Supporting the Gut: A Rheumatoid Arthritis Case

Autoimmune cases can be challenging for clinicians, especially when the patient sees little to no improvement in their symptoms after trying various treatments. This can be exacerbated by the fact that most autoimmune diseases have multiple potential causes, and these are often unknown. One significant factor in the development and course of autoimmune diseases is genetic predisposition.1 Analyzing a patient’s genetic makeup can give insight into abnormalities on the cellular or molecular level that have trickle down effects in the body’s processes and can provide potential therapeutic options.

Research suggests a connection between genetic risk and changes in the gut microbiome.2 After considering other factors for pathogenesis outside of family history, patients with rheumatoid arthritis (RA) and type 1 diabetes were found to have a different gut microbiota composition than that of healthy individuals.3 Lifestyle factors like nutrition can lead to gut dysbiosis, inflammation, and exacerbation of autoimmune conditions. In the same way, dietary interventions such as prebiotics, probiotics, and supplementation can restore gut microbiota3 and decrease inflammatory burden on the body.4 For patients with RA, dietary interventions have been shown to reduce inflammation and slow overall disease activity.5

In the following case presentation, Rajka Galbraith, MD, shares how she approached a patient presenting with RA. The successful resolution of the case is partially credited to intestinal support. Dr. Galbraith used genetic analysis to identify a gene mutation that was inhibiting nutrient absorption and biotransformation of toxins in the body. Through nutritional intervention, the patient showed improvement of their RA symptoms and even improved hormone balance.

For more strategies on treating autoimmune patients, from the simplest cases to the most complex, consult the Functional Medicine Guide to Autoimmunity. This guide lays the framework for identifying and addressing potential causes of autoimmune disorders and highlights clinical approaches to modulate immune activation, improve function, and reduce symptom severity.

Read more on Intestinal Permeability and Autoimmunity


  1. Theofilopoulos AN, Kono DH, Baccala R. The multiple pathways to autoimmunity. Nat Immunol. 2017;18(7):716?724. doi:1038/ni.3731
  2. Russell JT, Roesch LFW, Ördberg M, et al. Genetic risk for autoimmunity is associated with distinct changes in the human gut microbiome. Nat Commun. 2019;10(1):3621. doi:1038/s41467-019-11460-x
  3. Marietta E, Horwath I, Balakrishnan B, Taneja V. Role of the intestinal microbiome in autoimmune diseases and its use in treatments. Cell Immunol. 2019;339:50?58. doi:1016/j.cellimm.2018.10.005
  4. Opazo MC, Ortega-Rocha EM, Coronado-Arrázola I, et al. Intestinal microbiota influences non-intestinal related autoimmune diseases. Front Microbiol. 2018;9:432. doi:3389/fmicb.2018.00432
  5. Skoczy?ska M, ?wierkot J. The role of diet in rheumatoid arthritis. Reumatologia. 2018;56(4):259?267. doi:5114/reum.2018.77979