Background/Purpose: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease that primarily affects synovial tissues. While the exact etiology is unknown, it is hypothesized that RA is caused by a combination of environmental and genetic factors. One possible etiology of RA is Mycobacterium avium subspecies paratuberculosis (MAP), a bacterium found in cattle and cow’s milk. MAP is known to cause Johne’s disease in cattle and has implications in human autoimmune diseases such as type 1 diabetes, Crohn’s disease, and recently RA.^1-2 It is unknown if RA patients who are MAP positive have different dietary habits and medication use. This study examines the relationships between MAP serostatus, RA medication use, dietary habits, and perceived levels of joint pain in patients with RA.

Methods: Patients at the UCF Health Clinic with confirmed RA diagnosis according to the ACR classification criteria had blood samples drawn to determine MAP serostatus and were surveyed regarding their dietary habits, perceived levels of joint pain, and RA medication regimen. A total of 69 patients were included in the final analysis. Fisher’s exact test was used to explore relationships and p-values < 0.05 were considered statistically significant. All statistical tests were conducted in SPSS 24.0 (IBM Corp. Armonk, NY).

Results: Fisher’s exact test revealed a significant association between use of adalimumab and MAP serostatus (p-value for 2-sided test 0.025, p-value for 1-sided test 0.017). There was a significant association between using at least one biologic medication and MAP serostatus (p-value for 2-sided test 0.010, p-value for 1-sided test 0.006). Compared to those that are not on adalimumab, those that are on it have 8.667 times the odds of being MAP+ (95% CI = 1.057-71.077). Compared to those that are on no biologic medications, those that are on at least one biologic medication have 4.680 times the odds of being MAP+ (95% CI = 1.482-14.774). There were no other significant associations between MAP serostatus, medication use, dietary habits, and patient-perceived joint pain. However, 50.7% of patients surveyed (34/67) reported that diet influences their level of joint pain, 25% (17/68) reported that dairy consumption increases their joint pain, and 25.8% (17/66) reported that red meat consumption increases their joint pain.

Conclusion: There is a significant association between adalimumab use and MAP serostatus and using at least one biologic medication and MAP serostatus. Additionally, dietary habits in RA patients may play a role in patient-perceived joint pain.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/determining-the-relationship-between-mycobacterium-avium-subspecies-paratuberculosis-serostatus-dietary-habits-medication-regimen-and-joint-pain-in-patients-with-rheumatoid-arthritis/