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Gut dysbiosis has been implicated in PsA pathogenesis, raising interest in probiotics as potential immunomodulatory agents. In a pilot, double\u2010blind, randomized, placebo\u2010controlled trial, 14 adults aged 18\u201360\u2009years with mild\u2010to\u2010moderate psoriatic arthritis (PsA; Disease Activity in Psoriatic Arthritis [DAPSA]\u2009&lt;\u200928) were randomized to receive either probiotic capsules or placebo daily for 12\u2009weeks. The probiotic group received a multi\u2010strain cocktail with a total concentration of 1\u2009\u00d7\u200910\n                    <jats:sup>9<\/jats:sup>\n                    \u2009CFU (including\n                    <jats:italic>\n                      <jats:styled-content style=\"fixed-case\">Lactobacillus rhamnosus<\/jats:styled-content>\n                      ,\n                      <jats:styled-content style=\"fixed-case\">Lactobacillus plantarum<\/jats:styled-content>\n                      ,\n                      <jats:styled-content style=\"fixed-case\">Lactobacillus casei<\/jats:styled-content>\n                      ,\n                      <jats:styled-content style=\"fixed-case\">Lactobacillus helveticus<\/jats:styled-content>\n                      ,\n                      <jats:styled-content style=\"fixed-case\">Lactobacillus acidophilus<\/jats:styled-content>\n                      ,\n                      <jats:styled-content style=\"fixed-case\">Bifidobacterium bifidum<\/jats:styled-content>\n                      ,\n                      <jats:styled-content style=\"fixed-case\">Lactobacillus bulgaricus<\/jats:styled-content>\n                      ,\n                      <jats:styled-content style=\"fixed-case\">Lactobacillus gasseri<\/jats:styled-content>\n                      ,\n                      <jats:styled-content style=\"fixed-case\">Bifidobacterium lactis<\/jats:styled-content>\n                      ,\n                      <jats:styled-content style=\"fixed-case\">Bifidobacterium longum<\/jats:styled-content>\n                      , and\n                      <jats:styled-content style=\"fixed-case\">Streptococcus thermophilus<\/jats:styled-content>\n                    <\/jats:italic>\n                    ). The placebo group received lactose\u2010based inert capsules for the same period. Immune cell populations (CD4\n                    <jats:sup>+<\/jats:sup>\n                    IFN\u2010\u03b3 T cells, B cells, Th2 cells) and cytokine levels (IFN\u2010\u03b3, IL\u201010, TGF\u2010\u03b2, IL\u20104) were assessed. Compared with the placebo, probiotic supplementation resulted in a significant reduction in CD4\n                    <jats:sup>+<\/jats:sup>\n                    IFN\u2010\u03b3 T cells (6%\u2009\u00b1\u20090.82 vs. 3.6%\u2009\u00b1\u20090.8;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), B cells (14.6%\u2009\u00b1\u20091.05 vs. 8.9%\u2009\u00b1\u20091.7;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001), and IFN\u2010\u03b3 concentrations (37.5\u2009\u00b1\u20092.4\u2009pg\/mL vs. 29.3\u2009\u00b1\u20092.6\u2009pg\/mL,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.016). In addition, a significant increase was observed in IL\u201010 (9.4\u2009\u00b1\u20092.8\u2009pg\/mL vs. 99.89\u2009\u00b1\u200928.1\u2009pg\/mL,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.0032), TGF\u2010\u03b2 (18.1\u2009\u00b1\u20092.7\u2009pg\/mL vs. 30.48\u2009\u00b1\u20097.7\u2009pg\/mL,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.0073), and IL\u20104 (17.6\u2009\u00b1\u20096.7\u2009pg\/mL vs. 58.3\u2009\u00b1\u200929.2\u2009pg\/mL,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.0117). Changes in Th2 cell levels were not statistically significant (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.54). A multi\u2010strain probiotic demonstrated promising immunomodulatory effects in PsA by reducing pro\u2010inflammatory markers and enhancing regulatory cytokines that can be used as a complementary or alternative treatment for PsA patients.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial Registration:<\/jats:bold>\n                    IRCT20221213056802N1\n                  <\/jats:p>","DOI":"10.1002\/fsn3.71132","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T04:52:09Z","timestamp":1762404729000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Immunomodulatory Effects of Multi\u2010Strain Probiotic Capsules for Psoriatic Arthritis: A Pilot Double\u2010Blind Randomized Controlled Trial"],"prefix":"10.1002","volume":"13","author":[{"given":"Ahmed Hussein Hasan","family":"Alshihmani","sequence":"first","affiliation":[{"name":"Immunology Research Center Mashhad University of Medical Sciences  Mashhad Iran"},{"name":"Immunology Department, Faculty of Medicine Mashhad University of Medical Sciences  Mashhad Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanieh","family":"Kolahdooz","sequence":"additional","affiliation":[{"name":"Immunology Research Center Mashhad University of Medical Sciences  Mashhad Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Mahmoudi","sequence":"additional","affiliation":[{"name":"Immunology Research Center Mashhad University of Medical Sciences  Mashhad Iran"},{"name":"Immunology Department, Faculty of Medicine Mashhad University of Medical Sciences  Mashhad Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Rezaieyazdi","sequence":"additional","affiliation":[{"name":"Rheumatic Diseases Research Center Mashhad University of Medical Sciences  Mashhad Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramiar","family":"Kamal Kheder","sequence":"additional","affiliation":[{"name":"Medical Laboratory Science Department, College of Science University of Raparin  Rania Iraq"},{"name":"Department of Medical Analysis, Faculty of Applied Science Tishk International University  Erbil Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nafiseh sadat","family":"Tabasi","sequence":"additional","affiliation":[{"name":"Immunology Research Center Mashhad University of Medical Sciences  Mashhad Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afsane","family":"Fadaee","sequence":"additional","affiliation":[{"name":"Immunology Research Center Mashhad University of Medical Sciences  Mashhad Iran"},{"name":"Immunology Department, Faculty of Medicine Mashhad University of Medical Sciences  Mashhad Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9371-4170","authenticated-orcid":false,"given":"Seyed\u2010Alireza","family":"Esmaeili","sequence":"additional","affiliation":[{"name":"Immunology Research Center Mashhad University of Medical Sciences  Mashhad Iran"},{"name":"Immunology Department, Faculty of Medicine Mashhad University of Medical Sciences  Mashhad Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.2174\/1871530321666210316103403"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","unstructured":"Abdollahi H. 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