Microbiome-based mechanisms hypothesized to initiate obesity-associated rheumatoid arthritis

Worldwide, the growing obesity pandemic contributes to a range of chronic diseases. Recent epidemiological studies have suggested an association between obesity and the development of rheumatoid arthritis (RA), particularly among young women, whereby pro-inflammatory effects of adipokines provide one explanatory hypothesis. Yet, recent clinical and laboratory-based studies provide emerging evidence indicating microbiome involvement in RA initiation and development, including anti-citrullinated antibody formation and Th17 cell activation. Obesity and RA-associated microbiome alteration might provide a plausible link to address the impact of obesity to RA pathogenesis. The microbiome's influence on RA development - at mucosal as well as articular sites - and relevant pathophysiological mechanisms regarding obesity's association with RA are presented herein to discuss this hypothesis and aid understanding of obesity's role in RA development.