Intestinal bacteria and rheumatic disease.

The striking clinical and pathological similarities between certain naturally occurring infectious diseases in animal species and those of some human rheumatic diseases, such as rheumatoid arthritis (RA), have stimulated the search for a microbial etiology of the latter syndrome. A long series of microbial species, including aerobic and anaerobic intestinal bacteria, mycoplasma and several viruses have been put into focus. Most often, however, an initially positive report has been followed by several reports denying an etiological role of the microbial species in focus. However, the concept of a microbial trigger in the etiology and symptomatology of RA is still a subject of intense debate. Recent results have indicated a reversed effect of gram-positive vs. gram-negative intestinal bacteria on adjuvant-induced arthritis in germfree rats and microbial peptidoglycans have been shown to play a major role in this experimental model. It has been shown that the intestinal flora may include bacteria containing antigenic determinant(s) cross-reacting with some markers within the HLA-system. The intestinal flora may also influence upon several digestive and absorptive functions and thereby acting upon parameters of importance in the development of rheumatic disease.