Inflammation. 2025 Dec 17;49(1):6. doi: 10.1007/s10753-025-02373-7.

ABSTRACT

The management of rheumatoid arthritis (RA) has evolved from the conventional “treat-to-target” approach to strategies that emphasize individualized, patient-centered care. Concepts such as “therapeutic matchmaking” and “smart-to-target” highlight the importance of biomarkers, comorbidities, and quality-of-life priorities in selecting treatments. There is increasing evidence that identifies the gut-joint axis as a critical factor in RA pathogenesis. This axis links gut microbiota composition, intestinal barrier integrity, and systemic inflammation. Dysbiosis, reduced short-chain fatty acid production, and increased gut permeability can lead to immune dysregulation and joint inflammation. Nutritional interventions, such as high-fiber diets, prebiotics, probiotics, polyphenols, and omega-3 fatty acids, can restore microbial balance, enhance barrier function, and reduce inflammation. Precision nutrition, which tailors dietary recommendations based on genetic, microbiome, metabolic, and lifestyle factors, provides a framework for incorporating gut health into RA management. Microbiome-guided dietary strategies may improve responses to pharmacologic treatments, enable early intervention, and provide preventive benefits for high-risk individuals. Combining personalized nutrition with pharmacotherapy could optimize disease control, mitigate side effects, and promote sustainable, patient-empowering care. Future research should focus on randomized controlled trials and advanced analytic tools to refine predictive models and establish personalized nutrition as a cornerstone of holistic RA management.

PMID:41405656 | PMC:PMC12711927 | DOI:10.1007/s10753-025-02373-7