Even experts at mainstream institutions like the Arthritis Foundation, Mayo Clinic and Johns Hopkins acknowledge that certain types of arthritis can be triggered or exacerbated by an imbalance in the gut microbiome if a patient is predisposed to the condition.

See Types of Arthritis

Unfortunately, there are no established therapies for manipulating the gut microbiome to treat diseases such as rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. However, early research suggests there are several ways to maintain or improve the gut’s overall microbial diversity and health.

See The Science Behind Leaky Gut, the Gut Microbiome, and Arthritis


Avoid unnecessary antibiotic treatment. Antibiotics can kill bacteria that cause infection, but they can also kill normal, beneficial bacteria. Taking an oral antibiotic can reduce the gut’s microbial diversity9 and permanently change a gut microbiome.6

One step a patient can take to avoid oral antibiotics is to ask the doctor for an injection of antibiotics. If the doctor agrees, the injected medicine is likely to be as beneficial as an oral dose --unless, of course, the infection is in the gut.

Patients who are hesitant to take an antibiotic can ask their health care providers questions, such as, “What will happen if I don’t take this antibiotic? Is there another option?” A health care provider can explain whether or not an antibiotic is necessary.

Make dietary changes. Most experts agree that diet can influence the immune system by affecting changes in the gut microbiome.10,11,12,13 A diet that emphasizes raw leafy greens supports beneficial bacteria that can produce chemicals that help to regulate inflammation in the body. In addition, fermented foods, such as sauerkraut and kimchi, may be beneficial due to the presence of bacterial and fungal products that stimulate the immune system.14

See An Anti-Inflammatory Diet for Arthritis

…And stick to them. Dietary changes can cause temporary shifts in the gut microbiome relatively quickly, but permanent change takes 9 to 15 months.15

See Improving the Gut Microbiome and Arthritis Symptoms with Diet

Exercise more. Regular moderate exercise seems to make positive changes to the gut microbiome, which have been linked to decreases in inflammation.16,17,18

See Exercising with Arthritis

Meditate and be mindful. Stress and anxiety may affect the gut microbiome, and vice versa.19,20,21,22 Meditating and practicing mindfulness can reduce the levels of hormones associated with stress and anxiety, which can change the gut microbiome.

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Stop smoking. Smoking affects the gut microbiome, including microbes in the mouth.23 Smokers are at a greater risk for periodontal disease, which is associated with rheumatoid arthritis and may be a precursor to it.24 (Smoking is already an established risk factor for RA.)

Interact with nature. Things like outdoor recreation, petting domesticated animals (not wild ones), and gardening expose a person to rich microbial diversity and help train a healthy immune system.25 This is especially important for young children with developing immune systems; adult immune systems are more difficult to re-program.

Consider taking a probiotic. There is evidence that probiotic supplements can reduce RA symptoms.26,27,28 It is not clear that taking a probiotic supplement works by changing the microbiome, but the live bacteria in the probiotic may stimulate the immune system, which can effect change in RA symptoms. To maintain this effect it may be necessary to take the probiotic long term; however, that has not yet been proven.

See Dietary Supplements for Treating Arthritis

It is important to note that healthy people do not necessarily benefit from taking a probiotic. Also, probiotics are considered supplements and not regulated by the FDA. People shopping for probiotics are advised to consult with their doctor and choose a reputable brand and vendor.


It is much easier to foster a healthy gut microbiome than to repair a damaged one. Children aged 0 to 3, who have developing immune systems, may benefit from taking some or all of the steps listed above. But the rule of thumb is try and eat a balanced healthy diet, reducing sugar and fat intake, or at least replacing saturated fats with good fats, such as those found in nuts.

See Foods for a Healthier Gut and Less Arthritis Pain

It is less clear whether the steps listed above can help older children and adults who have already developed immune systems. For example, many studies indicate there is a connection between diet and the gut microbiome and arthritic disease, but the exact connection is not well understood, and research is ongoing. Until much more is known, mainstream medical organizations will not endorse specific treatments or prevention plans that aim to alter the gut microbiome.

In general, medical professionals agree that many patients can improve their symptoms by losing weight, eating healthily, and being physically active.


  1. Dethlefsen L, Huse S, Sogin ML, Relman DA. The pervasive effects of an antibiotic on the human gut microbiota, as revealed by deep 16S rRNA sequencing. PLoS Biol. 2008;6(11):e280.
  2. Mackos AR, Varaljay VA, Maltz R, Gur TL, Bailey MT. Role of the Intestinal Microbiota in Host Responses to Stressor Exposure. Int Rev Neurobiol. 2016;131:1-19
  3. Abhari K, Shekarforoush SS, Hosseinzadeh S, Nazifi S, Sajedianfard J, Eskandari MH. The effects of orally administered Bacillus coagulans and inulin on prevention and progression of rheumatoid arthritis in rats. Food Nutr Res. 2016 Jul 15;60:30876

Complete Listing of References