Supplementation with probiotics was shown to improve hyperuricemia and symptoms of gout, among other inflammatory diseases such as juvenile arthritis (JIA), osteoarthritis (OA), osteoporosis and osteopenia, inflammatory bowel disease (IBD), spondyloarthritis, rheumatoid arthritis (RA), and psoriasis (PsO). Investigators note that further randomized controlled trials (RCTs) are necessary to evaluate efficacy and optimal dosages of probiotics, according to a study published in Frontiers in Immunology.1
“There is a need for new related target therapeutic approaches for drug development and treatment of joint inflammation, thereby reducing the disease burden of inflammatory arthritis,” investigators stated. “A study showed that gut microbial dysbiosis (in combination with environmental triggers) may contribute to inflammatory immune disturbances in inflammatory arthritis in combination with genetically predisposed individuals.”
Information on the treatment of rheumatic diseases with probiotics was obtained via databases in this systematic review, including the China National Knowledge Infrastructure (CNKI), PubMed, Embase, and the Cochrane Library, until May 2022. RCTs of probiotics regarding treatment of hyperuricemia and gout were evaluated and the Cochrane risk assessment tool was used to determine quality evaluation. Controls were participants without probiotic preparation. Adverse events, disease efficacy indicators, and inflammatory indicators were the primary outcomes.
In total, 37 records included in the study, of which 34 were RCTs and 8 types of autoimmune disease were analyzed. Of the 10 RCTs (involving 632 participants), probiotic intervention reduced C-reactive protein (CRP). Of the psoriasis RCTs, probiotics reduced Psoriasis Area and Severity Index (PASI) scores. Patients with spondyloarthritis who received probiotics had improvements in disease-related symptoms. Bone mineral density was improved in patients with osteoporosis and osteopenia receiving probiotic intervention and symptoms were improved in patients with OA (433 participants). Symptoms were also improved in patients with JIA (72 participants) and IBD (120 participants). Lastly, serum uric acid was improved in those with hyperuricemia and gout in 4 RCTs (294 participants). Probiotics did not increase the incidence of adverse events in any of the RCTs included in the analysis.
While the study was strengthened by including 8 types of inflammatory arthritis, providing clinical references, the quality of the RCTs involved is hindered by the lack of detailed random sequence generation, blinding information, and allocation concealment. Further, certain RCTs used probiotic-rich foods in their analyses, which not include specific strains and doses, while others had uncertain dosages, which allowed for discrepancies among results. Additionally, the methods of recording efficacy indicators were different among RCTs. Adverse events were not reported in many RCTs evaluated. Lastly, only 8 types of inflammatory arthritis were observed, possibly due in part to the fact that probiotics have just recently emerged as a supplementation option in this patient population.
“Probiotic supplements may improve hyperuricemia and gout, inflammatory bowel disease arthritis, JIA, OA, Osteoporosis and Osteopenia, psoriasis, RA, and spondyloarthritis,” investigators emphasized. “However, lack of evidence and heterogeneity of studies do not allow us to recommend them to patients with inflammatory arthritis to manage their disease. More randomized controlled trials are needed in the future to determine the efficacy and optimal dosing design of probiotics.”
Zeng L, Deng Y, He Q, et al. Safety and efficacy of probiotic supplementation in 8 types of inflammatory arthritis: A systematic review and meta-analysis of 34 randomized controlled trials. Front Immunol. 2022;13:961325. Published 2022 Sep 23. doi:10.3389/fimmu.2022.961325