The link between your gut health and rheumatoid arthritis

If you live with rheumatoid arthritis, you probably won’t be surprised to hear that the health of your joints is interlinked with the health of your gut.  Many clients I work with who have rheumatoid arthritis either have irritable bowel syndrome, have experienced food poisoning or a stomach bug, or have been through a significant life event which has caused them stress and affected their gut.

And it isn’t just a coincidence. 

Rheumatoid arthritis (RA) is a chronic autoimmune disease where the immune system mistakenly attacks the body’s own joint tissues, leading to inflammation, pain, and joint damage. While RA has traditionally been viewed as a condition affecting the joints, emerging research highlights a deeper connection between gut health and autoimmune diseases like RA. This connection, known as the joint-gut axis, positions the gut microbiome and systemic inflammation at the heart of rheumatoid arthritis development and progression.

In this article, we’ll explore the role of the joint-gut axis in rheumatoid arthritis, how inflammation drives the disease, and how natural therapies can help mitigate symptoms by targeting gut health.

What is the joint-gut axis in rheumatoid arthritis?

At the core of the joint-gut axis is the idea that gut health profoundly impacts immune regulation. 

When I was suffering from joint issues myself, the pain and swelling would often intensify after I ate certain foods, or after I was ill with a cold or stomach bug, and what I didn’t realise at the time was how interrelated this was. 

In people with rheumatoid arthritis, an imbalanced gut microbiome—or dysbiosis—is common. This imbalance allows harmful bacteria to overpopulate, leading to an increase in gut permeability, commonly known as leaky gut. As the gut barrier weakens, toxins, bacterial fragments, and undigested food particles can leak into the bloodstream, triggering immune responses.

If you have rheumatoid arthritis, these leaked substances can drive systemic inflammation and worsen the immune system’s attack on joint tissues. 

Recent studies have shown that individuals with RA tend to have a reduced diversity of gut bacteria, with certain pathogenic strains (like Prevotella copri) being more prevalent. This suggests that gut dysbiosis may be a contributing factor to both the onset and progression of RA. This is the reason why I often recommend stool testing to my clients with RA.

The immune system’s interaction with gut bacteria or the toxins they produce may initiate or exacerbate joint inflammation, reinforcing the connection between the gut and joints. 

By targeting the gut and reducing inflammation, it may be possible to improve symptoms and even prevent the development of rheumatoid arthritis in those who are genetically susceptible. 

How inflammation is a critical driver in RA symptoms

Inflammation is the primary mechanism behind rheumatoid arthritis symptoms. It leads to swollen, stiff, and painful joints as the immune system attacks the synovium, the soft tissue lining the joints. Over time, this chronic inflammation can cause irreversible joint damage.

Even though I was never diagnosed with arthritis, the issues I experienced with my joints were some of the most debilitating symptoms I had when I was living with chronic fatigue syndrome. I was in constant pain, I was unable to exercise, and even chopping vegetables became difficult. 

I see now that inflammation was at the heart of it, and every time my inflammation spiked, my joints would hurt.

But this inflammatory response doesn’t just affect the joints; it’s systemic. If you have rheumatoid arthritis, you are more likely to have elevated levels of inflammatory markers (such as cytokines) circulating throughout your body. When the gut is inflamed or leaky, these inflammatory markers can further activate immune cells in the joints, worsening symptoms.

Because the inflammatory processes in RA can be traced back to the gut, reducing gut inflammation is crucial for managing RA. This is why focusing on gut health could potentially provide significant relief if you are living with RA.

So, what can you do to improve your gut health?

While conventional RA treatments often focus on symptom management through medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or disease-modifying antirheumatic drugs (DMARDs), natural therapies can complement these treatments by targeting the root cause of inflammation. 

By healing the gut and restoring microbial balance, systemic inflammation that drives RA can be reduced.

One of the first areas I address when working with clients is supporting their gut barrier function. By improving the integrity of the gut barrier, we help ensure that bacteria and toxins, which may trigger inflammation, remain contained within the gut and do not enter the bloodstream.

Glutamine is an amino acid that plays a critical role in maintaining gut barrier integrity. It is often used to repair leaky gut, which is common in people with both RA and gut dysbiosis. By strengthening the gut lining, glutamine may reduce systemic inflammation and prevent inflammatory substances from entering the bloodstream and affecting the joints.

Stewed apples can support gut health by providing pectin, a soluble fibre that acts as a prebiotic, feeding beneficial gut bacteria and promoting a healthy microbiome. The cooking process makes the apples easier to digest, reducing irritation for sensitive guts and enhancing overall digestion. 

Additionally, the antioxidants in apples, such as quercetin and vitamin C, offer anti-inflammatory benefits. Stewed apples are also gentle on the gut, helping to maintain regular bowel movements and prevent constipation with their natural juices. Including stewed apples in your diet can therefore help improve gut barrier integrity and reduce systemic inflammation.

You can also consider prebiotics and probiotics to support gut function, but it's important to proceed with caution, especially if you have existing imbalances in your gut, as they may sometimes exacerbate the issue. Understanding your current gut health baseline through stool testing can provide valuable insights and help tailor your approach to ensure these supplements are beneficial rather than potentially harmful.

However, research has shown that certain probiotic strains, such as Lactobacillus and Bifidobacterium, may lower inflammation markers and improve gut barrier function in RA patients. These probiotics can help modulate the immune response, reduce gut permeability, and lessen joint inflammation.

And you don’t have to take supplements to reap the benefits. Fermented foods like yoghurt, kefir, sauerkraut, and kombucha contain probiotics as well. 

Prebiotics are fibres that feed beneficial bacteria in the gut. By promoting the growth of healthy gut flora, prebiotics can help combat dysbiosis and reduce gut inflammation. If you have rheumatoid arthritis, ensuring a diet rich in prebiotic fibres can help restore microbial balance and strengthen the gut barrier. Good choices of prebiotic foods are garlic, onions, leeks, asparagus, bananas, and chicory root. You can also consider supplementing inulin.

Inulin is a type of soluble fibre which helps to feed beneficial gut bacteria and promote a healthy microbiome. It can be particularly useful for improving digestion, enhancing nutrient absorption, and supporting overall gut function. But if you have small intestinal bacterial overgrowth or other gut dysfunctions, it can make matters worse, so always consult a health practitioner before taking supplements. 

Herbs like ginger, Boswellia, and green tea extract have been shown to have anti-inflammatory properties and may be helpful for those with RA. These herbs can improve digestive health by reducing localised and systemic joint inflammation in those with RA.

The joint-gut axis highlights the powerful link between gut health and inflammation in conditions like RA. Chronic inflammation, driven by gut dysbiosis and leaky gut, plays a key role in both joint and autoimmune diseases. By addressing the root cause of inflammation such as poor gut health you may find relief from joint pain, stiffness and swelling.