Fast forward to #ARA2026 and there’s a good chance we could be talking about the use of faecal transplants to treat rheumatoid arthritis.

In a session eloquently named epigenetics, poo and arthritis, Tim Spector,  Professor of Genetic Epidemiology and Rheumatology at Kings College in London, said there was increasing evidence that the microbiome might have a  key role to play in rheumatoid arthritis.

One study published in Nature Medicine last year by Chinese researchers looked at faecal, dental and salivary samples from a cohort of individuals with rheumatoid arthritis and healthy controls.

Similar to other chronic diseases they discovered a lack of microbiome diversity in the RA cases, whereas the controls had more species and diversity.

“There seems to be a rule, that if you want to be healthy you want to have a really diverse microbiome,” Professor Spector told delegates.

The study not only confirmed a lack of diversity but also showed a few species that were decreased in cases, for example, haemophilus, whereas lactobacillus salavarius was increased.

They study also showed that just by looking at a persons microbes through a poo sample could predict whether they had RA just as well as autoantibody tests.

The findings reinforce his view that a microbial sample is much better than a DNA test for diagnosing most conditions and for health states, says Professor Spector who also heads up the TwinsUK registry.

New studies also showed that how well people respond to medications for arthritis depends very much on the type of microbes they have.

“This is extremely new area that’s very exciting…we’re just starting some research looking at whether it is possible to predict how well people are going to do on their biologic drugs for arthritis with the microbes they have,” Professor Spector said in a press conference.

“And if not, can we replace them because the exciting thing abut microbe research is that you can replace them instantly, as a probiotic or by changing the food so that we can increase or change your gut microbes.”

“Manipulating the microbiome offers great potential and we should start seeing faecal transplants much more.”

“People undergoing autologous transplants, even the use of targeted anti-inflammatory antibiotics could be the future,” he added.