{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:28:03Z","timestamp":1792013283881,"version":"4.4.0"},"reference-count":40,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,1,14]],"date-time":"2022-01-14T00:00:00Z","timestamp":1642118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: We aimed to provide a systematic review and meta-analysis of randomized controlled trials assessing the effect of probiotics supplementation on symptoms and disease activity in patients with chronic inflammatory rheumatic diseases (rheumatoid arthritis (RA), spondylarthritis (SpA), or psoriatic arthritis). Methods: A systematic literature review and meta-analysis from RA and SpA randomized controlled trials were conducted searching for articles in MEDLINE\/PubMed and abstracts from recent international rheumatology meetings. The control group was a placebo or another dietary intervention. The risk of bias of the selected studies was evaluated using the Cochrane Collaboration tool and the Jadad scale. Results: The initial search yielded 173 articles. Of these, 13 studies were included in the qualitative synthesis, 8 concerning a total of 344 RA patients and 2 concerning a total of 197 SpA patients. Three meta-analyses were also analyzed. Probiotic strains and quantities used were different among trials (5 studies using Lactobacillus sp., 1 trial Bacillus\u00a0coagulans and the others a mix of different probiotic strains). Time to assess response ranged from 8 weeks to one year. Two studies associated probiotic supplementation with a dietary intervention. Meta-analysis showed a statistically significant decrease of C-reactive protein (CRP) concentration (mean difference (MD)) \u22123.04 (95% CI \u22124.47, \u22121.62) mg\/L, p &lt; 0.001; I2 = 20%, n patients = 209) with probiotics in RA. However, after excluding high-risk-of-bias trials of meta-analysis, there was no difference between probiotics and placebo on DAS28 (standard MD \u22120.54; 95% CI \u22121.94 to 0.85, p = 0.45, I2 93%, n patients = 143). The two studies on SpA patients showed no efficacy of probiotics. Conclusions: Probiotic supplementation might decrease RA activity with a moderate decrease effect on CRP, but lack of evidence and studies\u2019 heterogeneity do not allow us to propose them to patients with inflammatory arthritis to control their disease. Further RCTs are required in the future to determinate the efficacy of probiotics and the optimal administration design.<\/jats:p>","DOI":"10.3390\/nu14020354","type":"journal-article","created":{"date-parts":[[2022,1,16]],"date-time":"2022-01-16T20:45:21Z","timestamp":1642365921000},"page":"354","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":58,"title":["Efficacy of Probiotics in Rheumatoid Arthritis and Spondyloarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.3390","volume":"14","author":[{"given":"Pauline","family":"Sanchez","sequence":"first","affiliation":[{"name":"Department of Rheumatology, CHU de Montpellier, Montpellier University, F-34295 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2793-6303","authenticated-orcid":false,"given":"Jean-Guillaume","family":"Letarouilly","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, CHU Lille, Universit\u00e9 de Lille, F-59000 Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0866-3824","authenticated-orcid":false,"given":"Yann","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, H\u00f4pital Beaujon, AP-HP Nord, Universit\u00e9 de Paris, F-92100 Clichy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Sigaux","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, H\u00f4pital Avicenne, AP-HP, INSERM U1125, Universit\u00e9 Paris 13, F-93017 Bobigny, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Barnetche","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, FHU ACRONIM, Bordeaux University Hospital, F-33076 Bordeaux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"Czernichow","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Specialized Obesity Center, H\u00f4pital Europ\u00e9en Georges Pompidou, Universit\u00e9 de Paris, AP-HP, F-75015 Paris, France"},{"name":"Epidemiology and Biostatistics Sorbonne Paris City Center, UMR1153, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, F-75004 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ren\u00e9-Marc","family":"Flipo","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, CHU Lille, Universit\u00e9 de Lille, F-59000 Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9r\u00e9mie","family":"Sellam","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, H\u00f4pital Saint Antoine, AP-HP, DMU 3ID, CRSA Inserm UMRS_938, Sorbonne Universit\u00e9, F-75012 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Da\u00efen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, CHU de Montpellier, Montpellier University, F-34295 Montpellier, France"},{"name":"PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, F-34295 Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,14]]},"reference":[{"key":"ref_1","unstructured":"Food and Agriculture Organization, and World Health Organization (2001). Evaluation of Health and Nutritional Properties of Probiotics in Food including Powder Milk with Live Acid Bacteria, Report of a Joint FAO\/WHO Expert Consultation; FAO Food and Nutrition Paper; World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s10787-016-0277-0","article-title":"Probiotic bacteria: A viable adjuvant therapy for relieving symptoms of rheumatoid arthritis","volume":"24","author":"Wang","year":"2016","journal-title":"Inflammopharmacology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1186\/s12967-016-0989-3","article-title":"Microbiota and Chronic Inflammatory Arthritis: An Interwoven Link","volume":"14","author":"Diamanti","year":"2016","journal-title":"J. Transl. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1080\/22953337.1996.11718528","article-title":"The Role of Gut Inflammation in the Pathogenesis of Spondyloarthropathies","volume":"51","author":"Mielants","year":"1996","journal-title":"Acta Clin. Belg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.imlet.2004.02.005","article-title":"Commensal Bacteria (Normal Microflora), Mucosal Immunity and Chronic Inflammatory and Autoimmune Diseases","volume":"93","author":"Hudcovic","year":"2004","journal-title":"Immunol. Lett."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/j.1365-2036.1997.tb00805.x","article-title":"Review Article: Role of the Enteric Microflora in the Pathogenesis of Intestinal Inflammation and Arthritis","volume":"11","author":"Sartor","year":"1997","journal-title":"Aliment Pharmacol. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1365-2249.1993.tb05938.x","article-title":"Rheumatoid arthritis: How well do the theories fit the evidence?","volume":"92","author":"McCulloch","year":"1993","journal-title":"Clin. Exp. Immunol."},{"key":"ref_8","first-page":"595","article-title":"Commonly Used Disease-Modifying Antirheumatic Drugs in the Treatment of Inflammatory Arthritis: An Update on Mechanisms of Action","volume":"16","author":"Danning","year":"1998","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_9","first-page":"37","article-title":"Immunomodulatory Effects of Probiotics in the Intestinal Tract","volume":"10","author":"Delcenserie","year":"2008","journal-title":"Curr. Issues Mol. Biol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"153","DOI":"10.4315\/0362-028X-65.1.153","article-title":"Oral Intake of Lactobacillus Delbrueckii Subsp. Bulgaricus OLL1073R-1 Prevents Collagen-Induced Arthritis in Mice","volume":"65","author":"Kano","year":"2002","journal-title":"J. Food Prot."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2690","DOI":"10.1016\/j.molimm.2007.12.010","article-title":"Lactobacillus Casei Suppresses Experimental Arthritis by Down-Regulating T Helper 1 Effector Functions","volume":"45","author":"So","year":"2008","journal-title":"Mol. Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1136\/gut.2009.179325","article-title":"Probiotic Carbohydrates Reduce Intestinal Permeability and Inflammation in Metabolic Diseases","volume":"58","author":"Strowski","year":"2009","journal-title":"Gut"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"105319","DOI":"10.1016\/j.jbspin.2021.105319","article-title":"Dietary Recommendations of the French Society for Rheumatology for Patients with Chronic Inflammatory Rheumatic Diseases","volume":"89","author":"Daien","year":"2021","journal-title":"Jt. Bone Spine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"b2535","DOI":"10.1136\/bmj.b2535","article-title":"Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement","volume":"339","author":"Moher","year":"2009","journal-title":"BMJ"},{"key":"ref_15","unstructured":"(2021, November 23). Cochrane Handbook for Systematic Reviews of Interventions. Available online: https:\/\/training.cochrane.org\/handbook."},{"key":"ref_16","unstructured":"(2007). Appendix: Jadad Scale for Reporting Randomized Controlled Trials. Evidence-Based Obstetric Anesthesia, John Wiley & Sons, Ltd."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.nut.2013.09.007","article-title":"Probiotic Supplementation Improves Inflammatory Status in Patients with Rheumatoid Arthritis","volume":"30","author":"Alipour","year":"2014","journal-title":"Nutrition"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1111\/1756-185X.12333","article-title":"Effects of Lactobacillus Casei Supplementation on Disease Activity and Inflammatory Cytokines in Rheumatoid Arthritis Patients: A Randomized Double-Blind Clinical Trial","volume":"17","author":"Alipour","year":"2014","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1080\/03009740310003695","article-title":"Effects of Probiotic Therapy on the Activity and Activation of Mild Rheumatoid Arthritis\u2014A Pilot Study","volume":"32","author":"Hatakka","year":"2003","journal-title":"Scand. J. Rheumatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1093\/ajcn\/nqaa019","article-title":"Anti-Inflammatory Diet In Rheumatoid Arthritis (ADIRA)\u2014A Randomized, Controlled Crossover Trial Indicating Effects on Disease Activity","volume":"111","author":"Vadell","year":"2020","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_21","first-page":"CR347","article-title":"A Randomized, Double-Blinded, Placebo-Controlled Pilot Study of Probiotics in Active Rheumatoid Arthritis","volume":"17","author":"Pineda","year":"2011","journal-title":"Med. Sci. Monit."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1093\/rheumatology\/37.3.274","article-title":"Uncooked, lactobacilli-rich, vegan food and rheumatoid arthritis","volume":"37","author":"Nenonen","year":"1998","journal-title":"Rheumatology"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Mandel, D.R., Eichas, K., and Holmes, J. (2010). Bacillus Coagulans: A Viable Adjunct Therapy for Relieving Symptoms of Rheumatoid Arthritis According to a Randomized, Controlled Trial. BMC Complementary Altern. Med., 10.","DOI":"10.1186\/1472-6882-10-1"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1111\/1756-185X.12888","article-title":"Clinical and Metabolic Response to Probiotic Supplementation in Patients with Rheumatoid Arthritis: A Randomized, Double-Blind, Placebo-Controlled Trial","volume":"19","author":"Zamani","year":"2016","journal-title":"Int. J. Rheum. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1017\/S000711451700085X","article-title":"Synbiotic Supplementation and the Effects on Clinical and Metabolic Responses in Patients with Rheumatoid Arthritis: A Randomised, Double-Blind, Placebo-Controlled Trial","volume":"117","author":"Zamani","year":"2017","journal-title":"Br. J. Nutr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2118","DOI":"10.3899\/jrheum.100193","article-title":"Probiotic Therapy for the Treatment of Spondyloarthritis: A Randomized Controlled Trial","volume":"37","author":"Jenks","year":"2010","journal-title":"J. Rheumatol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Brophy, S., Burrows, C.L., Brooks, C., Gravenor, M.B., Siebert, S., and Allen, S.J. (2008). Internet-Based Randomised Controlled Trials for the Evaluation of Complementary and Alternative Medicines: Probiotics in Spondyloarthropathy. BMC Musculoskelet. Disord., 9.","DOI":"10.1186\/1471-2474-9-4"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"101207","DOI":"10.1016\/j.ctcp.2020.101207","article-title":"A Systematic Review of the Effects of Probiotic Administration in Inflammatory Arthritis","volume":"40","author":"Lowe","year":"2020","journal-title":"Complementary Ther. Clin. Pract."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s10787-017-0436-y","article-title":"The Efficacy of Probiotic Supplementation in Rheumatoid Arthritis: A Meta-Analysis of Randomized, Controlled Trials","volume":"26","author":"Rahmdel","year":"2018","journal-title":"Inflammopharmacology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2697","DOI":"10.1007\/s10067-017-3814-3","article-title":"The Therapeutic Effect of Probiotics on Rheumatoid Arthritis: A Systematic Review and Meta-Analysis of Randomized Control Trials","volume":"36","author":"Mohammed","year":"2017","journal-title":"Clin. Rheumatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1111\/cei.12818","article-title":"Effect of Probiotics on Clinical and Immune Parameters in Enthesitis-Related Arthritis Category of Juvenile Idiopathic Arthritis","volume":"185","author":"Shukla","year":"2016","journal-title":"Clin. Exp. Immunol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1007\/s11906-020-01080-y","article-title":"Efficacy of Probiotics in Patients of Cardiovascular Disease Risk: A Systematic Review and Meta-Analysis","volume":"22","author":"Dixon","year":"2020","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1016\/j.jpeds.2004.06.068","article-title":"Effect of Probiotics on Gastrointestinal Symptoms and Small Intestinal Permeability in Children with Atopic Dermatitis","volume":"145","author":"Rosenfeldt","year":"2004","journal-title":"J. Pediatr."},{"key":"ref_34","first-page":"1","article-title":"Bacterial Translocation from the Intestines","volume":"34","author":"Berg","year":"1985","journal-title":"Jikken Dobutsu"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1964","DOI":"10.1093\/jn\/134.8.1964","article-title":"Lactobacillus GG Bacteria Ameliorate Arthritis in Lewis Rats","volume":"134","author":"Baharav","year":"2004","journal-title":"J. Nutr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s10787-997-0001-1","article-title":"Dietary Therapy with Lactobacillus GG, Bovine Colostrum or Bovine Immune Colostrum in Patients with Juvenile Chronic Arthritis: Evaluation of Effect on Gut Defence Mechanisms","volume":"5","author":"Malin","year":"1997","journal-title":"Inflammopharmacology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1128\/CMR.16.4.658-672.2003","article-title":"Potential Uses of Probiotics in Clinical Practice","volume":"16","author":"Reid","year":"2003","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s00005-012-0170-5","article-title":"Lactobacillus Rhamnosus Exopolysaccharide Ameliorates Arthritis Induced by the Systemic Injection of Collagen and Lipopolysaccharide in DBA\/1 Mice","volume":"60","author":"Nowak","year":"2012","journal-title":"Arch. Immunol. Ther. Exp."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1097\/BOR.0000000000000008","article-title":"Microbiome and Mucosal Inflammation as Extra-Articular Triggers for Rheumatoid Arthritis and Autoimmunity","volume":"26","author":"Brusca","year":"2014","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13073-016-0299-7","article-title":"An Expansion of Rare Lineage Intestinal Microbes Characterizes Rheumatoid Arthritis","volume":"8","author":"Chen","year":"2016","journal-title":"Genome Med."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/2\/354\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T14:15:02Z","timestamp":1760364902000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/2\/354"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,14]]},"references-count":40,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["nu14020354"],"URL":"https:\/\/doi.org\/10.3390\/nu14020354","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,14]]}}}