Capparis spinosa significantly improves Th17/Treg imbalance in patients with rheumatoid arthritis: A randomized double blind, placebo-controlled clinical trial in Iran

Aim: This study investigated the therapeutic effect of C. spinosa on clinical and laboratory indices, and the T lymphocyte populations in refractory female RA patients as a randomized, double-blind placebo-controlled, clinical trial (IRCT20151028024760N5). Materials and Methods: Thirty informed women with refractory RA were randomly divided into three groups including C. spinosa , placebo (, and control. The therapeutic regimen was continued for three consecutive months. Before and after the intervention, patients were evaluated for VAS pain score, DAS28, DAS28-ESR, ESR, CRP, RF, and anti-CCP antibody parameters. Blood samples were also collected to evaluate the percentage of CD4+ T, CD8+ T, Treg, and Th17 cells by flow cytometry. Results and conclusion: C. spinosa treatment significantly reduced VAS pain score ( p = 0.0001), DAS28 ( p = 0.007), DAS28-ESR ( p = 0.001), ESR ( p = 0.003), and CRP ( p = 0.026) levels. In addition, C. spinosa treatment significantly increased the Treg population (p = 0.02) and Treg/Th17 ratio ( p = 0.0015), while decreased Th17 percentage ( p = 0.04). • C. spinosa significantly reduced VAS pain score in refractory RA patients. • C. spinosa dramatically modulated Treg/Th17 balance in refractory RA patients. • C. spinosa suppressed CRP and ESR inflammatory indexes in refractory RA patients. • C. spinosa showed beneficial effects as a complementary regimen for refractory RA patients.