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Emerging evidence implicates the gut-joint axis-specifically the synergistic interplay between immunosenescence, inflammaging, and gut microbiota dysbiosis-in the pathogenesis of EORA. This review aims to synthesize current evidence on the role of the gut microbiota in EORA, elucidate the mechanistic links between age-related immune changes and microbial dysbiosis, and evaluate the therapeutic potential of microbiota-targeted interventions, including dietary modifications, nutraceuticals, and fecal microbiota transplantation.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1850656","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T04:47:34Z","timestamp":1779425254000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Microbiota-targeted therapeutic strategies for elderly-onset rheumatoid arthritis: based on the gut-joint axis"],"prefix":"10.3389","volume":"17","author":[{"given":"Mengyao","family":"Liu","sequence":"first","affiliation":[{"name":"The People\u2019s Hospital of Rugao","place":["Rugao, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weijie","family":"Wang","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leilei","family":"Qian","sequence":"additional","affiliation":[{"name":"The Department of Nephrology and Rheumatology, The People's Hospital of Rugao","place":["Rugao, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(16)30173-8","article-title":"Rheumatoid arthritis","volume":"388","author":"Smolen","year":"2016","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-215920","article-title":"Global, regional and national burden of rheumatoid arthritis 1990-2017: a systematic analysis of the Global Burden of Disease study 2017","volume":"78","author":"Safiri","year":"2019","journal-title":"Ann Rheum Dis"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2020.102528","article-title":"Rheumatoid arthritis in the elderly: Characteristics and treatment considerations","volume":"19","author":"Serhal","year":"2020","journal-title":"Autoimmun Rev"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1186\/ar4540","article-title":"Age at onset determines severity and choice of treatment in early rheumatoid arthritis: a prospective study","volume":"16","author":"Innala","year":"2014","journal-title":"Arthritis Res Ther"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ket449","article-title":"Are there differences between young- and older-onset early inflammatory arthritis and do these impact outcomes? 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