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The therapeutic effect of probiotics on rheumatoid arthritis: a systematic review and meta-analysis of randomized control trials

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Abstract

Rheumatoid arthritis is an autoimmune disease in which probiotics appears to have an immune modulating action along with decreased inflammatory process. Therefore, we aim to investigate the efficacy of probiotics as an adjuvant therapy for rheumatoid arthritis. A comprehensive literature search was performed using nine databases including PubMed and Web of Science. Interesting data was extracted and meta-analyzed. We assessed the risk of bias using Cochrane Collaboration’s tool. The protocol was registered in PROSPERO (CRD 42016036769). We found nine studies involving 361 patients who met our eligibility criteria. Our meta-analysis indicated that pro-inflammatory cytokine IL-6 was significantly lower in the probiotics compared with the placebo group (standardized mean difference = − 0.708; 95% confidence interval (CI) − 1.370 to 0.047, P = 0.036). However, there was no difference between probiotics and placebo in disease activity score (mean difference 0.023; 95% CI − 0.584 to 0.631, P = 0.940). Probiotics lowered pro-inflammatory cytokines IL-6 in RA; however, its clinical effect is still unclear. Hence, many high-quality randomized controlled trials (RCTs) are still needed to prove this effect.

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Acknowledgements

We would like to thank Sarah Holloway of the University of North Texas for her thorough critical reading and English editing.

Author information

Author notes

  1. A.T.M., M.K., and A.M.A. contributed equally to this article.

Authors and Affiliations

  1. Faculty of Medicine, Al-Azhar University, Cairo, 11884, Egypt

    Abdelrahman Tarek Mohammed, Mohammed Khattab & Ali Mahmoud Ahmed

  2. Faculty of Medicine, Damascus University, Damascus, Syria

    Tarek Turk

  3. Faculty of Medicine, Menoufia University, Menoufia, Egypt

    Nora Sakr

  4. Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt

    Adham M. Khalil & Mohamed Abdelhalim

  5. Faculty of Medicine, Syrian Private University, Damascus, Syria

    Bisher Sawaf

  6. Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan

    Kenji Hirayama

  7. Evidence Based Medicine Research Group and Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam

    Nguyen Tien Huy

  8. Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan

    Nguyen Tien Huy

  9. Center for Molecular Bio-Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, District 5, Ho Chi Minh, 70000, Viet Nam

    Nguyen Tien Huy

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  1. Abdelrahman Tarek Mohammed
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Correspondence to Nguyen Tien Huy.

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Electronic supplementary material

ESM 1

Supplementary PRISMA checklist. (DOCX 59 kb)

Supplementary Table S2

(DOCX 34 kb)

Supplementary Figure S3

Supplementary figure Forest plot of the change in the clinical and laboratory parameters between probiotics and placebo, A, Change in HAQ, B, Change in the TJC. (JPEG 269 kb)

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Supplementary Table S4

(DOCX 45 kb)

Supplementary Figure S5

Supplementary figure Forest plot of the change in the level of cytokines between probiotics and placebo, A, Change in the level of IL-1β, B, Change in the level of IL-10, C, Change in the level of IL-12, D, Change in the level of TNF-α. (JPEG 367 kb)

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Mohammed, A.T., Khattab, M., Ahmed, A.M. et al. The therapeutic effect of probiotics on rheumatoid arthritis: a systematic review and meta-analysis of randomized control trials. Clin Rheumatol 36, 2697–2707 (2017). https://doi.org/10.1007/s10067-017-3814-3

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  • DOI: https://doi.org/10.1007/s10067-017-3814-3

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