The gastrointestinal microbiota can effect the development of RA through proximal intestinal immunomodulatory cells, that are located in precise places inside the intestine. Further procedure alternatives such as bDMARDs, tsDMARDs, biosimilars or mix therapy are available when csDMARDs are ineffective or inadequately tolerated. bDMARDs are a newer option for the https://www.directivepublications.org/journal-of-arthritis-and-rheumatology/