Psoriatic arthritis

Gut microbiome may play a role in psoriatic arthritis: case study  

A woman with psoriatic arthritis has achieved sustained remission of her rheumatic symptoms after receiving a fecal microbiota transplantation for Clostridium difficile infection, a case study from South Australia reports.

The 59 year old presented to the Queen Elizabeth Hospital, South Australia, with severe diarrhoea having recently completed a course of orally administered clindamycin for presumed facial cellulitis.

She had been diagnosed with psoriatic arthritis 12 years prior with recurrently active spondyloarthropathy and polyarthritis which manifested as sacroiliac joint pain and stiffness and synovitis of the small joints.

Her medication regimen included methotrexate 25 mg/week, hydroxychloroquine 200 mg twice daily, leflunomide 10 mg daily, folic acid, and paracetamol.

The patient was diagnosed with C difficile colitis and was treated with metronidazole and vancomycin but as she continued to experience regular bouts of diarrhoea the clinicians decided to treat her with FMT via colonoscopy.

At 3 days post-FMT her gastrointestinal symptoms improved but at a 10-month clinicians found that she had minimal morning stiffness, no sacroiliac joint stiffness, tender and swollen joint count of 0, and normal inflammatory biomarkers, and had discontinued her DMARDs.

At 13 months post-FMT, the patient reported an increase in disease activity with diffuse arthritis and increased morning stiffness, which coincided with an episode of traveler’s diarrhoea.

According to the authors their case study was the first to associate FMT with attainment of minimal disease activity in PsA.

“It is plausible that gut dysbiosis may directly contribute to the direction of differentiation of naive T cells that drive the pathogenesis of psoriatic arthritis, ” the study authors, including rheumatologist Fiona Goldblatt from Adelaide, wrote in Clinical and Experimental Rheumatology.

“The outcome in this case is hypothesis-generating in that it suggests that the gut microbiome may play a role in psoriatic arthritis and there may be the potential to treat psoriatic arthritis with gut microbial manipulation,” they concluded.

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