THE EFFECT OF PROBIOTIC MODULATION OF ENTERAL DYSBIOSIS ON DISEASE ACTIVITY IN PATIENTS WITH PSORIATIC ARTHRITIS – A RANDOMIZED CONTROLLED TRIAL
Authors: Muralikrishnan AS et al.
Probiotics may affect the composition of the microbiome and intestinal dysbiosis. This randomized controlled, double-blind trial was performed at the University of Graz and included 65 consecutive PsA patients with moderate disease activity (PASDAS > 3.2 and < 5.4) under stable DMARD treatment. Patients received either placebo or a probiotic that contained Bifidobacterium and Lactobacillus strains for 12 weeks, then all patients received the probiotic for another 12 weeks. Flow cytometry on peripheral blood mononuclear cells and stool microbiome 16s rRNA sequencing (among other tests) was performed. A significant reduction of PASDAS was observed in both groups and the proportion of patients that achieved low disease activity or remission was not different between the two groups. Zonulin as a potential marker that indicates permeability of enteric tight junctions decreased in patients who received the probiotic for 24 weeks. Flow cytometry revealed an increase in the proportion of Th2 cells in the probiotic group at week 24
Probiotic supplementation did not show an effect on disease activity in patients with moderately active PsA, but the sample size was small and the trial eventually too short. Some markers such as zonulin suggest that probiotic supplementation may exert an effect on enteric permeability. It would have been interesting to see whether or not DMARD treatment may have an effect on these parameters. Thus far, positive recommendations for the use of probiotics are not justified according to these trial results.