Abstract
Probiotics are considered as -immunomodulatory agents; their efficacy as an adjunct therapy option for rheumatoid arthritis (RA), however, remains controversial. The main aim of the present meta-analysis, therefore, was to compare available data from the published randomized, controlled trials (RCTs) recruiting adults with RA which compared probiotics with placebo. The English literature search was performed using Ovid version of Medline, EmBase, Web of Science, and the Central Cochrane library through October 2016 and supplemented by hand searching reference lists. Among 240 citations identified, 4 RCTs (153 participants; 89% female) were included. All data were pooled using a standardized mean difference (SMD) with a 95% CI. Compared to the placebo, probiotics did not change the inflammatory parameters (erythrocyte sedimentation rate, tumor necrosis factor [TNF]-α, interleukin [IL]-1β, IL-6, IL-10, and IL-12) and oxidative stress indices (total antioxidant capacity and malondialdehyde) significantly. The borderline significant reduction as a result of probiotic administration was only determined in C-reactive protein [SDM − 0.32 (95% CI − 0.65 to 0.00)]. Among disease activity indices (disease activity score [DAS], tender joint count, and swollen joint count), DAS showed a significant improvement following probiotic treatment with a SMD (95% CI) of − 0.58 (− 0.97 to − 0.19). The number of trials was too small to determine if a strain-, dose-, or duration-response effect was present. Probiotics seem to be less effective in RA; however, to reach a firm conclusion, we need further evidence.
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Alipour B, Homayouni-Rad A, Vaghef-Mehrabany E, Sharif SK, Vaghef-Mehrabany L, Asghari-Jafarabadi M, Nakhjavani MR, Mohtadi-Nia J (2014) Effects of lactobacillus casei supplementation on disease activity and inflammatory cytokines in rheumatoid arthritis patients: a randomized double-blind clinical trial. Int J Rheum Dis 17:519–527
Amdekar S, Singh V, Singh R, Sharma P, Keshav P, Kumar A (2011) Lactobacillus casei reduces the inflammatory joint damage associated with collagen-induced arthritis (cia) by reducing the pro-inflammatory cytokines. J Clin Immunol 31:147–154
Amdekar S, Singh V, Kumar A, Sharma P, Singh R (2013) Lactobacillus casei and lactobacillus acidophilus regulate inflammatory pathway and improve antioxidant status in collagen-induced arthritic rats. J Interferon Cytokine Res 33:1–8
De Los Angeles Pineda M, Thompson SF, Summers K, De Leon F, Pope J, Reid G (2011) A randomized, double-blinded, placebo-controlled pilot study of probiotics in active rheumatoid arthritis. Med Sci Monit 17:347–354
Delcenserie V, Martel D, Lamoureux M, Amiot J, Boutin Y, Roy D (2008) Immunomodulatory effects of probiotics in the intestinal tract. Curr Issues Mol Biol 10:37–54
Ejtahed HS, Mohtadi-Nia J, Homayouni-Rad A, Niafar M, Asghari-Jafarabadi M, Mofid V, Akbarian-Moghari A (2011) Effect of probiotic yogurt containing lactobacillus acidophilus and bifidobacterium lactis on lipid profile in individuals with type 2 diabetes mellitus. J Dairy Sci 94:3288–3294
Hatakka K, Martio J, Korpela M, Herranen M, Poussa T, Laasanen T, Saxelin M, Vapaatalo H, Moilanen E, Korpela R (2003) Effects of probiotic therapy on the activity and activation of mild rheumatoid arthritis-a pilot study. Scand J Rheumatol 32:211–215
Isolauri E, Sutas Y, Kankaanpää P, Arvilommi H, Salminen S (2001) Probiotics: effects on immunity. Am J Clin Nutr 73:444s–450s
Issazadeh-Navikas S, Teimer R, Bockermann R (2011) Influence of dietary components on regulatory t cells. Mol Med 18:95–110
Kuchmak OB, Klymnyuk SI, Romanyuk LB, Pokryshko OV (2014) The use of probiotics in patients with rheumatoid arthritis. Lik Sprava 12:63–65
Lee HJ, Waller RD, Stebbings S, Highton J, Orlovich DA, Schmierer D, Fawcett JP (2010) The effects of an orally administered probiotic on sulfasalazine metabolism in individuals with rheumatoid arthritis: a preliminary study. Int J Rheum Dis 13:48–54
Loguercio C, Federico A, Tuccillo C, Terracciano F, D’auria MV, De Simone C, Blanco CDV (2005) Beneficial effects of a probiotic VSL#3 on parameters of liver dysfunction in chronic liver diseases. J Clin Gastroenterol 39:540–543
Lomax AR, Calder PC (2009) Probiotics, immune function, infection and inflammation: a review of the evidence from studies conducted in humans. Curr Pharm Des 15:1428–1518
Malin M, Verronen P, Korhonen H, Syväoja EL, Salminen S, Mykkänen H, Arvilommi H, Eerola E, Isolauri E (1997) Dietary therapy with lactobacillus gg, bovine colostrum or bovine immune colostrum in patients with juvenile chronic arthritis: evaluation of effect on gut defence mechanisms. Inflammopharmacology 5:219–236
Mandel DR, Eichas K, Holmes J (2010) Bacillus coagulans: a viable adjunct therapy for relieving symptoms of rheumatoid arthritis according to a randomized, controlled trial. BMC Complement Altern Med 10:1–7
Nenonen M, Helve TA, Rauma AL, Hänninen OO (1998) Uncooked, lactobacilli-rich, vegan food and rheumatoid arthritis. Rheumatology 37:274–281
So JS, Kwon HK, Lee CG, Yi HJ, Park JA, Lim SY, Hwang KC, Jeon YH, Im SH (2008) Lactobacillus casei suppresses experimental arthritis by down-regulating t helper 1 effector functions. Mol Immunol 45:2690–2699
Toivanen P (2001) From reactive arthritis to rheumatoid arthritis. J Autoimmun 16:369–371
Vaghef-Mehrabany E, Alipour B, Homayouni-Rad A, Sharif SK, Asghari-Jafarabadi M, Zavvari S (2013) Probiotic supplementation improves inflammatory status in patients with rheumatoid arthritis. Nutrition 30:430–435
Vaghef-Mehrabany E, Homayouni-Rad A, Alipour B, Sharif SK, Vaghef-Mehrabany L, Alipour-Ajiry S (2015) Effects of probiotic supplementation on oxidative stress indices in women with rheumatoid arthritis: a randomized double-blind clinical trial. J Am Coll Nutr 35:291–299
Wang P, Tao JH, Pan HF (2016) Probiotic bacteria: a viable adjuvant therapy for relieving symptoms of rheumatoid arthritis. Inflammopharmacology 24:189–196
Zamani B, Golkar HR, Farshbaf S, Emadi-Baygi M, Tajabadi-Ebrahimi M, Jafari P, Akhavan R, Taghizadeh M, Memarzadeh MR, Asemi Z (2016) Clinical and metabolic response to probiotic supplementation in patients with rheumatoid arthritis: a randomized, double-blind, placebo-controlled trial. Int J Rheum Dis 19:869–879
Acknowledgements
This study was entirely financed by Shiraz University of Medical Sciences. The authors express their gratitude to Dr. Maryam Alavi, MD, consultant rheumatologist and Meta Research innovation Office, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran, as well.
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Aqaeinezhad Rudbane, S.M., Rahmdel, S., Abdollahzadeh, S.M. et al. The efficacy of probiotic supplementation in rheumatoid arthritis: a meta-analysis of randomized, controlled trials. Inflammopharmacol 26, 67–76 (2018). https://doi.org/10.1007/s10787-017-0436-y
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DOI: https://doi.org/10.1007/s10787-017-0436-y