Benefits of Probiotics in Rheumatic Diseases

Abstract

Rheumatic diseases are chronic conditions which affect a large proportion of the population worldwide (1). Among them, inflammatory chronic diseases including rheumatoid arthritis (RA), spondyloarthritis (SpA), crystal-induced arthritis (CIA), and connective tissue autoimmune diseases, such as systemic lupus erythematosus (SLE) and systemic sclerosis (SSc), are the most common. Chronic inflammation has been recognized to play a role also in osteoarthritis (OA), classically considered a non-inflammatory form of arthritis. Although different risk factors influence their onset and development, these heterogeneous conditions share common clinical outcome including joint pain, disability, and comorbidities (2). Over the last years increasing attention have been paid to the role of diet in the pathogenesis and progression of rheumatic diseases. It has been observed that healthy dietary habits and the consumption of foods rich in bioactive compounds, omega-3 fatty acids, and antioxidants are associated with a lower risk to develop these diseases and a less severe clinical outcome (3). In particular, an important link between gut microbiota and patients' clinical features highlighted the possibility to modulate disease progression and presentation through microbiota manipulation. In this setting, an emerging role might be attributed to probiotics, live microorganisms that, when administered in adequate amounts, confer a health benefit on the host (4). The most commonly used are Lactobacilli (L.), Bifidobacteria (B.), and Streptococci (S.), either as single species or in mixed culture. Their health effects are largely recognized and supported by randomized controlled clinical trials (RCTs) and meta-analyses conducted on infectious diseases, antibiotic-associated diarrhea, irritable bowel syndrome, abdominal pain, and colitis (5, 6).

Diet as a Modulator of Intestinal Microbiota in Rheumatoid Arthritis

“…In this study, the effectiveness of probiotic supplementation in improving disease-related outcomes in RA patients was considered weak [ 151 ]. A recent review by Oliviero et al has highlighted that the effect of probiotic supplementation in RA seems to be specie- and strain-specific [ 152 ].…”

Emerging story of gut dysbiosis in spondyloarthropathy: From gastrointestinal inflammation to spondyloarthritis

“…Through the manipulation of the gut epithelial barrier and mucus layer properties, the release of antimicrobial compounds, and the management of competition with pathogenic bacteria, specific probiotic metabolites may exert anti-inflammatory and antibacterial effects. Immune responses and systemic inflammation are also influenced by probiotic-driven metabolites such as short-chain fatty acids (SCFAs), which modulate immune cell activity ( Oliviero and Spinella, 2020 ). This characteristic may contribute to the correction of intestinal wall hyperpermeability in the “gut-joint axis”.…”

Probiotic Supplementation for Rheumatoid Arthritis: A Promising Adjuvant Therapy in the Gut Microbiome Era

“…A link between the composition and activity of GM and human health and disease has been previously described (Azad, Sarker, Li, et al, 2018). Although the local effects of probiotic bacteria on gut health are well reported, the mechanisms behind their systemic antiinflammatory and immunomodulating potential have not been wholly explored (Vieira et al, 2016;Plaza-Diaz et al, 2019;Oliviero and Spinella, 2020). A set of mechanisms whereby probiotics regulate inflammation have been postulated, which can be exerted not only via direct immune system modulation, but also through indirect mechanisms (La Fata et al, 2018;Kalinkovich and Livshits, 2019).…”

“…Cytokines travel to target organs and expand Tregs that traffic to inflammation sites (Marietta et al, 2016). Probiotic-driven metabolic products, such as SCFA, also impact immune response and systemic inflammation by regulating immune cell function (Oliviero and Spinella, 2020). SCFA as regulators of several leukocyte functions including production of eicosanoids and chemokines and cytokines, such as TNF, IL-2, IL-6 and IL-10, exhibit anti-inflammatory properties (Vinolo et al, 2011;Kalinkovich and Livshits, 2019).…”