Review of the Possible Role of the Stomach in the Gut–Joint Axis in Osteoarthritis: Avicenna’s Perspective Versus Modern Medicine

Osteoarthritis (OA) is the most common debilitating chronic joint disorder with no definitive treatment. Avicenna considers a strong relation between the Gastrointestinal Tract (GIT), with other body organs, including the joints. Specifically, he regards disorders of the stomach as the most important underlying cause of arthritis. The present review study aims to collect the available scientific evidence on the role of the stomach in OA in order to provide a new insight of the gut-joint axis based on Persian Medicine (PM) theory. In this narrative review, the term “vajae-al-mafasel” was searched (the equivalent term for arthritis) in Avicenna’s medical masterpiece, Canon of Medicine. Additionally, PubMed, Web of Science and Google Scholar databases were queried with keywords including OA, gut, stomach, PM, and systems biology. After gathering data, they were classified, coded, analyzed, and compared. Mechanisms that play a role in the GUT-OA axis include: 1) Gut Microbiota (GM) dysbiosis; 2) contribution of GM metabolites; 3) leaky gut syndrome; 4) bacteria transfer phenomenon; and 5) Metabolism disturbance. Growing evidence shows the pivotal role of the stomach, as part of the GIT, in the balance of metabolic functions and gut-joint axis. the role of the stomach is discussed in OA in the four sections: maintaining the metabolic balance by stomach, bone metabolism and gastric acid, controlling cartilage homeostasis by gastric hormones, gastric microbiota dysbiosis and OA.