Gum Arabic as Immunomodulator In Rheumatoid Arthritis Patients

Study Overview
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Brief Summary
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Gum Arabic (GA) rich dietary fiber it is a water-soluble dietary fiber derived from the dried gummy exudates of the stems and branches of Acacia senegal, GA found to have strong immuno modulator in vitro where it increased IL10 production showing strong anti-inflammatory effects (19). The aim of this study is to determine the role of gum Arabic in immunomodulation among patients with rheumatoid arthritis.

Detailed Description
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Butyrate is short chain fatty acids representing the most important end product of colonic bacterial aerobic fermentation of Gum Arabic , it has a potent anti-inflammatory effect and can down regulates TNF a expression by modulating NF-kB-DNA binding activity , in addition butyrate is known to act as histone deacetylase inhibitor in the cells.Recently, in vitro and in vivo data indicates that HDAC inhibitors may have anti-inflammatory effect due to their effects on cell death acting through acetylation of non-histone proteins. The possible anti-rheumatic mechanisms of HDAC inhibitors, including growth arrest in rheumatoid arthritis synovial fibroblasts (RASFs), suppression of pro-inflammatory cytokines, suppressing angiogenesis as well as the protective effects on bone and cartilage against their destruction. The investigators expect regular intake of GA will raise serum butyrate level. The endogenous butyrate decreases the TNF level. The latter will decrease the number of relapsing episodes, arresting the destruction of joints and improve both survival and life quality of rheumatoid arthritis patients.

Official Title
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Potential Role of Gum Arabic as Immunomodulator In Sudanese Rheumatoid Arthritis Patients

Conditions
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Rheumatoid Arthritis

Intervention / Treatment
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* Dietary Supplement: Gum Arabic


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinical diagnosis of Rheumatoid Arthritis Clinically stable as evidenced by medical history, complete physical examination All medications and dosages are stable for 6 weeks before study entry, Non Pregnant ladies. Exclusion Criteria: 1- hepatic, cardiovascular, pulmonary, malignant, hematologic, neurologic, infectious, or inflammatory diseases unrelated to Rheumatoid arthritis. 2-Hospital admission within 4 weeks of start of the study. 3- Uncontrolled hypertension 4- Asthma or severe atopic disease;

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Gum Arabic<br>Oral intake of 30 gram of Gum Arabic daily for 12 weeks | Dietary Supplement: Gum Arabic<br>* Oral intake of GA in powder from30 grams per day<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The level of C reactive protein (CRP)and Tumer necrosis factor alpha TNF |  | 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| clinical improvement |  | 12 weeks | 
| Total anti-oxidant capacity (TAC), malondialdehyde (MDA) and hydrogen peroxide (H2O2) level |  | 12 weeks |