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Also, COVID-19 triggered acute exacerbation was ruled out using real-time reverse transcription quantitative polymerase chain reaction on nucleic acids extracted from nasopharyngeal and pharyngeal swab samples at the diagnosis of acute exacerbation

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The proposed mechanism for the gut-joint axis in inflammatory arthritis is related to the hyperpermeability of the gut wall, which leads to the exposure of immune system to microorganisms, leading to a systemic immune response that triggers a local inflammatory process within the joints ( Considering the perturbed GM as a pivotal trigger in the pathogenesis of RA, interest has emerged regarding the clinical interest of probiotics to correct gut dysbiosis and downregulate the pro-inflammatory cytokine cascade implicated in inflammatory arthritis ( A meta-analysis of randomized trials investigating the effect of Lactobacillus as single species or in mixed cultures with Bifidobacterium species concluded that probiotic supplementation reduced serum levels of IL-6 ( Lactobacillus casei (L