The role of gut microbiota in juvenile idiopathic arthritis

Abstract

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood, with prevalence of 16–150 cases per 100,000 children. The etiopathogenesis of JIA is a challenge incorporating a complex network with only 18% attributed to genetic factors. The remaining part should therefore be explained by non-hereditary factors. Given that around 70% of the immune cells are located in the gut, the potential role of the gut microbiota in the etiopathogenesis of JIA has been recently investigated. The aim of this review is to discuss the complexity of the link between gut microbiota and JIA, the different methods for identifying bacteria, the shape-up of the microbiota from birth to adulthood. The objectives are to discuss various pathways involved in this process: changes in the microbiota contents in healthy individuals and JIA patients, increased gut permeability, influence on T-cell differentiation and proliferation. Factors that have been associated with dysbiosis: diet, pathogens and drug use, are discussed. JIA is not a benign disease, it is a chronic disease and an important cause of short- and long-term disability-significant joint contractures, leg-length inequalities and uveitis, which can lead to impaired vision. It is known that at least one-third of children will have ongoing active disease into their adult years, and many will have some limitation in their daily life activities. A deeper understanding of the pathways by which disturbances in the microbiome may evolve to disease may open doors to the development of new treatment or prevention strategies in the future.