Your Complete Guide to Probiotics for Rheumatoid Arthritis
Probiotics are certain types of bacteria and yeasts found in some foods and supplements that help keep your digestive system (gut) healthy. Some research suggests that consuming probiotics can have health benefits for people with rheumatoid arthritis (RA), an inflammatory autoimmune condition that causes joint pain, swelling, and stiffness.
The gut is home to trillions of microbes — called the gut microbiome — that play an important role in overall health, especially in supporting the immune system. A gut that has an imbalance of bad bacteria to good bacteria (dysbiosis) has been linked to certain diseases, including rheumatoid arthritis.
Probiotics may help reduce RA symptoms by improving gut bacteria balance and reducing inflammation, says Partha Nandi, MD, a longevity, aging, and gut health expert at Mayo Clinic Press.
Here’s what we know about probiotics and gut health:
They help boost good bacteria in the gut.
They reduce harmful bacteria that make you sick or cause allergies.
They restore helpful bacteria that you may lose when you’re sick.
Some probiotics help produce short-chain fatty acids (SCFAs), natural substances made when gut bacteria break down fiber. SCFAs help keep the gut healthy and strengthen its protective lining. “This can reduce systemic inflammation, which is a central driver of RA symptoms,” Dr. Nandi adds.
“Studies indicate that probiotic supplementation can improve inflammatory markers, reduce joint pain, and enhance overall well-being in RA patients,” says Ritu Nahar, MD, a board-certified gastroenterologist based in New Jersey.
But not all research is conclusive. Another review of 13 studies initially found that probiotics significantly reduced inflammation markers in people with RA. However, when researchers removed lower-quality studies from their analysis, the benefits became less clear.
Probiotics might also help with “leaky gut,” a condition in which the intestinal lining allows harmful substances to enter the bloodstream. Leaky gut can cause inflammation that spreads through the body. “Probiotics may help prevent harmful bacteria from entering the bloodstream and triggering immune responses, which can reduce the frequency and severity of RA flare-ups,” Nandi adds.
Probiotics are not a primary treatment for RA, says Dr. Nahar. “Patients should work with their rheumatologist to create a treatment plan that fits their needs,” she adds. Plus, the long-term impact of probiotics on RA and whether they can slow RA progression is still not known, so more large-scale studies are needed, Nandi notes.
RA and gut health are connected through what Nahar calls the “gut-joint axis.” This means that what happens in your gut can affect your joints. Issues with your gut health balance, such as dysbiosis, and what you eat can impact your immune system and cause long-term inflammation. Over time this may lead to joint issues or autoimmune diseases like RA.
Gut health isn’t only about removing harmful elements but also adding in what we’re missing or losing every day, says Aly Cohen, MD, a rheumatologist and integrative medicine practitioner based in New Jersey and author of DETOXIFY: The Everyday Toxins Harming Your Immune System and How to Defend Against Them. “That would be probiotic food supplements, fermented foods, and those that actually feed the microbes,” she says. A healthy gut can also help your body better absorb nutrients from food, which is important for overall health and immune function, notes Cohen.
Nahar adds that maintaining gut health with a balanced diet, regular exercise, and stress management can help keep inflammation in check and support the good bacteria your body needs.
For people with RA, experts point to the Mediterranean diet because it can help fight inflammation in the body. Cohen also recommends choosing clean, high-quality foods, particularly organic options, when possible to avoid chemicals that disturb gut balance. Cruciferous vegetables like broccoli, kale, and cauliflower are especially good choices for their fiber and health benefits. That said, diet alone isn’t a cure for RA, but it can be a valuable tool in managing symptoms and supporting overall well-being.
Both probiotic supplements and fermented foods support gut health and may help manage RA symptoms, but they work a bit differently. Fermented foods include pickles, sauerkraut, kimchi, yogurt, apple cider vinegar, and tempeh. They can help reduce inflammation and work well with anti-inflammatory diets like the Mediterranean diet.
The main differences between probiotic supplements and fermented foods are consistency and targeting. But because the probiotic strains in fermented foods aren’t standardized (and food manufacturers aren’t required to list exact probiotic doses), their effects can vary, explains Nahar.
Probiotic supplements, on the other hand, offer a more controlled way to introduce specific strains in consistent doses, she adds. The best choice depends on your needs and preferences, but a combination of both probiotic-rich foods and supplements may offer the most benefits.
Probiotics are actually part of a larger family of gut-supporting “biotics,” which includes:
Prebiotics: Types of fiber that feed the good bacteria in your gut (found in foods like garlic, onions, and asparagus)
Probiotics: Live good bacteria and yeasts that support gut health
Synbiotics: Products that combine both probiotics and prebiotics
Postbiotics: Beneficial substances created when probiotics break down fiber in your gut
When shopping for a probiotic supplement, consider the following:
Quality
It’s important to make sure you choose a reputable brand of probiotics that contains live bacteria, says Cohen. Probiotics sitting on store shelves are often not alive anymore because they might have traveled a long distance, she adds. Refrigerated probiotics tend to be more reliable because they’re kept in conditions that preserve the live bacteria.
Strain Types
The most studied probiotics are Lactobacillus and Bifidobacterium, both of which have been shown to regulate the immune response and reduce inflammation, says Nandi. Specific strains, such as Lactobacillus rhamnosus and Bifidobacterium longum, are especially useful for improving gut health and potentially reducing RA flare-ups, he adds.
Diverse Strains
Look for diversity in the types of bacteria included. “You don’t want to just have them alive. You also want diversity,” Cohen explains. Our gut contains more than a thousand different species of microbes. So the more varied the species, the more balance you may get. This may mean alternating between types of probiotics, all while aiming for supplements with at least 20 billion colony-forming units (CFUs), she adds.
Because dietary supplements, like most probiotics, aren’t regulated as strictly as medications by the FDA, some products may contain different ingredients or doses than what’s listed on the label. It’s a good idea to choose supplements with a USP label, which means that an independent group has checked the ingredients.
It can take a month or more to notice changes in RA symptoms after you start probiotics, says Nahar. If you don’t see any improvement, your healthcare provider can help you figure out the next steps.
Probiotics are generally safe for most people, but they’re not right for everyone. “One of the biggest concerns with probiotics is contamination,” says Cohen. You want to make sure they’re made in clean facilities without bad bacteria getting in. Buying from trusted brands and reputable retailers reduces the chance of getting a product that’s ineffective or unsafe.
When you start taking probiotics, you might experience mild bloating or gas, especially in the first few days or weeks, says Nandi. If discomfort continues, switching to a different strain or adjusting the dose may help.
If you have a weakened immune system or a serious gut condition like small intestinal bacterial overgrowth (SIBO), it’s best to check with your healthcare team before starting a probiotic, says Nahar. Probiotics can also interact with immunosuppressive medications, so if you take these, talk to your healthcare provider before trying a supplement.
Probiotics may help reduce inflammation markers in people with rheumatoid arthritis (RA). But more high-quality studies are needed to determine their effectiveness for slowing disease progression.
Both probiotic supplements and fermented foods can benefit gut health, and combining them may offer the most support.
When taken for RA, probiotics are not a standalone treatment. Ask your healthcare team about adding probiotics to your current RA treatments.
Probiotics are generally safe for most people. But if you have a weakened immune system or take immunosuppressive medications, talk to your healthcare provider first.
