The gut-joint axis in osteoarthritis

Osteoarthritis (OA) is a complex condition driven by biomechanical, metabolic and inflammatory factors; however, effective disease-modifying treatments remain unavailable. Growing evidence suggests that gut microbiota dysbiosis has an important role in OA pathogenesis, giving rise to the emerging concept of a functional and targetable gut-joint axis. Gut microbiota dysbiosis can impair enteroendocrine signalling, intestinal immunity and gut barrier integrity, alter the secretion of hormones and cytokines and facilitate the translocation of gut microorganisms, pro-inflammatory molecules and metabolites into the circulation or joints. These processes can disrupt systemic and local homeostasis, promote metabolic dysregulation and obesity, trigger low-grade inflammation and contribute to both the onset and progression of OA. Although these insights open up new avenues for disease-modifying treatments and build on the long-standing paradigm in OA, which primarily focuses on pain relief rather than disease modification, evidence supporting therapeutic strategies that target the gut-joint axis remains limited. Further research is needed to translate this promising biology into clinical benefits, including deeper mechanistic elucidation through integrated multi-omics approaches, exploration of the interplay between host genetics, environmental factors and the gut microbiota and also multidimensional validation of the safety and efficacy of treatments that target this axis using complementary models (such as organoids and large animal models), clinical trials and real-world studies.