ASSESSING THE ROLE OF MICROBIOTA-TARGETED THERAPIES IN AUTOIMMUNE DISEASE MANAGEMENT, PARTICULARLY IN RHEUMATOLOGY

Abstract

Background: Autoimmune rheumatic diseases (ARDs), such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriatic arthritis (PsA), are characterized by chronic inflammation and immune dysregulation. Emerging research has highlighted the critical role of gut microbiota in modulating immune pathways and disease expression. Microbiota-targeted therapies—probiotics, prebiotics, synbiotics, and fecal microbiota transplantation (FMT)—are being explored as potential adjunctive treatments to conventional immunosuppressive therapies.

Objectives: This systematic review aims to evaluate the clinical and immunological outcomes associated with microbiota-targeted therapies in autoimmune diseases, particularly within rheumatology, and to identify key microbial mechanisms involved in disease modulation.

Methods: Following PRISMA 2020 guidelines, a systematic search was conducted across PubMed, Scopus, Web of Science, Embase, and Google Scholar to identify eligible studies published between 2010 and 2025. Eligible designs included randomized controlled trials, observational studies, and mechanistic reviews involving adult or animal populations with autoimmune rheumatic diseases receiving microbiota-targeted therapies.

Results: Fifteen studies met inclusion criteria. Probiotic interventions led to significant reductions in disease activity scores (e.g., DAS28 reduction from 4.6 to 3.1, p < 0.001), inflammatory cytokines (e.g., ↓ IL-17 by 42%), and improvements in regulatory T cell counts. FMT was shown to recalibrate microbial diversity and reduce pathogenic autoantibodies. Several studies also revealed that microbial signatures influenced biologic drug efficacy and predicted treatment outcomes.

Conclusions: Microbiota-targeted therapies demonstrate immunological and clinical benefits in autoimmune rheumatic diseases. Their integration into standard care may offer a novel route to personalized, gut-driven immunomodulation, although further standardization and longitudinal trials are necessary.