类风湿关节炎六种指标联合检测的临床意义

目的评价分析抗瓜氨酸化波形蛋白(MCV)抗体、抗葡萄糖-6-磷酸异构酶(GPI)抗体等六项指标在类风湿关节炎(RA)患者血清中的表达与疾病的相关性及应用价值。方法收集110例RA、26例SLE、23例强直性脊柱炎(OA)、20例干燥综合征(SS)患者和50名健康人血清标本,用ELISA检测血清中抗MCV、抗GPI和抗环瓜氨酸肽(CCP)抗体水平,采用间接免疫荧光法检测抗角蛋白(AKA)抗体,采用散射比浊法检测类风湿因子(RF)和hs-CRP水平。结果 4种抗体在RA患者组中的阳性率显著高于非RA疾病组和健康对照组。除AKA抗体阳性率较低(41.8%)外,其余抗体在RA组中的阳性率差异无统计学意义。结论抗MCV和抗GPI抗体诊断RA的敏感度最高;抗CCP抗体的特异性最高,AKA抗体具有较高的特异性,但敏感度最低,联合检测可弥补单项抗体检测造成的漏诊。

类风湿关节炎患者外周血单个核细胞Notch及其配体表达

为研究Notch信号途径在类风湿关节炎(RA)发病机制中的作用,选取活动期RA患者,采用流式细胞术结合细胞表面及细胞内染色技术检测外周血单个核细胞Notch受体及配体表达情况,并与正常对照进行比较。结果发现,活动期RA患者外周血T细胞Notch2、Notch3及Notch4表达较正常人明显增加,Notch1分子表达均较少,二者未见差异。其中表达Notch分子的细胞以CD4+T细胞为主。二者B细胞Notch1、Notch2、Notch3及Notch4的表达均较低,之间未见明显差异。RA患者单核细胞Jagged1分子表达明显增加,而Delta1表达降低。结果提示活动期RA患者外周血单个核细胞中不同群体细胞存在Notch及其配体表达水平的改变。

类风湿性关节炎膝关节病变的X线影像学研究

目的 :分析类风湿性关节炎(RA)膝关节病变的X线影像学特征,以提高诊断正确率。方法 :收集2015年2月至2017年2月收治的RA患者52例和骨关节炎患者45例,进行X线摄片,分析两组膝关节病变的影像学特征。结果 :RA组中,关节间隙呈均匀性狭窄47例(90.4%),髌上囊肿胀41例(78.8%),关节面毛糙、关节面不同程度侵蚀破坏22例,关节周缘轻度骨质增生43例,明显重度增生、骨赘形成5例,未见明显骨质增生4例,52例均有不同程度骨质疏松。OA组中,关节间隙呈均匀性狭窄5例(11.1%),髌上囊肿胀16例(35.6%),关节面下小囊性改变7例,45例有不同程度骨质增生、骨赘形成改变。两组关节间隙均匀狭窄及髌上囊肿胀改变发生率差异有统计学意义(P<0.05)。结论 :RA膝关节病变的X线影像学表现具有一定特征性,尤其是关节间隙均匀性狭窄、髌上囊肿胀及关节面侵蚀的改变在鉴别RA和OA的诊断中有重要价值。

Isolation and characteristics of autoreactive T cells specific to aggrecan G1 domain from rheumatoid arthritis patients

Our previous work showed that the cartilage proteoglycan aggrecan could induce an erosive polyarthritis and spondylitis in BALB/c mice and the GI globular domain of the aggrecan (GI) contained the arthritogenic region. To elucidate whether autoreactive T cells to G1 are expressed in rheumatoid arthritis patients, we analyzed the frequency of human G1-specific T cells in the peripheral blood of five rheumatoid arthritis patients and tried to establish G1-reactive T cell lines from these rheumatoid arthritis patients. The results showed that the G1-specific T cells in PBL were detectable at the range of 4.97 ±0.5 ×10-6 in peripheral blood lymphocytes. We have also generated 15 G1-specific T lymphocyte lines from these pateints with a standard split-well method. All these cells expressed fine specificity to human recombinant G1, but not to unrelated antigen. All the 15 lines expressed a panT cell marker and 13 of them selectively used the αβ T cell receptor. Two of them used rye T cell receptor. The 13 of these T cell lines was CD4 positive. One line expressed CD8. One line expressed both CD4 and CD8. Moreover, 14 out of 15 lines expressed the Th-1 cytokine profile, characterized by interferon-γpositivity and IL-4 negativity. No Th-2 type cell line was generated. These data provide strong evidence in favor of the presence of autoreactive T cells in the rheumatoid arthritis pateints. What is the mechanism(s) that these autoreactive T cells attack self-target and whether these G1-specific, Th-1 type T cell lines can induce arthritis in immune deficiency mice are currently under investigation.

False Human Immunodeficiency Virus Test Results Associated with Rheumatoid Factors in Rheumatoid Arthritis

Objective To investigate if immunological factors associated with rheumatoid arthritis(RA) affect the result of human immunodeficiency virus(HIV) screening by electrochemiluminescence immunoassay(ECLIA) and enzyme-linked immunosorbent assay(ELISA). Methods 100 RA cases were enrolled from January 2012 to February 2013 into this study. HIV screening was conducted with ECLIA detecting both HIV-1 p24 antigen, HIV-1 and HIV-2 antibodies, with ELISA and colloidal gold method detecting HIV-1 and HIV-2 antibodies. The samples producing positive results were submitted to the Center for Disease Control for confirmation using Western blotting method. The antibody titers of rheumatoid factors(RF) including RF-IgG, RF-IgM, RF-IgA, and CCP-IgG were analyzed by ELISA. Results The HIV positive-rate determined by ECLIA was significantly higher than that by ELISA and colloidal gold method(P<0.01). The false-positive rate of HIV screening was associated with antibody titers of RF-IgG, RF-IgM, RF-IgA, and CCP-IgG in RA(P<0.01). Conclusion Immunological factors, including RF and anti-CCP antibody, may influence the screening of HIV by ECLIA, producing false-positive result.

Expression of CC Chemokine Ligand 5 in Patients with Rheumatoid Arthritis and Its Correlation with Disease Activity and Medication

Objective To determine the levels of CC chemokine ligand 5 (CCL5) in serum and synovial fluid (SF) from patients with rheumatoid arthritis (RA) and their relations with disease activity and medication. Methods CCL5 in serum and SF was quantified by enzyme-linked immunosorbent assay (ELISA) in 28 RA patients and 21 osteoarthritis (OA) patients. In RA patients, the correlations of CCL5 levels in serum and SF with disease activity were analyzed. Meanwhile, the serum CCL5 levels among RA patients treated with disease-modifying antirheumatic drugs (DMARDs), Tripterygium Glucosides, and other Chinese herbs without disease-modifying effects were also compared. Results CCL5 levels in both serum and SF of RA patients were significantly higher than those of OA patients (P<0.05). Moreover, the level of CCL5 was higher in SF than that in serum of RA patients (P<0.01). Serum CCL5 level was correlated significantly with the number of swollen joints (r=0.3329, P<0.05), erythrocyte sedimentation rate (r=0.4001, P<0.05), and C reactive protein (r=0.3735, P<0.01). In addition, the level of CCL5 had a trend of lower in patients treated with DMARDs or Tripterygium Glucosides than those treated with other Chinese herbs, although the difference was not significant among those patients due to the small number of patients in each group. Conclusions In RA patients, the expression of CCL5 increases and correlates with some clinical and laboratory parameters of RA, which indicate that CCL5 plays an important role in RA and may serve as a useful marker of disease activity. DMARDs and Tripterygium Glucosides might exert their clinical effects through reducing CCL5 production in RA.

The pain-related behavior changes correlate with the bone damage in a rat model of rheumatoid arthritis

In view of the extensive bone damage in rheumatoid arthritis, we used a commonly utilized animal model to detect behavioral changes in pain-related and the bone damage during the early disease, and to explore the correlation between bone damage and pain-related behavioral changes. Methods： Arthritis were induced in Sprague-Dawley （SD） male rats by injecting complete Freund＇s adjuvant （CFA） into the tails. Pain-related behavior changes were studied using the Hargreaves, VonFrey, and acetone tests on the 0, 7, 14, day and 28 day after CFA injection. The rats were sacrificed according the same schedule. The bone damage of the right proximal tibia was studied by microCT scan and bone histological slices. Results： Animals developed soft tissue inflammation and polyarthritis on 7 days after CFA injection, and arthritic score proved obvious arthritis were established within the study period. Mechanical hyperalgesia and cold allodynia were present in the affected hind paw from the 7 day through the 28 day, but the heat hyperalgesia and the mechanical allodynia lasted a short time after CFA injection. Trabecular bone number （Tb.N）, Tissue Mineral Content （TMC） and Bone Volume to Tissue Volume （BV/TV） in the proximal tibia by microCT scan were also reduced after induction, especial 14 days after CFA injection. The bone histologicalslices showed the trabecular bone and proteoglycan diminished, the bone damage severity scores became more severely on the 7 day after CFA injection. Using analysis of covariance, these changes had statistical significance compared with baseline. By linear regression analysis demonstrated mechanical hyperalgesia and cold allodynia correlated well with arthritic score, bone damage parameters and bone damage severity scores. Conclusion： Adjuvant-induced arthritis （AA） were observed after CFA injection and lasted within the later experimental period. Pain-related behavioral changes were observed in the early time of AA. Bone damage was also occurred with arthritis development. Pain-related behavioral change correlated well with arthritic score and bone damage parameters

Analysis of the action mechanism of Fang Ji Huang Qi decoction in treating rheumatoid arthritis by network pharmacology

Objective:To explore the pharmacological action mechanism of Fang Ji Huang Qi decoction(FHD)in the treatment of rheumatoid arthritis(RA)by network pharmacology.Methods:The chemical compositions and functional targets of the TCM were retrieved using the systematic pharmacological analysis platform TCMSP,and the gene name of each target protein was obtained from the UniProtKB network platform.The targets of RA were queried through the CTD database.The protein–protein interaction network was constructed in the STRING database,and the network visualization analysis was performed in Cytoscape.The Gene Ontology and Kyoto Gene and Genomic Encyclopedia pathways enrichment analyses of key target proteins were performed using the DAVID data platform.Results:A total of 472 drug active ingredients were screened from the TCMSP database.Seventy-five disease targets from the CTD database were screened.The compound-target network map contained further screened out 98 components and corresponding 75 targets.The key compounds included quercetin and kaempferol.The key targets were prostaglandin G/H synthase 2 and nitric oxide synthase 2.The protein-protein interaction network consisted of 75 proteins,of which 37 were key proteins,including tumor protein 53,JUN and interleukin-6.There were 260 Gene Ontology entries,of which 246 were biological processes.Fifty-five Kyoto Gene and Genomic Encyclopedia pathways were enriched,mainly the cancer pathway,NOD-like receptor signaling pathway,and Toll-like receptor signaling pathway,which are involved in the action mechanism of FHD.Conclusion:The results of this study preliminarily verified the basic pharmacological action mechanism of FHD in the treatment of RA,laying a foundation for elucidating its mechanism of action.

Use of agents stimulating erythropoiesis in digestive diseases

Anemia is the most common complication of inflammatory bowel disease (IBD). Control and inadequate treatment leads to a worse quality of life and increased morbidity and hospitalization. Blood loss, and to a lesser extent, malabsorption of iron are the main causes of iron def iciency in IBD. There is also a variable component of anemia related to chronic inflammation. The anemia of chronic renal failure has been treated for many years with recombinant human erythropoietin (rHuEPO), which significantly improves quality of life and survival. Subsequently, rHuEPO has been used progressively in other conditions that occur with anemia of chronic processes such as cancer, rheumatoid arthritis or IBD, and anemia associated with the treatment of hepatitis C virus. Erythropoietic agents complete the range of available therapeutic options for treatment of anemia associated with IBD, which begins by treating the basis of the inflammatory disease, along with intravenous iron therapy as f irst choice. In cases of resistance to treatment with iron, combined therapy with erythropoietic agents aims to achieve near-normal levels of hemoglobin/hematocrit (11-12 g/dL). New formulations of intravenous iron (iron carboxymaltose) and the new generation of erythropoietic agents (darbepoetin and continuous erythropoietin receptor activator) will allow better dosing with the same eff icacy and safety.

Serum Levels of Interleukin-1 Beta, Interleukin-6 and Melatonin over Summer and Winter in Kidney Deficiency Syndrome in Bizheng Rats

Objective To observe the seasonal changes in serum levels of interleukin-1 beta(IL-1β), interleukin-6(IL-6) and melatonin(MT) in Bizheng rat model, and explore the relationship between MT and the pathogenesis of rheumatoid arthritis. Methods One hundred and sixty Sprague-Dawley rats were randomly divided into four groups in summer(n=80) and winter(n=80) respectively: normal group, collagen-induced arthritis(CIA) model group, operation group, and sham-operation group(n=20 in each group). The CIA model group was injected with collagen emulsion at the base of the tail to induce arthritis. The rats in the operation group received pineal gland resection, and 7 days after the first operation, underwent testectomy or oophorectomy. The rats in the sham-operation group were operated to ligature the sagittal sinus, without extracting the pineal gland. After the operations, the operation group and the sham-operation group both were immunized as the CIA group was. The serum levels of IL-1β, IL-6 and MT in different groups were measured by radioimmunoassay. Results Compared with the normal group, the serum levels of IL-1β and IL-6 increased in the CIA model, operation, and sham-operation groups both in summer and in winter(IL-1β in summer, P=0.008, P<0.01, P=0.012; IL-1β in winter, P=0.019, P<0.01, P=0.027; IL-6 in summer, P=0.028, P<0.01, P=0.024; IL-6 in winter, P=0.006, P<0.01, P=0.008). In the operation group, the serum levels of IL-1β and IL-6 in winter were higher than in summer, but with no statistically significant differences(P=0.844, 0.679). Compared with the normal group, the serum level of MT significantly increased in summer and winter in both the CIA model group(P=0.002, 0.008) and the sham-operation group(P=0.003, 0.007), while significantly decreased in the operation group(P=0.023, 0.003). There was no significant difference in MT level in the operation group between summer and winter(P=0.947). Conclusions The increase of serum levels of IL-1β and IL-6 may exacerbate the inflammatoryreaction and cause a more severe condition in the rheumatoid arthritis. The concentrations of IL-1β, IL-6, and MT correspond with the change of seasons, confirming that there are connections between nature and human body.

Combinative Approaches of Chemistry, Pharmacology and Toxicology for the Optimal Pharmaceutical Preparation of an Anti-arthritic Chinese Medicine Formulation QFJBT

Objective Qing Fu Juan Bi Tang(QFJBT)is an anti-arthritic Chinese medicine formula consisting of five herbs:Aconiti Lateralis Radix Praeparata(Fu Zi,附子),Sinomenii Caulis(Qing Feng Teng,青风藤),Astragali Radix(Huang Qi,黄芪),Paeoniae Radix Alba(Bai Shao,白芍)and Moutan Cortex(Mu Dan Pi,牡丹皮),which have well-established histories of use for treatment of rheumatic and arthritic diseases.We intended to establish the optimized and standardized pharmaceutical procedures and manufacturing processes for the pilot production of QFJBT to develop it as a novel botanical drug product for treatment of rheumatoid arthritis(RA).Methods The combinative approaches of chemical assessment,toxicological and pharmacological evaluation were explored to define the pharmaceutical preparation of QFJBT.Results The optimized and standardized pharmaceutical procedures and manufacturing processes for the pilot production of QFJBT were established in terms of greatest chemical contents of bioactive constituents,potent anti-inflammatory and antinociceptive activities,and favorable safety profile.Quality analysis of the pilot product of QFJBT by high-performance liquid chromatography(HPLC)demonstrated that the chromatographic fingerprint profiles of three batches of QFJBT were basically identical and the contents of four characteristic and bioactive markers were relatively consistent.General toxicological studies showed a favorable safety profile of QFJBT.The maximum tolerated single dose of QFJBT was determined in both sexes of rats to be 33.63 g/kg body weight which is equivalent to 346 times of clinical dose.In the chronic oral toxicity study,the results of laboratory investigation showed that QFJBT at doses of 3.89,6.80 and 9.72 g/kg body weight(equivalent to 40,70 and 100-fold clinical doses,respectively)caused no changes in all hematological parameters and blood biochemical parameters of rats.No mortality or specific toxic responses were observed in animals after three months of repeated dosing with QFJBT.Conclusion The optimized and standardized pharmaceutical and manufacturing processes for the production of QFJBT have been successfully screened and identified through established rigorous in-process controls.

Systematic review of robust experimental models of rheumatoid arthritis for basic research

Rheumatoid arthritis(RA)is a common autoimmune disease characterized by progressive joint inflammation and destruction,deformity,loss of mobility,and permanent disability.Although the cellular and molecular mechanisms involved in RA are understood in detail,no drugs or therapies can completely cure RA.Many long-term efforts have been directed towards a better understanding of RA pathogenesis and the development of new classes of therapeutics.Thus,the ongoing elucidation of pathogenic events underlying RA mostly relies on studies of animal models.Herein,we comprehensively review and discuss the characteristics,challenges,and unresolved of issues of various experimental models of RA to provide a basis and reference for the rational selection of experimental RA models for basic investigations into traditional Chinese medicine(TCM).

Expression of Peptidylarginine Deiminase 4 and Protein Tyrosine Phosphatase Nonreceptor Type 22 in the Synovium of Collagen-Induced Arthritis Rats

Objective To study the expression level of peptidylarginine deiminase 4(PADI4) and protein tyrosine phosphatase nonreceptor type 22(PTPN22) in the synovium of rat model of collagen-induced arthritis, and to explore their possible therapeutic role in rheumatoid arthritis. Methods Thirty-two female Wistar rats weighing 100±20 g were randomly assigned into 3-week collagen-induced arthritis(CIA) model group(n=8), 4-week CIA model group(n=8), 6-week CIA model group(n=8), and the control group(n=8). The body weight changes of each group were recorded. The expression levels of PADI4 and PTPN22 were detected and compared by the methods of immunohistochemical staining and Western blot. Results Arthritis of rat began to form 14 days after sensitization and the joint swelling reached peak at 28 days. The weights of the rats slowly grew both in CIA model groups and the control group. Immunohistochemical staining results showed that the positive expression of PADI4 and PTPN22 was mainly located in cartilage peripheral mononuclear cells, the cytoplasm of infiltrated cells, and bone marrow cavity. There were significant differences in the optical density of PADI4 and PTPN22 among CIA model groups and the control group(PADI4, 0.2898±0.012, 0.2982±0.022, 0.2974±0.031, 0.2530±0.013 in 3-week CIA model, 4-week CIA model, 6-week CIA model and control groups; PTPN22, 0.2723±0.004, 0.2781±0.010, 0.2767±0.008, 0.2422±0.019; all P <0.05). The expression bands of PADI4 were observed in Western blot 3 weeks after initial immunization, the thickest in the 4th week, and decreased in the 6th week. The expression bands of PTPN2 were observed at all the time points, with no obvious time-dependent trend. Conclusions PADI4 and PTPN22 are obviously correlated with CIA in rat model. PADI4 is expressed at early stage of the disease, while the expression of PTPN22 sustains throughout the course.

Leflunomide-induced acute liver failure: a case report

A 27-year-old male patient with rheumatoid arthritis was diagnosed with acute liver failure when he was taking leflunomide, a new immunosuppressant. This case illustrates the risk that leflunomide may lead to severe hepatotoxicity.

Role of Acetylated p53 in Regulating the Expression of map2 in Retinoic Acid-induced P19 Cells

Objective To investigate the regulatory mechanisms of acetylated p53 in the expression of microtubule-associated protein-2(MAP2) in neuronal differentiation of P19 cells induced by all-trans retinoic acid(RA).Methods Neuronal differentiation of P19 cells was initiated with 4-day RA treatment.Immunofluorescence,real-time reverse transcription-polymerase chain reaction(RT-PCR) assay,and map2 promoter driven luciferase assay were performed to detect the expression and relative promoter activity of MAP2 in those RA-treated cells.Real-time PCR-based chromatin immunoprecipitation assay(ChIP) was carried out to reveal the specific recruitment of acetylated p53 onto its binding sites on map2 promoter.Results The expression of MAP2 was markedly increased in RA-induced P19 cells.The map2 mRNA increased 34-fold after 4 days of RA treatment and 730-fold 2 days after the treatment,compared with the cells without RA treatment(control).p53 was recruited to the promoter of map2 gene in acetylated form and thereby enhanced its promoter activity.p300/CBP associated factor(PCAF) was found induced in RA-treated cells and enriched in the nucleus,which might contribute to the acetylation of p53 in the regulation of map2 gene.Conclusions Acetylated p53 may participate in regulating the expression of map2 in RA-induced differentiation of P19 cells.PCAF is possibly involved in this process by mediating the acetylation of p53.

Studies on Thermodynamic Properties of Some Imidazolinone Derivatives in DMF at 308.15 K

Density,ultrasonic velocity and viscosity of imidazolinone derivatives are studied in dimethyl formamide(DMF) at 308.15 K.From the experimental data,various acoustical parameters,such as specific impedance Z,isentropic compressibilityκs,Rao's molar sound function Rm,van der Waals constant b,relaxation strength r,intermolecular free length Lf,internal pressureπ,solvation number Sn,relative association RA,etc.are evaluated,which helps in understanding the molecular interactions occurring in these solutions.

In silico prediction of phytoconstituents from Ehretia laevis targeting TNF-αin arthritis

Objective Rheumatoid arthritis(RA)is an autoimmune disease involving the synovial lining of the major joints.Current therapies have noteworthy side effects.Our study involved in silico evaluation of Ehretia laevis(E.laevis)phytoconstituents targeting tumor necrosis factor-α(TNF-α).Methods Molecular docking studies performed to investigate the binding pattern of the plant E.laevis phytoconstituents along with the crystal structure of TNF-α(PDB ID:2 AZ5)using AutoDock Vina followed by a study of interacting amino acid residues and their influence on the inhibitory potentials of the active constituents.Further the pharmacokinetic profile and toxicity screening carried out using Swiss ADME and pk CSM.Results The docked results suggest that lupeol(-9.4 kcal/mol)andα-amyrin(-9.4 kcal/mol)has best affinity towards TNF-αcompared to standard drug thalidomide(-7.4 kcal/mol).The active chemical constituents represents better interaction with the conserved catalytic residues,leading to the inhibition/blockade of the TNF-α-associated signaling pathway in RA.Furthermore,pharmacokinetics and toxicity parameters of these phytochemicals were within acceptable limits according to ADMET studies.Conclusion The binding potential of phytoconstituents targeting TNF-αshowed promising results.Nonetheless,it encourages the traditional use of E.laevis and provides vital information on drug development and clinical treatment.

Production of Gel with Menthol, Benzocaine and Procaine HCl for Topical Application in Rheumatoid Arthritis Patients

Antirheurnatic and analgesics drugs are the most commonly prescribed medications for treatment of acute and chronic pain. Frequent application of these agents often causes adverse effects. So, in order to avoid the incidence of side effects, topical analgesics are treatment of choice for localized muscle pain. Topical analgesics offer the potential to provide the same analgesic relief provided by oral analgesics but with minimal adverse systemic effects. The aim of this study is to present the preparation and characterization of topical analgesic gel named ＂Russian water＂. Gel is composed of Menthol, Benzocaine, Procaine HCl as topical analgesic agents indicated for temporary relief of pain. Obtained results showed prolonged analgesic effect compared with liquid ethanol solution composed of the same components.

Whether Probiotic Supplementation Benefits Rheumatoid Arthritis Patients： A Systematic Review and Meta-Analysis

Gut and oral microflora are important factors in the pathogenesis and development of rheumatoid arthritis （RA）. Recent studies have shown that probiotic supplements have beneficial consequences on experimental arthritis in rats. However, results from randomized clinical trials on the effects of probi- otics have not been consistent. The aim of this study was to systematically review the existing evidence for the effects of probiotic intervention in RA. We included randomized controlled trials （RCTs） of RA patients receiving stable treatment with disease-modifying anti-rheumatic drugs （DMARDs） that： ①were combined with additional probiotic supplements or ② were combined with either no additional supplements or only a placebo treatment. Statistical analysis was performed using Review Manager 5.3.3. Six randomized clinical trials were eligible for inclusion in the meta-analysis, with 249 participants in total. The results showed that the probiotic intervention treatment has not yet achieved significant improvement in the American College of Rheumatology 20% improvement criteria （ACR20） score and the disease activity score in 28 joints （DAS28）. The laboratory index C-reactive protein （CRP） （mg.L-1） was significantly reduced in the intervention group. The expression of inflammatory cytokines tumor necrosis factor （TNF）-a and interleukine （IL）-ll] was also significantly reduced, while IL-10 expression increased in the probiotic intervention groups. This article is the first systematic review and meta-analysis providing a comprehensive assessment of the benefits of treating RA with probiotics. We found that probiotic supplementation may show a limited improvement in RA therapy in existing reports because of a lack of sufficiently high-quality work on the part of clinicians. More multi-centered, large-sample RCTs are needed in order to evaluate the benefits of probiotics in RA treatment.