الفهرس 
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Abstract
SUMMARY
R
A is a common inflammatory arthritis with multifactorial etiology and progressive course. The highly complicated etiology of RA is currently believed to be caused by an interaction of environmental, hormonal, and genetic factors, such as diet and nutrition, microbiota, and infections.
An increasing amount of evidence indicates that a variety of autoimmune illnesses, including RA, may be significantly influenced by gut dysbiosis. A chronic inflammatory reaction is one of these. This topic is vital since some RA patients have gastrointestinal issues that are either clinical or asymptomatic. Mucosal inflammation and the breakdown of immune tolerance at the level of the mucosal surface have been suggested to be caused at some point during the preclinical stage of RA by interactions between microbes, other possible environmental factors (such as diet, physical stress, and emotional stress), and host factors.
Two important modifying factors that may affect barrier strength and functional integrity and, in turn, control the regulation of intestinal permeability are diet and intestinal microbiota.
Research on humans has revealed that RA patients’ gut microbiotas differ markedly from those of healthy controls, and their gut microbial diversity is reduced. both of which are connected with how severe and long-lasting the illness is. Patients with RA have a particular gut microbiome enterotype, particularly those with erosive disease.
In this study, we aimed to study the effect of probiotic supplementation on the clinical status & disease activity in Egyptian Rheumatoid arthritis patients.
The study participants were recruited from the outpatient clinic and the inpatients of the Department of Rheumatology at Ain Shams University Hospital. Informed consent was taken from all participants. All the patients fulfilled the ACR/EULAR 2013 criteria for RA diagnosis.
Full History taking, thorough clinical examination, laboratory investigations, and assessment of RA disease activity according to DAS28-ESR, DAS28-CRP, SDAI, and CDAI, were done at the start of the study and after 8 weeks. Our study was conducted on 60 Egyptian Rheumatoid arthritis patients; their ages ranged from 18-60 years with 51 females and 9 males. The median disease duration was 7 years, and the patients were classified into 2 groups:
group A: received 1 capsule daily of probiotics (lactobacillus acidophilus & Bifidobacterium animalis) + DMARDs (30 Subjects).
group B: received only DMARDs (30 Subjects).
In our study the mean ESR was 48.63 ± 21.74 for group A and 45.5 ± 17.09 for group B before probiotic supplementation. After 8 weeks, ESR declined in both groups to 42.87 ± 23.16 and 37.6 ± 15.26 for group A and B respectively; which was significant in group A and highly statistically significant in group B; indicating that there was no more improvement in group A after probiotic supplementation if compared to the usually received DMARDs.
As regards CRP, the Median (IQR) of group A was 20 (12 - 26) and 20 (15 – 25) after 8 weeks of probiotic supplementation, which was the same with no difference, and as for group B, it was 23 (18 - 40) and 25 (15.6 - 30) before and after 8 which also didn’t change.
Our study showed that both groups had a median of 10 TJC; but for SJC, group A had a median of 4 and group B had a median of 8 joints at the beginning of the study and the difference between them was statistically non-significant. After 8 weeks of probiotic supplementation; the median of TJC in group A declined from 10 to 8 and the median of SJC declined from 4 to 2, on the other hand, the median of TJC in group B didn’t change, but that of SJC declined from 8 to 4. When we compared the change of median of both TJC and SJC between the two groups; we found a significant difference regarding TJC and a non-significant difference in SJC.
In our study, we found that there was no statistically significant difference between the 2 groups at the start and the end of the trial regarding the disease activity scores DAS28-ESR, DAS28-CRP, CDAI, and SDAI. Despite that the mean of the previously mentioned scores decreased in both groups after 8 weeks; the difference was statistically non-significant.
Therefore, the use of probiotics as an add-on therapy along with DMARDs showed no significant improvement among the studied group of patients