When I was in college, I developed stomach problems, which were identified as irritable bowel syndrome (also known as spastic colon, but not to be confused with inflammatory bowel disease (Ulcerative Colitis and Crohn's Disease). If I ate a lot of roughage, Chinese food, or drank black coffee, within no more than a half an hour, I would find myself needing to find a bathroom right away. While it hindered my social life, it also may have been the start of my immune system problems.
I have heard a lot of discussion from people about the importance of the balance of intestinal flora for overall health, and this seems to be fairly well documented (Bischoff 2011; Isolauri, Kirjavainen, and Salminen 2002).
This also may be even more so in the case of RA.
According to one article, "THE rheumatologist must be constantly aware of his patient's gastrointestinal tract for three reasons. First, the rheumatic diseases may affect the gut; secondly, the treatment of rheumatic diseases may have gastrointestinal effects; and thirdly; predominantly gastrointestinal diseases may have musculoskeletal components" (Haslock and Wright 1974: 51).*
Another article states that "Changes in the composition of bacterial populations might elicit an imbalance in proinflammatory and anti-inflammatory immune mechanisms"" (Scheinecker and Smolen 2011: 73).
One study found "[T]hat a primary abnormality in rheumatoid arthritis may be a reaction to a food antigen(s) and that the disease process starts within the intestine" (Podas, et al. 2007).
In fact, this is not a new idea. Some have posited that overgrowths of bacteria are a potential cause of RA (Henriksson, et al. 1993; O'Mahony and Ferguson 1991).
When I first got sick, there was some thought that I may have been suffering from a systemic yeast infection, as a rogue yeast infection was one of the many early signs that my immune system was having issues.
Now this is a condition that if often disputed, and is most typically found in patients with AIDS (Hyman 2013). However, systemic yeast infections are a problem that can lead to intestinal and joint problems, along with a litany of other symptoms. Most importantly, this condition is also associated with issues of gut health.
On the flipside to all of this, however, is that "Early life exposure to normal bacteria of the GI tract (gut microbes) protects against autoimmune disease" (Helmholtz Centre For Environmental Research 2013).
So good bacteria in the gut, in the correct amount, can be immune system promoting. But too much of a good thing seems to be implicated in a host of negative effects, including the potential for RA.
According to the Mayo Clinic (2012), "[I]dentifying new biomarkers in intestinal microbial populations and maintaining a balance in gut bacteria could help physicians stop rheumatoid arthritis before it starts."
So what does it all mean? Of course, research in this area is fairly new, and the links aren't exactly clear. But it seems like a combination of genetics and other factors work together to create a fertile environment for RA.
Of course, in the grand scheme, my GI problems, which were at the time considered a result of irritable bowel syndrome, were much less of an issue than RA is in my life now. But the fact that these two conditions might be connected is significant. It is also begs the question when dealing with patients in my age group, how much should be attributed to lifestyle and stress, and how much more probing should go into gut issues?
While it's hard to know exactly what came first, whether it was the RA and then gut problems, or gut problems and then RA, for me personally, it seems that RA did start in the gut.
Obviously if people have gut trouble, they should not run to their doctor assuming that they have something worse. But all of this research shows that you should go with, and listen to, your gut. It might just be telling you something very important about your body.
*It should be noted that this article is referring to how the gut is implicated in the etiology of RA and not how RA treatments can impact the gut.
Bischoff, Stephan C. 2011. "'Gut health': A New Objective in Medicine?" BMC Medicine 9 (24): np.
Haslock, Ian, and V. Wright. 1974. "The Gut and Arthritis." Rheumatology and Rehabilitation 13 (2): 51-61.
Hemholtz Centre For Environmental Research - UFZ. 2013. "GI Tract Bacteria May Protect Against Autoimmune Disease." Science Daily.
Henriksson, A.E.K, L. Blomquist, C-E. Nord, T. Midtvedt, and A. Uribe. 1993. "Small Intestinal Bacterial Overgrowth in Patients with Rheumatoid Arthritis." Annals of the Rheumatic Diseases 52: 503-510.
Hyman, Mark. 2013. "Is Hidden Fungus Making You Ill?" Huffpost Healthy Living (http://www.huffingtonpost.com/dr-mark-hyman/yeast-infection-symptoms_b_657354.html)
Isolauri, E., P.V. Kirjavainen, and S. Salminen. 2002. "Probiotics: A Role in the Treatment of Intestinal Infection and Inflammation?" Gut 50 (Suppl III): iii54-iii59.
Mayo Clinic. 2012. "Sick From Your Stomach: Bacterial Changes May Trigger Diseases Like Rheumatoid Arthritis." Science Daily.
O'Mahony, Seamus, and Anne Ferguson. 1991. "Small Intestinal Mucosal Protection Mechanisms and Their Importance in Rheumatology." Annals of the Rheumatic Diseases 80: 331-336.
Podas, Thrasyvoulos, Podas, Jeremy M.D. Nighingale, Roger Oldham, S. Roy, Nicholas J. Sheehan, and F. Mayberry. 2007. "Is rheumatoid Arthritis a Disease that Starts in the Intestine? A Pilot Study Comparing an Elemental Diet with Oral Prednisolone." Postgraduate Medical Journal 83: 128-131.
Scheinecker, Clemens, and Josef S. Smolen. 2011. "From the Gut to the Joint." Nature Review Rheumatology 7: 73-75.