Synbiotic supplementation and the effects on clinical and metabolic responses in patients with rheumatoid arthritis: a randomised, double-blind, placebo-controlled trial

Abstract

Synbiotic intake may be associated with reduced inflammation in patients with rheumatoid arthritis (RA) due to optimised inflammatory markers, oxidative stress and insulin resistance. This research was conducted to assess the effects of synbiotic supplementation on the clinical and metabolic parameters of patients with RA. A total of fifty-four patients with RA were allocated into two groups to receive either a synbiotic capsule (n 27) or a placebo (n 27) for 8 weeks in this randomised, double-blind, placebo-controlled trial. Fasting blood samples were taken at baseline and week 8 of the study to quantify related markers. After the 8-week intervention, compared with the placebo, synbiotic supplementation resulted in a significant reduction in serum high-sensitivity C-reactive protein (hs-CRP) levels (-1427·8 (sd 3267·2) v. +2833·4 (sd 5639·7) ng/ml, P=0·001). In addition, compared with the placebo, synbiotic supplementation improved disease activity score-28 joints (DAS-28) (-1·6 (sd 0·8) v. -0·3 (sd 0·5), P<0·001) and visual analogue scales (VAS) pain (-30·4 (sd 18·7) v. -11·5 (sd 15·9), P<0·001). In addition, a significant elevation in plasma nitric oxide (NO) (+0·8 (sd 4·4) v. -2·6 (sd 4·5) µmol/l, P=0·008), and significant reductions in insulin values (-13·8 (sd 26·4) v. +4·2 (sd 28·2) pmol/l, P=0·01), homoeostasis model of assessment-estimated insulin resistance (HOMA-IR) (-0·5 (sd 1·0) v.+0·1 (sd 1·1), P=0·03) and homoeostatic model assessment-β-cell function (HOMA-B) (-9·4 (sd 17·9) v. +3·3 (sd 18·9), P=0·01) following supplementation with the synbiotic compared with the placebo. Compared with the placebo, synbiotic supplementation also resulted in a significant increase in plasma GSH (+36·6 (sd 63·5) v. -58·5 (sd 154·4) µmol/l, P=0·005). Overall, our study demonstrated that synbiotic supplementation for 8 weeks among patients with RA had beneficial effects on hs-CRP, DAS-28, VAS, NO, insulin levels, HOMA-IR, HOMA-B and GSH levels.

Oxidative Stress in Rheumatoid Arthritis: What the Future Might Hold regarding Novel Biomarkers and Add-On Therapies

“…Probiotic therapy has also been described in RA individuals. Synbiotic capsule supplements with Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium bifidum, for example, improved DAS-28 and VAS pain and increased nitrite, an indirect marker of ⋅ NO concentrations, and the GSH in plasma [62]. However, probiotic supplementation containing only Lactobacillus casei was not enough to induce significant effect on oxidative stress indices and antioxidant status in such patients [28].…”

“…RA: rheumatoid arthritis. 4 Oxidative Medicine and Cellular Longevity critical contributor in the initiation and maintenance of pathogenic mechanisms observed in systemic inflammatory conditions, including RA [12,19,29,33,34,61,62]. When it comes to physiological conditions, the production and clearance of ROS and RNS should be maintained, ideally, in a dynamic balance, once they exert pleiotropic effects on growth, differentiation, chemotaxis, and cell death [15], being also crucial in the defense mechanisms against pathogens [14].…”

“…Several works showed different therapies as efficient complementary alternatives in disease activity control (Table 1) through antioxidant effects, with improvements observed in many disease activity parameters, such as disease activity score-28 joints (DAS-28), erythrocyte sedimentation rate (ESR), health assessment questionnaire-disability index (HAQ-DI), and visual analog scale (VAS). Among them are N-acetylcysteine, used in other diseases due to its antioxidant effect [37], synbiotic supplementation [62], pomegranate extract [66], coenzyme Q10 [70] and sesamin supplementation [68], rectal insufflation of ozone [35], saline balneotherapy [64], and laser acupuncture [69]. For all adjuvant therapies already described in the literature to date, Table 1 shows the route of administration, dose, duration, and other details from each selected study.…”

Nutrition in RMDs: is it really food for thought? Focus on rheumatoid arthritis

“…On the contrary, probiotic use in RA showed controversial results, which could be explained by the use of different bacterial strains [35]. A recent randomized placebo-controlled trial showed that the association of Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum probiotics with fiber supplement could significantly decrease disease activity [36].…”

Effectiveness of probiotics in the management of inflammatory arthritis: a systematic review protocol

“…Of the 154 articles that were reviewed, a final 12 studies met inclusion criteria and were obtained in full form. [218][219][220][221][222][223][224][225][226][227][228][229] Of these, ten were randomised controlled trials of which nine employed a placebo control methodology and one compared to standard treatment. Two articles were quasiexperimental and only one of these employed a placebo.…”