In the past three decades, extraordinary advances have been made in the understanding of the pathogenesis of, and treatment options for, inflammatory arthritides, including rheumatoid arthritis and spondyloarthritis. The use of methotrexate and subsequently biologic therapies (such as TNF inhibitors, among others) and oral small molecules have substantially improved clinical outcomes for many patients with inflammatory arthritis; for others, however, these agents do not substantially improve their symptoms. The emerging field of pharmacomicrobiomics, which investigates the effect of variations within the human gut microbiome on drugs, has already provided important insights into these therapeutics. Pharmacomicrobiomic studies have demonstrated that human gut microorganisms and their enzymatic products can affect the bioavailability, clinical efficacy and toxicity of a wide array of drugs through direct and indirect mechanisms. This discipline promises to facilitate the advent of microbiome-based precision medicine approaches in inflammatory arthritis, including strategies for predicting response to treatment and for modulating the microbiome to improve response to therapy or reduce drug toxicity.

中文翻译：

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炎症性关节炎中的药物微生物组学：肠道微生物组作为治疗反应的调节剂。

在过去的三年中，在对炎症性关节炎（包括类风湿性关节炎和脊柱关节炎）的发病机制和治疗方案的理解方面取得了非凡的进展。使用甲氨蝶呤和随后的生物疗法（如 TNF 抑制剂等）和口服小分子药物显着改善了许多炎症性关节炎患者的临床结果；然而，对于其他人来说，这些药物并没有显着改善他们的症状。新兴的药物微生物组学领域研究了人类肠道微生物组的变化对药物的影响，已经为这些疗法提供了重要的见解。药物微生物组学研究表明，人体肠道微生物及其酶产物会影响生物利用度，通过直接和间接机制对多种药物的临床疗效和毒性进行研究。该学科有望促进炎症性关节炎中基于微生物组的精准医学方法的出现，包括预测治疗反应和调节微生物组以改善治疗反应或降低药物毒性的策略。