Available online 21 December 2022, 101806
Author links open overlay panelAbstractMultiple studies have demonstrated abnormalities in the contents of the fecal microbiota in patients with a variety of forms of arthritis. This has prompted interest in microbial-altering therapy as a therapeutic tool. While antibiotics as a long-term therapeutic tool have largely fallen out of favor, there have been multiple studies evaluating probiotics in rheumatoid arthritis, spondyloarthritis, or systemic sclerosis; a small number of studies have tested fecal microbial transplantation (FMT) in rheumatic diseases. Although probiotics were well tolerated, few studies detected meaningful clinical benefit regardless of indication. Likewise, one of the two randomized studies evaluating FMT showed minimal clinical benefit, while the other demonstrated worsening compared to sham treatment. In this review article, I summarize the literature on probiotics and FMT in rheumatic diseases, discuss potential reasons for the absence of demonstrable benefit, and suggest avenues of future direction of research.
KeywordsBacteriotherapy
Fecal microbial transplantation (FMT)
Lupus
Probiotics
Rheumatoid arthritis (RA)
Spondyloarthritis (SpA)
Systemic sclerosis
AbbreviationsACRAmerican College of Rheumatology
BASDAIBath Ankylosing Spondylitis Disease Activity Index
DASDisease Activity Score
ERAEnthesitis Related Arthritis
FMTFecal microbial transplantation
GITGastrointestinal tract
JIAJuvenile idiopathic arthritis
PCoAPrincipal coordinates analysis
PROPatient reported outcome
SLEDAISystemic lupus erythematosis disease activity index
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