Probiotics and Arthritis: What Does the Evidence Show for Inflammatory Joint Diseases?

Inflammatory joint diseases, such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis are painful conditions that can significantly affect a person’s quality of life. While there is no cure for these conditions, the right combination of medical treatments and lifestyle changes can help reduce pain and inflammation. One potential approach that has been explored is probiotics. But what does the evidence show about probiotic use for inflammatory joint diseases?

A number of research studies have examined the effects of probiotics on inflammatory joint disease and other bone diseases such as osteoporosis. While the evidence is not conclusive as to whether this is an effective treatment for these conditions, it does suggest that probiotic therapy has positive benefits.

The use of probiotics may positively affect inflammatory joint diseases through:

• Improving overall bone health-A meta-analysis (review of multiple studies) of probiotic consumption showed that they positively affect calcium and parathyroid levels to promote bone health1 This can help to prevent inflammation, cartilage, and bone degradation.
• Helping maintain the gut-brain barrier- The gut-brain barrier is interrupted in most chronic disease conditions, with inflammatory autoimmune joint conditions being a primary example. Probiotics can help keep the lining of the gut intact and prevent holes in the lining of the gut or “leaky gut” which can result in undesired food particles and bacteria leaking into the circulation and triggering inflammation and chronic inflammatory joint conditions or other autoimmune disease.
• Supporting a healthy microbiome in the gut-A high-quality microbiome can help prevent inflammation due to specific species of probiotic strains. While a number of metanalyses of the use of probiotic therapy on chronic inflammatory joint conditions have been reported, results have been inconclusive, due to the broad range of populations and study designs. However, most show improvement in markers of inflammation and suggest that probiotics provide benefits for inflammatory joint conditions such as arthritis and recommend that more research is needed.^2,3,4,5–9 One study found that combining Bifidobacteria and Lactobaccillus strains may reduce pain, lower inflammation, and improve quality of life, although this may differ depending on the type of inflammatory arthritis. ¹⁰ More recently, Bungau et.al, while also supporting in their review the impact that specific probiotic strains may have on arthritis, suggest that clinicians lack both knowledge and research on the role of specific probiotic strains in diseases like RA.¹¹
• Prevent bad (pathogenic) bacteria from over-producing in the gut or entering the circulation-When a healthy diet, adequate intake of fruits/vegetables, and supplementation with prebiotic/probiotics stimulate a healthy gut microbiome, this makes it difficult for bad bacteria when they enter the gut, to survive and infect an individual.
• Reducing inflammation-Probiotics can support the production of short-chain fatty acids (SCFA’s) such as butyrate, among other substances that help prevent inflammation and have anti-microbial effects. These substances help to regulate inflammation.
• Avoid over-active chronic inflammation of the immune system-About 70% of our immune system is in the gut. Probiotic strains can directly and indirectly affect the immune response in the gut. Because research metanalyses have shown inconsistent results of the impact of various probiotic strains on reducing inflammatory markers or on symptom improvement in individuals with chronic inflammatory joint diseases, more randomized, controlled clinical trials are needed.

Summary:

Overall, the evidence suggests that probiotics may offer some relief from pain and inflammation associated with inflammatory joint diseases. However, more research is needed to determine which probiotic strains are most effective and provide the greatest benefit.

It’s important to remember that probiotics are not a cure-all for inflammatory joint diseases. While they may help reduce pain and inflammation, these conditions will still require ongoing medical management. In addition, diet and lifestyle approaches are critical to helping reduce inflammation, pain, and promote proper functioning of the immune system. Talk to your functional practitioner about the best approach for managing your condition and reducing symptoms.

With the right combination of treatments, lifestyle changes, and possibly probiotics, people with inflammatory joint diseases can find relief and lead full, active lives.

For support with testing the gut microbiome and diet and lifestyle recommendations, get your free discovery call.

References:

1.          Malmir H, Ejtahed HS, Soroush AR, et al. Probiotics as a New Regulator for Bone Health: A Systematic Review and Meta-Analysis. Evidence-based Complementary and Alternative Medicine. 2021;2021. doi:10.1155/2021/3582989

2.          Zeng L, Deng Y, He Q, et al. Safety and efficacy of probiotic supplementation in 8 types of inflammatory arthritis: A systematic review and meta-analysis of 34 randomized controlled trials. Front Immunol. 2022;13. doi:10.3389/fimmu.2022.961325

3.          Sanchez P, Letarouilly JG, Nguyen Y, et al. Efficacy of Probiotics in Rheumatoid Arthritis and Spondyloarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2022;14(2). doi:10.3390/nu14020354

4.          Aqaeinezhad Rudbane SM, Rahmdel S, Abdollahzadeh SM, Zare M, Bazrafshan A, Mazloomi SM. The efficacy of probiotic supplementation in rheumatoid arthritis: a meta-analysis of randomized, controlled trials. Inflammopharmacology. 2018;26(1). doi:10.1007/s10787-017-0436-y

5.          Yuan Y, Ji W, Lin Z, Gan K. Benefits of probiotics in rheumatoid arthritis patients: A systematic review and meta analysis. Tropical Journal of Pharmaceutical Research. 2023;22(2). doi:10.4314/tjpr.v22i2.24

6.          Mohammed AT, Khattab M, Ahmed AM, et al. The therapeutic effect of probiotics on rheumatoid arthritis: a systematic review and meta-analysis of randomized control trials. Clin Rheumatol. 2017;36(12). doi:10.1007/s10067-017-3814-3

7.          Pan H, Li R, Li T, Wang J, Liu L. Whether Probiotic Supplementation Benefits Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis. Engineering. 2017;3(1). doi:10.1016/J.ENG.2017.01.006

8.          Grinnell M, Ogdie A, Wipfler K, Michaud K. Probiotic Use and Psoriatic Arthritis Disease Activity. ACR Open Rheumatol. 2020;2(6). doi:10.1002/acr2.11143

9.          Ferro M, Charneca S, Dourado E, Guerreiro CS, Fonseca JE. Probiotic Supplementation for Rheumatoid Arthritis: A Promising Adjuvant Therapy in the Gut Microbiome Era. Front Pharmacol. 2021;12. doi:10.3389/fphar.2021.711788

10.        Lowe JR, Briggs AM, Whittle S, Stephenson MD. A systematic review of the effects of probiotic administration in inflammatory arthritis. Complement Ther Clin Pract. 2020;40. doi:10.1016/j.ctcp.2020.101207

11.        Bungau SG, Behl T, Singh A, et al. Targeting probiotics in rheumatoid arthritis. Nutrients. 2021;13(10). doi:10.3390/nu13103376