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When to increase dose Consider increasing if: Minimal response after 4-6 weeks at current dose No side effects at current dose Current dose below the higher end of recommended range Goals not being met with conservative approach Increase gradually, typically by 25-50% at a time

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1 Introduction Autoimmune diseases (ADs) arise from the immune systems aberrant response against self-tissues, encompassing diverse conditions such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), inflammatory bowel disease (IBD), type 1 diabetes (T1D), and primary biliary cholangitis (PBC) ( Mounting evidence suggests that gut microbiota and its metabolites play a key role in host health and diverse diseases, such as obesity, depression, sclerosis, kidney disease, and dialysis ( At present, in the interest of reshaping the disordered intestinal immune activity in the disease state and alleviating the disease, people propose a series of flora-related immunotherapies based on the close interaction between the intestinal immune system and the flora ( Clostridium , a genus of anaerobic, Gram-positive, thick-walled bacteria, constitutes a dominant component of the healthy gut microbiota ( Clostridium species may confer clinical benefits across multiple ADs ( 2 Classification and sources of Clostridium as probiotics The intestinal clostridia as probiotics mainly contain Clostridium butyricum ( CB ), Faecalibacterium prausnitzii ( FP ), Clostridium cocleatum , etc