardship, being underweight or obese, time in transit during migration, experience of trauma, and immigration status were also associated with chronic pain. Anxiety, depression, and post-traumatic stress disorder diagnoses were also more prevalent in immigrants and were significantly associated with chronic pain. Several gaps in the literature were identified: research is limited in terms of quantity and quality, does not reflect actual immigration trends, and does not account for immigration factors.
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