Dr Shane Selvanderan

Faecal microbiota transplantation may have an added benefit in inflammatory arthritis, according to Adelaide gastroenterologists who report resolution of psoriatric arthritis (PsA) in a patient undergoing FMT for Clostridium difficile infection.

The case report from Dr Shane Selvanderan and Dr Sam Costello of the Centre for Nutrition and Gastrointestinal Disease, University of Adelaide, describes the outcome of a 59-year old woman who had a 12-year history of PsA as well as C. difficile-related pseudomembranous colitis.

She was accepted for FMT treatment after she presented with severe diarrhoea and was diagnosed with C. difficile colitis that persisted despite IV metronidazole and vancomycin treatment.

After undergoing FMT via colonoscopy she had resolution of diarrhoea and normalisation of her CRP within three days.

In addition, she also reported dramatic improvement in her PsA joint symptoms in the weeks following FMT. On review at one, four and ten months she had achieved minimal disease activity for her PsA with minimal morning stiffness, no sacroiliac joint pain and normal inflammatory markers, while remaining off all DMARDs.

The woman had no psoriasis prior to FMT so it was not possible to comment on the effect of FMT on skin symptoms of PsA.

Some joint symptoms returned at 13 months, which were managed with methotrexate but no immunosuppression.

Writing in the Clinical and Experimental Rheumatology, the clinicians said the gut microbiome could play an aetiological  role in autoimmune disease such as PsA, which may therefore be amenable to FMT treatment.

Psoriatic arthritis is a T cell-mediated disease, and the Th17 pathway targeted by biologics treatments is also influenced by some gut bacteria, they noted.

“It is therefore plausible that gut dysbiosis may directly contribute to the direction of differentiation of naïve T cells into specific effector T cells that drive the pathogenesis of psoriatic arthritis,” they wrote.

A single case report was hypothesis generating and suggested the potential for clinical trials to further explore the effects of FMT and modifying the microbiome in PsA, they concluded.