Rheumatoid Arthritis (RA)
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Gut Health and Rheumatoid Arthritis: What You Need to Know

Gut Health and Rheumatoid Arthritis: What You Need to Know
Canva; Everyday Health
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Updated on February 20, 2025
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Rheumatoid arthritis (RA) is an inflammatory disease that affects the joints and other parts of the body. It is also an autoimmune disease, meaning it causes the immune system to attack healthy tissue.

Gut microbiota are the microorganisms — bacteria, viruses, and fungi — that live in the digestive tract. They make up the gut microbiome and help digest foods, support the immune system, and fight off disease-causing microbes. Research has linked the health of the gut microbiome to various chronic conditions, including RA.

What’s the Connection Between the Gut and Rheumatoid Arthritis?

There’s growing evidence of a link between gut health and inflammatory diseases, including RA.

The various microbes in the microbiome play a role in digestion, the production of vitamins, and cell growth within organs.

 These microbes also teach the immune system to tell the difference between healthy organisms the body needs and unhealthy ones to eliminate.

How Gut Health Affects Rheumatoid Arthritis

“In RA there is a gut dysbiosis, meaning there is a disruption of the intestinal barrier, leading to a leaky gut. This can allow bacterial byproducts to enter the bloodstream and cause systemic inflammation,” says Micah Yu, MD, a rheumatologist and autoimmune specialist in private practice in Newport Beach, California.

As we age, exposure to diseases, various foods we eat, and environmental factors also change the microbiome, making the gut lining more permeable. This may explain why RA is more likely to appear as people get older.

RA also affects around three times as many women as men.

 This could be the result of differences in gut microbiota due to hormonal and other factors.

The Gut Microbiome in Rheumatoid Arthritis Diagnosis

In experimental or investigative settings, a doctor may sometimes test the composition of your gut flora, or microbiota, when diagnosing RA, though it is not a common practice. There’s evidence that people with RA have less variety in their gut microbiome. They may also have higher levels of certain microbes, such as Actinobacteria, Collinsella, and Eggerthella bacteria. Some research suggests that the microbiome changes before RA symptoms appear. Studying this could provide insights about how to readjust the microbiome to help prevent or delay RA’s onset.

Other Factors That Affect Gut Health and Rheumatoid Arthritis

Other factors that can affect gut health and cause an imbalance in the gut microbiome include:

  • Smoking
  • Stress
  • Certain foods
  • Obesity
  • Antibiotics
These are also risk factors for RA, further suggesting a link between a healthy gut and RA. While there’s growing evidence that gut health can influence RA, gut problems are not among the usual symptoms of RA.

 RA can cause gut dysbiosis and a “leaky gut,” but it doesn’t cause gastrointestinal symptoms, says Dr. Yu.

Which Bacteria Play a Role in Rheumatoid Arthritis?

There are many types of gut bacteria. Scientists have identified some species that may be linked to RA. According to one study, the following bacteria types might be present with RA, though this may not be true of all patients and more studies are needed.

High levels of:

  • Prevotella copri
  • Lactobacillus salivarius
  • Collinsella
  • Akkermansia

Low levels of:

  • Bacteroides fragilis
  • Bifidobacteria
  • Haemophilus spp.
  • Eubacterium rectale 
Some treatments, such as fecal flora transplants and oral probiotics, have shown promise in treating RA. Experts hope that new research will lead to more targeted and effective treatments.

How Is Diet Linked to Rheumatoid Arthritis?

Your diet can support the treatment of RA in various ways. Foods contributing to a healthy digestive system can help maintain a healthy microbiome. Dietary nutrients affect the composition and functioning of the microbiome, so diet may play a significant role in preventing and managing RA.

Dietary changes that may benefit RA symptoms include:

  • Dietary fiber: An important feature of many plant-based diets, fiber can improve the microbiome’s composition and reduce joint pain. The gut microbiome produces short-chain fatty acids (SCFAs) when it breaks down fiber. SCFAs have anti-inflammatory and immunoregulatory benefits and may help alleviate RA.

  • Reducing carb intake: This can help improve the balance of gut flora and the functioning of the immune system.
  • Omega-3s: These polyunsaturated fatty acids can help maintain the integrity of the intestinal barrier and interact with immune cells in the gut.

On the other hand, a high proportion of omega-6 fatty acids compared with omega-3s can promote inflammation, increasing the risk of RA. Similarly, a high-salt diet can damage the intestinal barrier, increasing the risk of inflammation and problems with the immune system.

Researchers believe RA treatments will become more effective as scientists learn more about the interaction between medical treatment, the gut microbiota, and nutrients.

Can a Specific Diet Help Treat Rheumatoid Arthritis?

Experts believe there’s great potential for diet to help with managing or preventing RA, such as by increasing antioxidant intake, reducing inflammation, and balancing the gut microbiota.

Research suggests that a Mediterranean diet supplemented with fermented foods could help manage symptoms and boost gut health in people with RA. However, scientists don’t yet know enough about the role of specific microbes in RA to recommend a specific diet or ingredients.

Yu says that an anti-inflammatory diet can help people with RA, and he suggests a Mediterranean, paleo, or vegan diet as a good option.

The Best Foods for Rheumatoid Arthritis

While doctors don’t yet understand all the specific connections between the gut microbiome and RA, there is evidence that some foods may promote a healthy gut microbiome and benefit people with RA. These include high-fiber and anti-inflammatory foods, such as:

  • Fresh fruits and vegetables
  • Whole grains
  • Lentils, beans, and other pulses
  • Brown rice
  • Oats
  • Nuts and seeds
  • Foods rich in omega-3 fatty acids, such as oily fish
  • Foods rich in antioxidants, such as berries and green tea

Pro-inflammatory foods can worsen or trigger inflammation. “RA is an inflammatory disease, so someone would want to eat foods that do not exacerbate inflammation and avoid those that do. There is not [enough] good evidence on this ... but we do know a little about pro-inflammatory foods,” says Jennifer Frediani, PhD, a registered dietitian and assistant professor at Emory University Nell Hodgson Woodruff School of Nursing in Atlanta.

If you have RA, it’s best to limit or avoid the following:

  • Red or processed meat
  • Commercial baked goods
  • Bread and pasta made with white flour
  • Deep-fried foods
  • Trans fats, found in margarine and nondairy creamers
  • Refined sugars

Dr. Frediani also suggests:

  • Eating more omega-3-rich foods than those containing omega-6s
  • Cutting down on sugars and refined carbohydrates
  • Reducing or limiting alcohol intake

“There is not any evidence that says a healthy diet will cure or significantly lessen RA, but eating a healthy diet can reduce inflammation and may prevent other chronic diseases associated with chronic inflammation,” she says. “People with RA could look to diets like the Mediterranean diet or the DASH diet for ideas on recipes and types of foods that would be helpful.”

Melissa Prest, RDN, a doctor of clinical nutrition, spokesperson for the Academy of Nutrition and Dietetics, and expert in arthritis and inflammation nutrition, also recommends the Mediterranean diet, citing the diet’s emphasis on whole foods, plant-based foods, and healthy fats.

“Diet is important in RA because it can help with symptom management,” says Dr. Prest. “Not all foods are equal for people with RA, so understanding which foods cause more pain and swelling and which ones do not can go a long way for quality of life.”

Can Supplements Help Balance the Microbiome in People With Rheumatoid Arthritis?

Some experts are looking into whether specific supplements or probiotics might help manage or prevent RA, alongside medical treatment.

According to Yu, “Specific bacteria in probiotics that can help with RA include lactobacillus and bifidobacterium, which can reduce inflammation.”

While over-the-counter (OTC) probiotic supplements may help some people with RA, there is no guarantee of their safety or effectiveness. OTC probiotic supplements are not subject to U.S. Food and Drug Administration approval, so these supplements are not routinely recommended by physicians.

The Takeaway

  • Some limited evidence shows a link between gut health and RA. It seems likely that an imbalance in the gut microbiome contributes to the inflammation involved in RA.
  • Experts are now looking for specific features in the gut microbiome that could indicate a higher risk of RA, and identifying such features could be a key step in diagnosing RA early and developing new therapies.
  • Meanwhile, following a diet rich in anti-inflammatory foods, including natural probiotics in your diet, as well as avoiding smoking, may help boost gut health to manage or prevent RA’s onset.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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  13. Vadell AK et al. Anti-Inflammatory Diet In Rheumatoid Arthritis (ADIRA) — a Randomized, Controlled Crossover Trial Indicating Effects on Disease Activity. The American Journal of Clinical Nutrition. February 2020.
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Yuying Luo, MD

Medical Reviewer

Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.

Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.

She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.

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Yvette Brazier's career has focused on language, communication, and content production, particularly in health education and information. From 2005 to 2015, she supported learning in the health science department of a higher education establishment, teaching the language of health, research, and other language application skills to paramedic, pharmacy, and medical imaging students.

From 2015 to 2023, Yvette worked as a health information editor at Medical News Today and Healthline. Yvette is now a freelance writer and editor, preparing content for Everyday Health, Medical News Today, and other health information providers.

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