There has been a progressive interest on modifications of the human defense system following insults occurring in the interface between our body and the external environment, as they may provoke or worsen disease states. Studies suggest that billions of germs, which compose the gut microbiota influence one's innate and adaptive immune responses at the intestinal level, but these microorganisms may also impact rheumatic diseases. The microbiota of the skin, respiratory, and urinary tracts may also be relevant in rheumatology. Evidence indicates that changes in the gut microbiome alter the pathogenesis of immune-mediated diseases such as rheumatoid arthritis and ankylosing spondylitis but also of other disorders like atherosclerosis and osteoarthritis. Therapeutic strategies to modify the microbiota, including probiotics and fecal microbiota transplantation, have been received with skepticism, which, in turn, has drawn attention back to previously developed interventions such as antibiotics. Helminths adapted to humans over the evolution process, but their role in disease modulation, particularly immune-mediated diseases, remains to be understood.

The present review focuses on data concerning modifications of the immune system induced by interactions with microbes and pluricellular organisms, namely helminths, and their impact on rheumatic diseases. Practical aspects, including specific microbiota-targeted therapies, are also discussed.

人们对在我们的身体和外部环境之间的界面发生损伤后改变人类防御系统越来越感兴趣，因为它们可能引发或恶化疾病状态。研究表明，组成肠道微生物群的数十亿细菌会影响肠道水平的先天性和适应性免疫反应，但这些微生物也可能影响风湿性疾病。皮肤、呼吸道和泌尿道的微生物群也可能与风湿病相关。有证据表明，肠道微生物群的变化会改变类风湿性关节炎和强直性脊柱炎等免疫介导疾病的发病机制，同时也会改变动脉粥样硬化和骨关节炎等其他疾病的发病机制。改变微生物群的治疗策略，包括益生菌和粪便微生物群移植，受到了质疑，这反过来又使人们的注意力重新回到先前开发的干预措施，例如抗生素。蠕虫在进化过程中适应了人类，但它们在疾病调节，特别是免疫介导的疾病中的作用仍有待了解。

本综述重点关注与微生物和多细胞生物（即蠕虫）相互作用引起的免疫系统改变的数据及其对风湿性疾病的影响。还讨论了实际方面，包括特定微生物群靶向疗法。