INS and metabolic dysfunction-associated steatotic liver disease: Alterations in gut microbiota composition may serve as a link between RA and NAFLD.[56–58] Patients with RA often exhibit gut dysbiosis, characterized by increased intestinal permeability and bacterial endotoxin translocation, which contribute to hepatic inflammation.[59,60] Endotoxins such as lipopolysaccharides (LPS) activate hepatic immune responses, exacerbating liver injury.[61,62] Additionally, gut-derived metabolites influence hepatic lipid metabolism and insulin sensitivity.