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The rate of progression is significantly rapid in the first few years of undetected or misdiagnosed RA ( Furthermore, patients with RA generally complain of gastrointestinal tract problems particularly dyspepsia (bloating, postprandial fullness, nausea, early satiety, epigastric pain, and burning and belching), mucosal ulceration, and altered bowel habits (constipation/diarrhea) ( Prevotella copri significantly prevalent in RA patients than healthy controls providing the support that the “gut-joint axis” hypothesis is relevant for human rheumatic diseases and may lead to pathogenesis of RA ( Streptococci found in milk was thought to be a cause of RA ( Dietary Interventions in RA With the increasing evidence of altered microbiota in the gut of RA patients being responsible for pathogenesis as well as disease progression (39), such as medically supervised 7–10 days fasting (40–43), vegan (44–47) or Mediterranean diets (MDs) (48)

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