Probiotics (VSL#3) in arthralgia in patients with ulcerative colitis and Crohn's disease: A pilot study

Abstract

Arthralgia is a common extraintestinal manifestation of inflammatory bowel disease (IBD). Alterations of the immunologic regulation in the gut may contribute to the pathogenesis of arthralgia. Probiotics (VSL#3) have proven effective in the treatment of pouchitis in patients with ileal pouch anal anastomosis after panproctocolectomy for ulcerative colitis both in maintaining remission and in preventing a flare-up without side effects. The aim of this study was to determine the safety and efficacy of VSL#3 in patients with quiescent IBD who suffered from arthralgia for more than two weeks. An open-label trial was conducted using VSL#3. Pre- and post-treatment joint pain intensity were measured on the Ritchie Articular Index and visual analog scale. Disease activity of the bowel was assessed by the Truelove-Witts and the Harvey-Bradshaw scores. Sixteen of 29 patients completed the trial; in 10 of the 16 patients a statistically significant improvement was documented by the Ritchie Articular Index. No one of the patients had a relapse of intestinal disease while on probiotics. These preliminary results suggest that the probiotic mixture VSL#3 may be an alternative treatment for arthralgia in patients with IBD without inducing exacerbation of the disease. Because probiotics may be effective in the treatment of IBD as well, our results suggest that patients with active disease and arthralgia may also derive benefit from this treatment. Proper randomized controlled studies are indicated.

Manipulation of Intestinal Flora as a Way to Treat Crohn's Disease: The Role of Probiotics, Prebiotics and Antibiotics

“…Yeast S. boulardii was shown to be more effective than melsalazine in maintaining remission of CD (Guslandi et al, 2000) and improving intestinal permeability in CD patients (Van Gossum et al, 2007). Probiotic mixture VSL#3 was successful in the treatment of CD-induced arthralgia (Karimi et al, 2005) and in the prevention of postoperative recurrence of CD (Madsen et al, 2008). These studies offer support for the commonly asserted claim that further trials are justified.…”

“…They are reported to occur in 10-35% of patients. Since beneficial effects of probiotics were observed in the treatment of ulcerative colitis and sometimes of CD, the treatment of arthralgia with probiotics mixture VSL#3 was also suggested (Karimi et al, 2005). Of 29 patients with IBD involved in the study, only 16 patients ended the 3 months study and 9 of them were CD patients.…”

Gut microbiota imbalance and chaperoning system malfunction are central to ulcerative colitis pathogenesis and can be counteracted with specifically designed probiotics: a working hypothesis

“…Likewise, probiotics have been proposed for treating extra-intestinal complications of IBD [111][112][113][114]. We believe that the reduction in HSPs levels in the colonic mucosa of patients with UC by probiotics reflects, at least in part, the efficacy that probiotics might have in the treatment for systemic complications.…”

Probiotics Applications in Autoimmune Diseases

“…In a recent in vivo study, Wistar rats were administered a probiotic formulation (VSL#3) daily for seven days. After probiotic treatment, basal luminal mucin content increased by 60% which has been linked to better protective effect and substantial stimulation of mucin secretion at the level of DNA-gene expression [90][91][92][93].…”

“…The studies showed a low number of reported side effects which were consistently mild, so safety in the trialled patient types was assumed. The outcomes from the trials were encouraging as the probiotic treated groups usually showed an improvement in disease state [92,[161][162][163][164][165][166]. This identified VSL#3 as a feasible new UC treatment but a large, randomised, placebo controlled study was needed to verify results [167].…”