Can Probiotics Help With Psoriatic Arthritis?

Some healthcare practitioners believe that the ‘good’ bacteria in probiotics can help patients with autoimmune diseases like psoriatic arthritis.

probiotic supplements over an abstract illustration of intestinal bacteria
High-quality probiotic supplements could benefit people with psoriatic arthritis.Adobe Stock, iStock

You may think of bacteria as harmful microbes that cause infection and disease. But the truth is, our bodies are home to trillions of beneficial bacteria that help regulate our digestive systems, ensure proper elimination, and support immunity.

The relationship between the gut microbiome — which consists of these microorganisms — and autoimmune disorders is complex and not yet fully understood. But there’s evidence suggesting that changes in the makeup of the gut microbiome and how it functions contribute to the development of autoimmune diseases by excessively activating the immune system. Research shows that people with psoriatic arthritis (PsA)?have lower levels of “good” bacteria in their gut than people without the condition. And studies have shown distinct alterations and imbalances in the gut microbiome of people with psoriasis and psoriatic arthritis.

To help maintain a healthy gut, some healthcare practitioners recommend that patients increase their consumption of probiotics, the beneficial bacteria found in yogurt and other foods as well as in supplements. A review of research found that probiotic supplementation may improve psoriasis and autoimmune-related, inflammatory arthritis like psoriatic arthritis.

How Probiotics Could Help Psoriatic Arthritis

Probiotics, live microorganisms, work to prevent and treat dysbiosis, which is either an imbalance or a lack of beneficial microbes in your gut, according to the Cleveland Clinic.

People with forms of inflammatory arthritis, notes the Arthritis Foundation, may also have inflammation of the intestinal tract, which leads to increased intestinal permeability — meaning certain bacteria cross into the bloodstream and trigger an inflammatory response.

Probiotics may be able to lessen inflammation in the intestinal tract, though the data on their effectiveness is conflicting. A small pilot study found that intake of probiotics containing nine bacterial strains of Lactobacillus and Bifidobacterium led to a decrease in intestinal permeability as well as disease activity. Another study of psoriatic arthritis patients, however, found “no statistical difference in health outcomes after probiotic use.”

“We’re not at a point where we know exactly which bugs are contributing to exactly which diseases,” says Aly Cohen, MD, a rheumatologist and integrative medicine and environmental health expert in Princeton, New Jersey. Dr. Cohen is also the founder of The Smart Human?health and wellness platform. “We know there are good and bad, we know there are almost 700 to 800 species of microbes that live in the gut.” But, she notes, our gut microbiota is affected by everything from “lifestyle, to what we drink in terms of water quality, to food chemicals, pesticides, to stress levels that affect pH [balance]. There are so many factors that go into gut health that may reduce risk of flare, but probiotics are just one component.”

RELATED:?Can Probiotics Help You Manage Chronic Health Conditions?

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Are There Risks to Taking Probiotics When You Have PsA?

In general, says Cohen, there isn’t much risk in adding probiotics to your psoriatic arthritis treatment plan. There’s currently no data suggesting that probiotics negatively interact with specific psoriatic arthritis medications. Still, it’s very important to consider the purity of whatever supplement you’re taking. If it’s somehow contaminated, it could create the potential for infection. “Technically, we’re lowering immune system defenses with autoimmune disease medications,” notes Cohen, which raises the issue of “whether or not that creates an opportunity for some type of impurity or even bacteria that’s already present to cause problems like infection.”

Another thing to keep in mind is the cost of high-quality, effective probiotic supplements. “You get what you pay for,” says Cohen. With a chronic disease like PsA, the cost of maintenance can be challenging and it’s worth considering whether that money could be better spent (in improving the quality of your diet or taking care of your mental health, for example).

Picking the Best Probiotic for Psoriatic Arthritis

It’s a good idea to talk with your rheumatologist before you incorporate probiotics into your treatment plan.

And it’s worth making sure you have a handle on the many factors that can affect your psoriatic arthritis. “Probiotics really won’t do much if you’re not also looking into food quality, which is what feeds the microbiome,” says Cohen. “You want to think about pesticide-free or organic produce. You want to think about no antibiotics in meat and poultry. … If you get to a point where you have clean food, clean water, you’re managing stress as best as possible, you’re getting good sleep, and you’re managing other medications that compete to be absorbed, then you can start to look at probiotics for what they are in terms of [their] purity.”

When you’re searching for a probiotic, look at the label to see the number of colony-forming units (CFUs). “To make a dent you have to have at least 20 billion microbes or CFUs,” says Cohen. Though she adds that that may be very low for people with psoriatic arthritis because they often have GI-related issues connected to the disease. Cohen also notes that “you want a variety of bacteria that are considered healthful, you don’t want just one species of microbes, to create more of a balance.” (If one bacteria group is already overgrown in the gut, which is the case with a relatively rare condition known as SIBO, taking probiotics could create further imbalance and worsen symptoms.)

RELATED: When Psoriatic Arthritis and Crohn’s Disease Strike

Remember that probiotics sold as dietary supplements are not regulated by the U.S. Food and Drug Administration (FDA). To ensure quality and purity, read labels carefully, look for supplements that are rigorously screened for contaminants, and that are tested by third-party labs.

There are a number of different kinds of probiotics to choose from and it will likely take some effort on your part. Cohen cautions against being swayed by marketing and what you may see on social media and recommends doing your due diligence, not only when it comes to buying supplements but also in choosing practitioners.

Use probiotics as directed but be sure to introduce any probiotic supplement carefully and independently of other supplements, advises Cohen, so you can identify any side effects or problems that may occur.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Resources

  • Amarnani A, Silverman G. Understanding the Roles of the Microbiome in Autoimmune Rheumatic Diseases. Rheumatology and Immunology Research. December 2023.
  • Scher JU et al. Decreased Bacterial Diversity Characterizes the Altered Gut Microbiota in Patients with Psoriatic Arthritis, Resembling Dysbiosis in Inflammatory Bowel Disease. Arthritis and Rheumatology. January 2015.
  • Yu N et al. Investigating the Gut Microbiota's Influence on Psoriasis and Psoriatic Arthritis Risk: A Mendelian Randomization Analysis.?Precision Clinical Medicine. September 2023.
  • Zeng L et al. Safety and Efficacy of Probiotic Supplementation in 8 Types of Inflammatory Arthritis: A Systematic Review and Meta-Analysis of 34 Randomized Controlled Trials. Frontiers in Immunology. September 2022.
  • Probiotics. Cleveland Clinic. October 2023.
  • Probiotics and Arthritis. Arthritis Foundation.
  • Haidmayer A et al. Effects of Probiotic Strains on Disease Activity and Enteric Permeability in Psoriatic Arthritis–A Pilot Open-Label Study. Nutrients. August 2020.
  • Grinnell M et al. Probiotic Use and Psoriatic Arthritis Disease Activity. ACR Open Rheumatology. May 2020.
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