Therapeutic alteration of the microbiota in rheumatic diseases: Hype or potential?

Elsevier

Available online 21 December 2022, 101806

Best Practice & Research Clinical RheumatologyAuthor links open overlay panelAbstract

Multiple 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.

Keywords

Bacteriotherapy

Fecal microbial transplantation (FMT)

Lupus

Probiotics

Rheumatoid arthritis (RA)

Spondyloarthritis (SpA)

Systemic sclerosis

AbbreviationsACR

American College of Rheumatology

BASDAI

Bath Ankylosing Spondylitis Disease Activity Index

DAS

Disease Activity Score

ERA

Enthesitis Related Arthritis

FMT

Fecal microbial transplantation

GIT

Gastrointestinal tract

JIA

Juvenile idiopathic arthritis

PCoA

Principal coordinates analysis

PRO

Patient reported outcome

SLEDAI

Systemic lupus erythematosis disease activity index

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