Gut Health and Joint Pain: Is There a Connection?
Current evidence suggests a link between microbial imbalance in the gut and pain associated with osteoarthritis and rheumatoid arthritis. However, whether impaired gut health directly causes or increases joint pain remains unconfirmed.
Our gut is home to trillions of microbes, including bacteria, viruses, and fungi. Together, they constitute the ecosystem of different microbial species known as the gut microbiome. The gut microbiome plays a crucial role in digestion, nutrient production, immune regulation, and metabolism. Additionally, it interacts with our nerve cells and hormone-producing cells.
Recent research shows our gut microorganisms and joints talk to each other through a two-way communication channel called the “gut-joint axis”.
The state in which the microbial communities in the gut are in proper balance is known as eubiosis. Eubiosis is essential for the general health and well-being of human beings. On the other hand, an imbalance in the microbial communities in the gut, dysbiosis, has been linked to many health conditions, including: (1)
- Long-term inflammation
- Gut disorders
- Metabolic disorders, such as obesity and diabetes
- Weakened immune system
Dysbiosis can also lead to a decline in “friendly” microbes and an overgrowth of disease-causing microbes.
In this article, we will discuss the link between gut dysbiosis and joint health and potential mechanisms through which gut microbiome may affect joint pain. Besides, we will learn about lifestyle factors that promote gut health.
Gut Health and Joint Pain: What We Know So Far
Almost all studies linking gut health and joint pain have looked into the potential effect of gut microbiome on osteoarthritis and rheumatoid arthritis.
Gut health and osteoarthritis
Osteoarthritis (OA) is a degenerative joint disease that affects nearly 10 million people in the UK. (2)
It occurs when the connective tissue that lines our joints (cartilage) degenerates over time. As a result, bones in the affected joints rub against each other, causing pain, swelling, stiffness, and joint weakness.
Also Read: Cartilage Damage: What It Is, And What You Can to Protect Your Cartilage
For several decades, osteoarthritis was considered a cartilage degenerative disease. However, over the last few years, researchers have found that OA is a complex disorder involving both wear and tear of cartilage and chronic inflammation.
While the exact mechanism remains unclear, researchers believe that gut dysbiosis may lead to low-grade inflammation in the joints, potentially contributing to OA. (3)
Moreover, research indicates that bacterial toxins that travel from the gut through weakened gut linings (leaky gut) into the bloodstream promote systemic inflammation. Long-term systemic inflammation may increase pain sensitivity and worsen OA symptoms.
Contrarily, certain gut bacteria produce substances with anti-inflammatory properties. These substances may help reduce joint inflammation and improve OA symptoms.
Gut microbiome may also affect bone formation. For example, some friendly bacteria in the gut enhance bone formation by stimulating growth factors in the liver and fat cells. On the other hand, microbial imbalance in the gut may impair bone formation by reducing the level of growth factors necessary for bone formation.
Gut health and rheumatoid arthritis
Rheumatoid arthritis (RA) is a long-term autoimmune condition. It occurs when the immune system attacks the cells lining the joints, causing joint pain, swelling, and stiffness. RA affects approximately 700,000 people in the UK. (4)
Preliminary studies show that gut dysbiosis may trigger rheumatoid arthritis. (5) In fact, some health experts believe that RA actually starts in the gut, long before the symptoms appear. However, no single microorganism has been found to cause RA.
Our gut barrier function prevents harmful microorganisms from traveling to systemic circulation from the gut. But when this barrier function is impaired, mainly due to gut dysbiosis, harmful microorganisms and bacterial toxins can easily access the gut tissues and systemic circulation.
Our immune system reacts to bacterial toxins by releasing pro-inflammatory substances. Over time, accumulation of these substances can lead to systemic inflammation. Also, when there’s an excess of pro-inflammatory substances, the immune system may start producing proteins that mistakenly attack the healthy tissues in the body.
Additionally, immune cells that move to the joints as a part of host defense can damage cartilage and bone. (5)
In both OA and RA, gut dysbiosis can worsen pain and other symptoms by increasing systemic inflammation.
Expert-Recommended Tips for Better Gut Health
Improving gut health is not a Herculean task. Simply following standard dietary and lifestyle guidelines is almost enough for a healthy gut.
Eat that fibre
Dietary fibre is arguably the one nutrient with the most gut health benefits. According to the UK government guidelines, an adult should consume about 30g fibre a day. However, most UK adults get only about 20g a day. (6)
Because ultraprocessed foods comprise a large portion of our diet, many of us struggle to get the daily recommended amount of dietary fibre.
Further Reading: How food processing starves our bodies of nutrients, leaving us feeling run down and tired
Read our recent blog Why Leafy and Green Vegetables Should Be on Every Plate to increase your daily fibre intake.
Feed the tiny friends in the gut
The balance of microbial communities in the gut is essential for general health and well-being. To maintain this balance, we need to feed the friendly bacteria in the gut. These microbes feed on the fibre we eat.
For a healthy gut, most of our daily fibre should come from wholegrains, vegetables, and fruits. We may include probiotic foods such as live yoghurt, sauerkraut, kefir, and kimchi in our diet. Probiotics can boost the growth of beneficial bacteria in the gut and decrease OA symptoms and inflammation.
Prebiotic foods such as leeks, garlic, onions, and oats also support our gut health.
Keep chronic inflammation under control
Adopt an anti-inflammatory lifestyle. Apart from a healthy diet, an anti-inflammatory lifestyle comprises:
- Enough sleep daily
- An ideal body weight
- Regular physical activity
- Moderate drinking, if any
- No tobacco use
- Stress management
Key Takeaways
Our gut health is central to our overall health and well-being. Microbial imbalance in the gut can worsen joint health and may lead to inflammatory joint conditions. To reduce joint health problems, we need to get enough daily fibre, move more, stress less, and have a regular sleep schedule.
Gut Health and Joint Pain: Frequently Asked Questions
- Can gut imbalance cause joint pain?
Harmful bacteria and toxins that move from the gut to the joints may result in immune-mediated joint inflammation and pain.
- How do I start healing my gut?
Eat a wide variety of fibre-rich foods, such as fruits, vegetables, legumes, and wholegrains.
- Which type of diet is best for rheumatoid arthritis?
Among the various diets studied for rheumatoid arthritis, the Mediterranean and vegetarian diets appear to be effective in reducing disease activity.
References:
- Jeyaraman, Madhan et al. “The Gut-Joint Axis in Osteoarthritis.” Cureus vol. 15,11 e48951. 17 Nov. 2023, doi:10.7759/cureus.48951
- Overcoming osteoarthritis. (n.d.-b). Arthritis UK. https://www.arthritis-uk.org/news/2025/october/overcoming-osteoarthritis/
- Longo, U.G.; Lalli, A.; Bandini, B.; de Sire, R.; Angeletti, S.; Lustig, S.; Ammendolia, A.; Budhiparama, N.C.; de Sire, A. Role of the Gut Microbiota in Osteoarthritis, Rheumatoid Arthritis, and Spondylarthritis: An Update on the Gut–Joint Axis. Int. J. Mol. Sci. 2024, 25, 3242. https://doi.org/10.3390/ijms25063242
- “Empowering 1.3 Million UK Citizens with Rheumatoid Arthritis.” National Institute for Health and Care Research, 10 Apr. 2026, www.nihr.ac.uk/story/empowering-13-million-uk-citizens-rheumatoid-arthritis. Accessed 20 Apr. 2026.
- Romero-Figueroa MS, Ramírez-Durán N, Montiel-Jarquín AJ and Horta-Baas G (2023) Gut-joint axis: Gut dysbiosis can contribute to the onset of rheumatoid arthritis via multiple pathways. Front. Cell. Infect. Microbiol. 13:1092118. doi: 10.3389/fcimb.2023.1092118
- How to get more fibre into your diet. nhs.uk. https://www.nhs.uk/live-well/eat-well/digestive-health/how-to-get-more-fibre-into-your-diet/
