While fMRS studies have revealed dynamic changes in metabolite levels in response to functional stimulation (Stanley and Raz 2018), clear quantitative relationships between stimulus and response are still to be described
Smolen JS, Landew RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, McInnes IB, Sepriano A, Van Vollenhoven RF, De Wit M, Aletaha D, Aringer M, Askling J, Balsa A, Boers M, Den Broeder AA, Buch MH, Buttgereit F, Caporali R, Cardiel MH, De Cock D, Codreanu C, Cutolo M, Edwards CJ, Van Eijk-Hustings Y, Emery P, Finckh A, Gossec L, Gottenberg JE, Hetland ML, Huizinga TWJ, Koloumas M, Li Z, Mariette X, Mller-Ladner U, Mysler EF, Da Silva JAP, Por G, Pope JE, Rubbert-Roth A, Ruyssen-Witrand A, Saag KG, Strangfeld A, Takeuchi T, Voshaar M, Westhovens R, Van Der Heijde D (2020) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update
It is not yet well-understood how these bacteria can exert these benefits, but documented mechanisms of action include antimicrobial activity against major gastrointestinal 171 and urogenital pathogens 172 , barrier-promoting effects at the gut epithelium 173 and other mucosa 174 , immunomodulatory effects by stimulating host antimicrobial compounds such as - defensins 175 and modulating the secretion of cytokines such as IL-10, IL-6, IL-1b, IL-2, TNF-, and impacting different cell types such as intestinal epithelial cells, dendritic cells, macrophages and regulatory T cells 176,177,178
Hence, there is the tantalizing possibility that advanced imaging might allow us to better predict which patients with hyperuricemia are likely to develop symptomatic gouty arthritis, and thereby inform earlier intervention strategies
